Delayed anaphylaxis to red meat in patients with IgE specific for galactose alpha-1,3-galactose (alpha-gal).
Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal. In instances where the triggering allergen is not known, establishing the etiology of anaphylaxis is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody (Ab) response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal), that has been associated with two distinct forms of anaphylaxis: (1) immediate onset anaphylaxis during first exposure to intravenous cetuximab, and (2) delayed onset anaphylaxis 3-6 h after ingestion of mammalian food products (e.g., beef and pork). The results of our studies strongly suggest that tick bites are a cause, if not the only significant cause, of IgE Ab responses to alpha-gal in the southern, eastern and central United States. Patients with IgE Ab to alpha-gal continue to emerge and, increasingly, these cases involve children. This IgE Ab response cross-reacts with cat and dog but does not appear to pose a risk for asthma; however, it may impair diagnostic testing in some situations.
Department of Internal Medicine & Pediatrics, Division of Allergy and Immunology, University of Virginia Health System, Charlottesville, VA 22908, USA. spc7w@virginia.edu
Scott P
SP
Commins
Thomas A E
TA
Platts-Mills
D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000209:etiology* / Q000276:immunology; D000818:Animals; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D001249:Asthma / Q000276:immunology; D000068818:Cetuximab; D003429:Cross Reactions / Q000276:immunology; D004187:Disaccharides / Q000276:immunology*; D000939:Epitopes / Q000276:immunology; D005512:Food Hypersensitivity / Q000209:etiology* / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007299:Insect Bites and Stings / Q000276:immunology; D008460:Meat / Q000009:adverse effects*; D013987:Ticks
D000485:Allergens; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004187:Disaccharides; D000939:Epitopes; C055075:galactosyl-(1-3)galactose; D007073:Immunoglobulin E; D000068818:Cetuximab