title: Galactose-α-1,3-galactose-specific IgE is associated with anaphylaxis but not asthma.
abstract: BACKGROUND
  IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal) are common in the southeastern United States. These antibodies, which are induced by ectoparasitic ticks, can give rise to positive skin tests or serum assays with cat extract.
  
  
  OBJECTIVE
  To evaluate the relationship between IgE antibodies to α-gal and asthma, and compare this with the relationship between asthma and IgE antibodies to Fel d 1 and other protein allergens.
  
  
  METHODS
  Patients being investigated for recurrent anaphylaxis, angioedema, or acute urticaria underwent spirometry, exhaled nitric oxide, questionnaires, and serum IgE antibody assays. The results were compared with control subjects and cohorts from the emergency department in Virginia (n = 130), northern Sweden (n = 963), and rural Kenya (n = 131).
  
  
  RESULTS
  Patients in Virginia with high-titer IgE antibodies to α-gal had normal lung function, low levels of exhaled nitric oxide, and low prevalence of asthma symptoms. Among patients in the emergency department and children in Kenya, there was no association between IgE antibodies to α-gal and asthma (odds ratios, 1.04 and 0.75, respectively). In Sweden, IgE antibodies to cat were closely correlated with IgE antibodies to Fel d 1 (r = 0.83) and to asthma (P < 0.001).
  
  
  CONCLUSIONS
  These results provide a model of an ectoparasite-induced specific IgE response that can increase total serum IgE without creating a risk for asthma, and further evidence that the main allergens that are causally related to asthma are those that are inhaled.
authors.affiliation: Division of Allergy and Immunology, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Commins
authors.forename: Libby A
authors.initials: LA
authors.lastname: Kelly
authors.forename: Eva
authors.initials: E
authors.lastname: Rönmark
authors.forename: Hayley R
authors.initials: HR
authors.lastname: James
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Pochan
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Peters
authors.forename: Bo
authors.initials: B
authors.lastname: Lundbäck
authors.forename: Lucy W
authors.initials: LW
authors.lastname: Nganga
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Cooper
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Hoskins
authors.forename: Saju S
authors.initials: SS
authors.lastname: Eapen
authors.forename: Luis A
authors.initials: LA
authors.lastname: Matos
authors.forename: Dane C
authors.initials: DC
authors.lastname: McBride
authors.forename: Peter W
authors.initials: PW
authors.lastname: Heymann
authors.forename: Judith A
authors.initials: JA
authors.lastname: Woodfolk
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Perzanowski
authors.forename: Thomas A E
authors.initials: TA
authors.lastname: Platts-Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000209:etiology / Q000276:immunology*; D000818:Animals; D001249:Asthma / Q000209:etiology / Q000276:immunology*; D016022:Case-Control Studies; D002648:Child; D004187:Disaccharides / Q000276:immunology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D009664:Norway; D012307:Risk Factors; D013147:Spirometry; D013548:Sweden; D013987:Ticks / Q000276:immunology; D014768:Virginia; D055815:Young Adult
chemical_list: D004187:Disaccharides; C055075:galactosyl-(1-3)galactose; D009569:Nitric Oxide; D007073:Immunoglobulin E