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Galactose-α-1,3-galactose and delayed anaphylaxis, angioedema, and urticaria in children.
Pediatrics. 2013 May; 131(5):e1545-52.Ped

Abstract

BACKGROUND AND OBJECTIVE

Despite a thorough history and comprehensive testing, many children who present with recurrent symptoms consistent with allergic reactions elude diagnosis. Recent research has identified a novel cause for "idiopathic" allergic reactions; immunoglobulin E (IgE) antibody specific for the carbohydrate galactose-α-1,3-galactose (α-Gal) has been associated with delayed urticaria and anaphylaxis that occurs 3 to 6 hours after eating beef, pork, or lamb. We sought to determine whether IgE antibody to α-Gal was present in sera of pediatric patients who reported idiopathic anaphylaxis or urticaria.

METHODS

Patients aged 4 to 17 were enrolled in an institutional review board-approved protocol at the University of Virginia and private practice allergy offices in Lynchburg, VA. Sera was obtained and analyzed by ImmunoCAP for total IgE and specific IgE to α-Gal, beef, pork, cat epithelium and dander, Fel d 1, dog dander, and milk.

RESULTS

Forty-five pediatric patients were identified who had both clinical histories supporting delayed anaphylaxis or urticaria to mammalian meat and IgE antibody specific for α-Gal. In addition, most of these cases had a history of tick bites within the past year, which itched and persisted.

CONCLUSIONS

A novel form of anaphylaxis and urticaria that occurs 3 to 6 hours after eating mammalian meat is not uncommon among children in our area. Identification of these cases may not be straightforward and diagnosis is best confirmed by specific testing, which should certainly be considered for children living in the area where the Lone Star tick is common.

Authors+Show Affiliations

Division of Allergy and Immunology, Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23569097

Citation

Kennedy, Joshua L., et al. "Galactose-α-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children." Pediatrics, vol. 131, no. 5, 2013, pp. e1545-52.
Kennedy JL, Stallings AP, Platts-Mills TA, et al. Galactose-α-1,3-galactose and delayed anaphylaxis, angioedema, and urticaria in children. Pediatrics. 2013;131(5):e1545-52.
Kennedy, J. L., Stallings, A. P., Platts-Mills, T. A., Oliveira, W. M., Workman, L., James, H. R., Tripathi, A., Lane, C. J., Matos, L., Heymann, P. W., & Commins, S. P. (2013). Galactose-α-1,3-galactose and delayed anaphylaxis, angioedema, and urticaria in children. Pediatrics, 131(5), e1545-52. https://doi.org/10.1542/peds.2012-2585
Kennedy JL, et al. Galactose-α-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children. Pediatrics. 2013;131(5):e1545-52. PubMed PMID: 23569097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Galactose-α-1,3-galactose and delayed anaphylaxis, angioedema, and urticaria in children. AU - Kennedy,Joshua L, AU - Stallings,Amy P, AU - Platts-Mills,Thomas A E, AU - Oliveira,Walter M, AU - Workman,Lisa, AU - James,Haley R, AU - Tripathi,Anubha, AU - Lane,Charles J, AU - Matos,Luis, AU - Heymann,Peter W, AU - Commins,Scott P, Y1 - 2013/04/08/ PY - 2013/4/10/entrez PY - 2013/4/10/pubmed PY - 2013/7/19/medline KW - delayed anaphylaxis KW - galactose-α-1,3-galactose KW - pediatric urticaria KW - α-Gal SP - e1545 EP - 52 JF - Pediatrics JO - Pediatrics VL - 131 IS - 5 N2 - BACKGROUND AND OBJECTIVE: Despite a thorough history and comprehensive testing, many children who present with recurrent symptoms consistent with allergic reactions elude diagnosis. Recent research has identified a novel cause for "idiopathic" allergic reactions; immunoglobulin E (IgE) antibody specific for the carbohydrate galactose-α-1,3-galactose (α-Gal) has been associated with delayed urticaria and anaphylaxis that occurs 3 to 6 hours after eating beef, pork, or lamb. We sought to determine whether IgE antibody to α-Gal was present in sera of pediatric patients who reported idiopathic anaphylaxis or urticaria. METHODS: Patients aged 4 to 17 were enrolled in an institutional review board-approved protocol at the University of Virginia and private practice allergy offices in Lynchburg, VA. Sera was obtained and analyzed by ImmunoCAP for total IgE and specific IgE to α-Gal, beef, pork, cat epithelium and dander, Fel d 1, dog dander, and milk. RESULTS: Forty-five pediatric patients were identified who had both clinical histories supporting delayed anaphylaxis or urticaria to mammalian meat and IgE antibody specific for α-Gal. In addition, most of these cases had a history of tick bites within the past year, which itched and persisted. CONCLUSIONS: A novel form of anaphylaxis and urticaria that occurs 3 to 6 hours after eating mammalian meat is not uncommon among children in our area. Identification of these cases may not be straightforward and diagnosis is best confirmed by specific testing, which should certainly be considered for children living in the area where the Lone Star tick is common. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/23569097/Galactose_α_13_galactose_and_delayed_anaphylaxis_angioedema_and_urticaria_in_children_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=23569097 DB - PRIME DP - Unbound Medicine ER -