The alpha-gal story: lessons learned from connecting the dots.
Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal, and therefore establishing its cause is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with 2 distinct forms of anaphylaxis: (1) immediate-onset anaphylaxis during first exposure to intravenous cetuximab and (2) delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products (eg, beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern, and central United States; Europe; Australia; and parts of Asia. Typical immune responses to carbohydrates are considered to be T-cell independent, whereas IgE antibody production is thought to involve sequential class-switching that requires input from T cells. Therefore, establishing the mechanism of the specific IgE antibody response to alpha-gal will be an important aspect to address as this area of research continues.
Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.
John W
JW
Steinke
Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va. Electronic address: tap2z@virginia.edu.
Thomas A E
TA
Platts-Mills
Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.
Scott P
SP
Commins
D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D002417:Cattle; D000068818:Cetuximab; D004187:Disaccharides / Q000276:immunology*; D000939:Epitopes / Q000276:immunology; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D007073:Immunoglobulin E / Q000097:blood; D008460:Meat; D013552:Swine; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D064927:Tick Bites / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology
D000485:Allergens; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D004187:Disaccharides; D000939:Epitopes; C055075:galactosyl-(1-3)galactose; D007073:Immunoglobulin E; D000068818:Cetuximab
Anaphylaxis; delayed reaction to red meat; galactose-alpha-1,3-galactose