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The alpha-gal story: lessons learned from connecting the dots.

Abstract

Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal, and therefore establishing its cause is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with 2 distinct forms of anaphylaxis: (1) immediate-onset anaphylaxis during first exposure to intravenous cetuximab and (2) delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products (eg, beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern, and central United States; Europe; Australia; and parts of Asia. Typical immune responses to carbohydrates are considered to be T-cell independent, whereas IgE antibody production is thought to involve sequential class-switching that requires input from T cells. Therefore, establishing the mechanism of the specific IgE antibody response to alpha-gal will be an important aspect to address as this area of research continues.

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  • Authors+Show Affiliations

    ,

    Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.

    ,

    Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va. Electronic address: tap2z@virginia.edu.

    Asthma and Allergic Diseases Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.

    Source

    The Journal of allergy and clinical immunology 135:3 2015 Mar pg 589-96; quiz 597

    MeSH

    Allergens
    Anaphylaxis
    Animals
    Antibodies, Monoclonal, Humanized
    Antineoplastic Agents
    Cattle
    Cetuximab
    Disaccharides
    Epitopes
    Food Hypersensitivity
    Humans
    Hypersensitivity, Delayed
    Immunoglobulin E
    Meat
    Swine
    T-Lymphocytes
    Tick Bites

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    25747720

    Citation

    Steinke, John W., et al. "The Alpha-gal Story: Lessons Learned From Connecting the Dots." The Journal of Allergy and Clinical Immunology, vol. 135, no. 3, 2015, pp. 589-96; quiz 597.
    Steinke JW, Platts-Mills TA, Commins SP. The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135(3):589-96; quiz 597.
    Steinke, J. W., Platts-Mills, T. A., & Commins, S. P. (2015). The alpha-gal story: lessons learned from connecting the dots. The Journal of Allergy and Clinical Immunology, 135(3), pp. 589-96; quiz 597. doi:10.1016/j.jaci.2014.12.1947.
    Steinke JW, Platts-Mills TA, Commins SP. The Alpha-gal Story: Lessons Learned From Connecting the Dots. J Allergy Clin Immunol. 2015;135(3):589-96; quiz 597. PubMed PMID: 25747720.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The alpha-gal story: lessons learned from connecting the dots. AU - Steinke,John W, AU - Platts-Mills,Thomas A E, AU - Commins,Scott P, PY - 2014/10/09/received PY - 2014/11/21/revised PY - 2014/12/10/accepted PY - 2015/3/10/entrez PY - 2015/3/10/pubmed PY - 2015/5/1/medline KW - Anaphylaxis KW - delayed reaction to red meat KW - galactose-alpha-1,3-galactose SP - 589-96; quiz 597 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 135 IS - 3 N2 - Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal, and therefore establishing its cause is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with 2 distinct forms of anaphylaxis: (1) immediate-onset anaphylaxis during first exposure to intravenous cetuximab and (2) delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products (eg, beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern, and central United States; Europe; Australia; and parts of Asia. Typical immune responses to carbohydrates are considered to be T-cell independent, whereas IgE antibody production is thought to involve sequential class-switching that requires input from T cells. Therefore, establishing the mechanism of the specific IgE antibody response to alpha-gal will be an important aspect to address as this area of research continues. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/25747720/The_alpha_gal_story:_lessons_learned_from_connecting_the_dots_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(15)00076-7 DB - PRIME DP - Unbound Medicine ER -