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Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose.

Abstract

BACKGROUND

Carbohydrate moieties are frequently encountered in food and can elicit IgE responses, the clinical significance of which has been unclear. Recent work, however, has shown that IgE antibodies to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate commonly expressed on nonprimate mammalian proteins, are capable of eliciting serious, even fatal, reactions.

OBJECTIVE

We sought to determine whether IgE antibodies to alpha-gal are present in sera from patients who report anaphylaxis or urticaria after eating beef, pork, or lamb.

METHODS

Detailed histories were taken from patients presenting to the University of Virginia Allergy Clinic. Skin prick tests (SPTs), intradermal skin tests, and serum IgE antibody analysis were performed for common indoor, outdoor, and food allergens.

RESULTS

Twenty-four patients with IgE antibodies to alpha-gal were identified. These patients described a similar history of anaphylaxis or urticaria 3 to 6 hours after the ingestion of meat and reported fewer or no episodes when following an avoidance diet. SPTs to mammalian meat produced wheals of usually less than 4 mm, whereas intradermal or fresh-food SPTs provided larger and more consistent wheal responses. CAP-RAST testing revealed specific IgE antibodies to beef, pork, lamb, cow's milk, cat, and dog but not turkey, chicken, or fish. Absorption experiments indicated that this pattern of sensitivity was explained by an IgE antibody specific for alpha-gal.

CONCLUSION

We report a novel and severe food allergy related to IgE antibodies to the carbohydrate epitope alpha-gal. These patients experience delayed symptoms of anaphylaxis, angioedema, or urticaria associated with eating beef, pork, or lamb.

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  • Authors+Show Affiliations

    ,

    Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA, USA.

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    Source

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Allergens
    Anaphylaxis
    Angioedema
    Animals
    Cattle
    Disaccharides
    Female
    Food Hypersensitivity
    Humans
    Hypersensitivity, Delayed
    Immunoglobulin E
    Male
    Meat
    Middle Aged
    Sheep
    Skin Tests
    Swine
    Urticaria
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19070355

    Citation

    Commins, Scott P., et al. "Delayed Anaphylaxis, Angioedema, or Urticaria After Consumption of Red Meat in Patients With IgE Antibodies Specific for Galactose-alpha-1,3-galactose." The Journal of Allergy and Clinical Immunology, vol. 123, no. 2, 2009, pp. 426-33.
    Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123(2):426-33.
    Commins, S. P., Satinover, S. M., Hosen, J., Mozena, J., Borish, L., Lewis, B. D., ... Platts-Mills, T. A. (2009). Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. The Journal of Allergy and Clinical Immunology, 123(2), pp. 426-33. doi:10.1016/j.jaci.2008.10.052.
    Commins SP, et al. Delayed Anaphylaxis, Angioedema, or Urticaria After Consumption of Red Meat in Patients With IgE Antibodies Specific for Galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123(2):426-33. PubMed PMID: 19070355.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. AU - Commins,Scott P, AU - Satinover,Shama M, AU - Hosen,Jacob, AU - Mozena,Jonathan, AU - Borish,Larry, AU - Lewis,Barrett D, AU - Woodfolk,Judith A, AU - Platts-Mills,Thomas A E, Y1 - 2008/12/13/ PY - 2008/07/09/received PY - 2008/09/26/revised PY - 2008/10/28/accepted PY - 2008/12/17/entrez PY - 2008/12/17/pubmed PY - 2009/3/4/medline SP - 426 EP - 33 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 123 IS - 2 N2 - BACKGROUND: Carbohydrate moieties are frequently encountered in food and can elicit IgE responses, the clinical significance of which has been unclear. Recent work, however, has shown that IgE antibodies to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate commonly expressed on nonprimate mammalian proteins, are capable of eliciting serious, even fatal, reactions. OBJECTIVE: We sought to determine whether IgE antibodies to alpha-gal are present in sera from patients who report anaphylaxis or urticaria after eating beef, pork, or lamb. METHODS: Detailed histories were taken from patients presenting to the University of Virginia Allergy Clinic. Skin prick tests (SPTs), intradermal skin tests, and serum IgE antibody analysis were performed for common indoor, outdoor, and food allergens. RESULTS: Twenty-four patients with IgE antibodies to alpha-gal were identified. These patients described a similar history of anaphylaxis or urticaria 3 to 6 hours after the ingestion of meat and reported fewer or no episodes when following an avoidance diet. SPTs to mammalian meat produced wheals of usually less than 4 mm, whereas intradermal or fresh-food SPTs provided larger and more consistent wheal responses. CAP-RAST testing revealed specific IgE antibodies to beef, pork, lamb, cow's milk, cat, and dog but not turkey, chicken, or fish. Absorption experiments indicated that this pattern of sensitivity was explained by an IgE antibody specific for alpha-gal. CONCLUSION: We report a novel and severe food allergy related to IgE antibodies to the carbohydrate epitope alpha-gal. These patients experience delayed symptoms of anaphylaxis, angioedema, or urticaria associated with eating beef, pork, or lamb. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/19070355/Delayed_anaphylaxis_angioedema_or_urticaria_after_consumption_of_red_meat_in_patients_with_IgE_antibodies_specific_for_galactose_alpha_13_galactose_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(08)01931-3 DB - PRIME DP - Unbound Medicine ER -