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Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose.

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.

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  • 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.

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    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.

    Source

    MeSH

    Adult
    Anaphylaxis
    Animals
    Basophils
    Biomarkers
    Case-Control Studies
    Cattle
    Disaccharides
    Female
    Food Hypersensitivity
    Humans
    Immunoglobulin E
    Male
    Meat
    Middle Aged
    Sheep
    Swine
    Tetraspanin 30
    Time Factors
    Urticaria

    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 -