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Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose.
J Allergy Clin Immunol 2014; 134(1):108-15JA

Abstract

BACKGROUND

In 2009, we reported a novel form of delayed anaphylaxis to red meat related to serum IgE antibodies to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal). Although patients were remarkably consistent in their description of a 3- to 6-hour delay between eating mammalian meat and the appearance of symptoms, this delay has not been demonstrated under observed studies.

OBJECTIVES

We sought to formally document the time course of clinical symptoms after the ingestion of mammalian meat in subjects with IgE to alpha-gal and to monitor ex vivo for the appearance of markers of an allergic reaction.

METHODS

Open food challenges were performed with mammalian meat in 12 subjects with a history of severe urticarial reactions 3 to 6 hours after eating beef, pork, or lamb, as well as in 13 control subjects. Blood samples were taken hourly during each challenge.

RESULTS

Ten of 12 subjects with IgE to alpha-gal had clinical evidence of a reaction during the food challenge (vs none of the control subjects, P < .001). The reactions occurred 3 to 7 hours after the initial ingestion of mammalian meat and ranged from urticaria to anaphylaxis. Tryptase levels were positive in 3 challenges. Basophil activation, as measured by increased expression of CD63, correlated with the appearance of clinical symptoms.

CONCLUSION

The results presented provide clear evidence of an IgE-mediated food allergy that occurs several hours after ingestion of the inciting allergen. Moreover, here we report that in vivo basophil activation during a food challenge occurs in the same time frame as clinical symptoms and likely reflects the appearance of the antigen in the bloodstream.

Authors+Show Affiliations

Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va. Electronic address: scottcommins@virginia.edu.Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va.Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va.Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va.Duke Asthma, Allergy and Airway Center, Duke University, Durham, NC.Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va.Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va.Asthma and Allergic Diseases Center, Department of Medicine, University of Virginia, Charlottesville, Va.

Pub Type(s)

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

Language

eng

PubMed ID

24656556

Citation

Commins, Scott P., et al. "Delayed Clinical and Ex Vivo Response to Mammalian Meat in Patients With IgE to Galactose-alpha-1,3-galactose." The Journal of Allergy and Clinical Immunology, vol. 134, no. 1, 2014, pp. 108-15.
Commins SP, James HR, Stevens W, et al. Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2014;134(1):108-15.
Commins, S. P., James, H. R., Stevens, W., Pochan, S. L., Land, M. H., King, C., ... Platts-Mills, T. A. (2014). Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. The Journal of Allergy and Clinical Immunology, 134(1), pp. 108-15. doi:10.1016/j.jaci.2014.01.024.
Commins SP, et al. Delayed Clinical and Ex Vivo Response to Mammalian Meat in Patients With IgE to Galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2014;134(1):108-15. PubMed PMID: 24656556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. AU - Commins,Scott P, AU - James,Hayley R, AU - Stevens,Whitney, AU - Pochan,Shawna L, AU - Land,Michael H, AU - King,Carol, AU - Mozzicato,Susan, AU - Platts-Mills,Thomas A E, Y1 - 2014/03/20/ PY - 2013/09/12/received PY - 2014/01/15/revised PY - 2014/01/18/accepted PY - 2014/3/25/entrez PY - 2014/3/25/pubmed PY - 2014/12/15/medline KW - Anaphylaxis KW - alpha-gal KW - basophil KW - food allergy KW - mammalian meat SP - 108 EP - 15 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 134 IS - 1 N2 - BACKGROUND: In 2009, we reported a novel form of delayed anaphylaxis to red meat related to serum IgE antibodies to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal). Although patients were remarkably consistent in their description of a 3- to 6-hour delay between eating mammalian meat and the appearance of symptoms, this delay has not been demonstrated under observed studies. OBJECTIVES: We sought to formally document the time course of clinical symptoms after the ingestion of mammalian meat in subjects with IgE to alpha-gal and to monitor ex vivo for the appearance of markers of an allergic reaction. METHODS: Open food challenges were performed with mammalian meat in 12 subjects with a history of severe urticarial reactions 3 to 6 hours after eating beef, pork, or lamb, as well as in 13 control subjects. Blood samples were taken hourly during each challenge. RESULTS: Ten of 12 subjects with IgE to alpha-gal had clinical evidence of a reaction during the food challenge (vs none of the control subjects, P < .001). The reactions occurred 3 to 7 hours after the initial ingestion of mammalian meat and ranged from urticaria to anaphylaxis. Tryptase levels were positive in 3 challenges. Basophil activation, as measured by increased expression of CD63, correlated with the appearance of clinical symptoms. CONCLUSION: The results presented provide clear evidence of an IgE-mediated food allergy that occurs several hours after ingestion of the inciting allergen. Moreover, here we report that in vivo basophil activation during a food challenge occurs in the same time frame as clinical symptoms and likely reflects the appearance of the antigen in the bloodstream. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/24656556/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(14)00180-8 DB - PRIME DP - Unbound Medicine ER -