Thermo Fisher – alpha-Gal Syndrome
Alpha-Gal syndrome, a trigger of red meat allergy
Alpha-Gal syndrome, a red meat allergy, is triggered by IgE antibodies targeting galactose-alpha-1,3-galactose, known as ‘alpha-Gal’, found in the meats of non-primate mammals. Tick bites are the primary carrier for this sensitisation. Recognising a potential connection to tick bites can significantly aid the diagnostic process. 1,3
Alpha-Gal clinical manifestations
Alpha-Gal syndrome commonly appears in adolescents and adults, as symptoms range from unexpected urticaria (itchy rash and hives) to gastrointestinal problems (diarrhoea), and, in severe cases, anaphylaxis. Symptoms typically appear 3-6 hours after consuming red meat (like beef, pork, lamb or innards).1-4
Often misdiagnosed as irritable bowel syndrome, there is a significant amount of underdiagnosis, with about 80% of patients experiencing delays of over seven years in receiving an accurate diagnosis. Fortunately, efforts in heightened awareness and enhanced diagnostic methods are fostering a positive shift. This progress holds promise for shorter diagnosis times, providing an improvement in recognising and managing alpha-Gal allergies.5
The risk and severity of reactions in alpha-Gal syndrome are influenced by the oligosaccharide quantity in food, drugs or therapeutics. Administration route matters, as intravenous exposure triggers rapid reactions, while oral ingestion leads to delayed onset.
Diagnostic approaches
In the case of suspected mammalian meat allergy, a detailed clinical history focusing on predisposing factors such as tick bites, meat consumption and the onset of symptoms, as well as potential cofactors like alcohol consumption, physical activity and the use of nonsteroidal anti-inflammatory drugs, is essential due to the varying reactions among patients.2,7
The employment of specific IgE blood tests, such as the ImmunoCAP™ Specific IgE test, enhances this analysis by offering a more precise and reliable diagnosis. This approach enables healthcare professionals to develop tailored and effective care strategies for each patient.6,8
In a typical alpha-Gal allergic patient:
- Diagnosis is supported by IgE to several mammalian meats: pork, beef and lamb.9
- IgE levels against alpha-Gal are higher compared to IgE against mammalian meats.9, 10
References:
- Taylor, M. L. et al. Intrinsic risk factors for alpha-gal syndrome in a case-control study, 2019 to 2020. Annals of Allergy, Asthma & Immunology (2024) doi:10.1016/j.anai.2024.01.029.
- Steinke, J. W., Platts-Mills, T. A. E. & Commins, S. P. The alpha gal story: Lessons learned from connecting the dots. J Allergy Clin Immunol 135, 589 (2015).
- Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; Available from: https://www.mayoclinic.org/diseases-conditions/alpha-gal-syndrome/symptoms-causes/syc-20428608.
- Jackson, W. L. Mammalian meat allergy following a tick bite: a case report. Oxf Med Case Reports 2, 58–60 (2018).
- Flaherty, M. G., Kaplan, S. J. & Jerath, M. R. Diagnosis of Life-Threatening Alpha-Gal Food Allergy Appears to Be Patient Driven. J Prim Care Community Health 8, 345–348 (2017).
- Platts-Mills, T., Li, R. C., Smith, A. R. & Wilson, J. M. Diagnosis and management of patients with the α-Gal syndrome. J Allergy Clin Immunol Pract. 8(1), 15–23 (2020).
- Patel, C. & Iweala, O. I. ‘Doc, will i ever eat steak again?’: Diagnosis and management of alpha-gal syndrome. Current Opinion in Pediatrics vol. 32 816–824 Preprint at https://doi.org/10.1097/MOP.0000000000000955 (2020).
- Commins, S. P. Diagnosis & management of alpha-gal syndrome:lessons from 2,500 patients. Expert Rev Clin Immunol 16, 667 (2020).
- Commins, S. P. et al. Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. (2014) doi:10.1016/j.jaci.2014.01.024.
- Hamsten, C. et al. Red meat allergy in Sweden: Association with tick sensitization and B-negative blood groups. J Allergy Clin Immunol. 132(6), 1431–1434 (2013).
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