title: Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat.
abstract: IgE-mediated hypersensitivity refers to immune reactions that can be rapidly progressing and, in the case of anaphylaxis, are occasionally fatal. To that end, identification of the associated allergen is important for facilitating both education and allergen avoidance that are essential to long-term risk reduction. As the number of known exposures associated with anaphylaxis is limited, discovery of novel causative agents is crucial to evaluation and management of patients with idiopathic anaphylaxis. Within the last 10 years several apparently separate observations were recognized to be related, all of which resulted from the development of antibodies to a carbohydrate moiety on proteins. Interestingly, the exposure differed from airborne allergens but was nevertheless capable of producing anaphylactic and hypersensitivity reactions. Our recent work has identified these responses as being due to a novel IgE antibody directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose ("alpha-gal"). This review will present the historical summary of the identification of cetuximab hypersensitivity due to alpha-gal IgE and discuss the non-primate mammalian meat food allergy as well as current goals and directions of our research programs.
authors.affiliation: Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address: scommins@email.unc.edu.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Commins
authors.affiliation: Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: Maya R
authors.initials: MR
authors.lastname: Jerath
authors.affiliation: Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Cox
authors.affiliation: Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA; Carter Immunology Center, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Loren D
authors.initials: LD
authors.lastname: Erickson
authors.affiliation: Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA; Carter Immunology Center, University of Virginia Health System, Charlottesville, VA, USA; Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Platts-Mills
mesh_terms: D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000209:etiology* / Q000276:immunology; D000818:Animals; D000068818:Cetuximab / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000276:immunology; D005512:Food Hypersensitivity / Q000209:etiology* / Q000276:immunology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology* / Q000276:immunology; D007073:Immunoglobulin E / Q000276:immunology; D008460:Meat / Q000009:adverse effects*; D009844:Oligosaccharides / Q000276:immunology*; D064927:Tick Bites; D013987:Ticks
chemical_list: D000485:Allergens; D009844:Oligosaccharides; D007073:Immunoglobulin E; D000068818:Cetuximab
keywords: Alpha-gal; Delayed anaphylaxis; Glycan; IgE; Red meat allergy