title: Prevalence of type I sensitization to alpha-gal in forest service employees and hunters.
abstract: BACKGROUND
  The production of IgE molecules specific to the carbohydrate galactose-α-1,3-galactose (alpha-gal) is known to induce delayed anaphylaxis against mammalian meat. Tick bites constitute the primary sensitization source, as ticks transfer alpha-gal in their saliva to a host during a bite. The reported prevalence of alpha-gal-specific IgE (alpha-gal-sIgE) positivity varies between different populations from diverse geographic regions.
  
  
  OBJECTIVE
  To investigate the prevalence of alpha-gal-sIgE positivity in a population of forest service employees who are highly exposed to ticks in comparison with a residential population and a historic sample.
  
  
  METHODS
  A cross-sectional study evaluating 300 forest service employees and hunters from southwest Germany was performed. Alpha-gal-sIgE levels were assessed by ImmunoCAP assay. The prevalence of alpha-gal-sIgE-positive individuals was compared with a matched cohort composed of a residential population and blood samples from forest service employees collected 15 years ago.
  
  
  RESULTS
  In the study population, the prevalence of alpha-gal-sIgE-positive (≥0.10 kUA/L) individuals was 35.0%, whereas the prevalence of individuals with alpha-gal-sIgE levels ≥0.35 kUA/L was 19.3%. Alpha-gal-sIgE positivity was associated with total IgE levels and recent tick bites. Mammalian meat-induced delayed anaphylaxis was found in 8.6% of the participants with alpha-gal-sIgE levels ≥0.35 kUA/L. For forest service employees and hunters, the odds ratio for alpha-gal-sIgE positivity was 2.48 compared to the residential population. The prevalence of alpha-gal-sIgE positivity in the current and historic cohort was comparable.
  
  
  CONCLUSIONS
  Forest service employees and hunters compose a population with a high prevalence of alpha-gal-sIgE positivity and carry a considerable risk of red meat allergy.
authors.affiliation: Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
authors.forename: J
authors.identifier: http://orcid.org/0000-0001-6305-6659
authors.initials: J
authors.lastname: Fischer
authors.affiliation: Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Lupberger
authors.affiliation: Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hebsaker
authors.affiliation: Department of Clinical Epidemiology and Applied Biostatistics, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Baden-Württemberg State Health Office, District Government Stuttgart, Stuttgart, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Aichinger
authors.affiliation: Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
authors.forename: A S
authors.initials: AS
authors.lastname: Yazdi
authors.affiliation: Baden-Württemberg State Health Office, District Government Stuttgart, Stuttgart, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Reick
authors.affiliation: Baden-Württemberg State Health Office, District Government Stuttgart, Stuttgart, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Oehme
authors.affiliation: Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.|Department of Dermatology and Allergy Biederstein, Technische Universität, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Biedermann
mesh_terms: D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000918:Antibody Specificity / Q000276:immunology; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D065928:Forests; D005690:Galactose / Q000276:immunology*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology* / Q000276:immunology*; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D062486:Public Health Surveillance; D012621:Seasons; D064927:Tick Bites
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D005690:Galactose
keywords: alpha-gal syndrome; anaphylaxis; galactose-α-1, 3-galactose; occupational medicine, tick bite