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Investigation into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy.
J Allergy Clin Immunol Pract. 2019 Sep - Oct; 7(7):2348-2358.e4.JA

Abstract

BACKGROUND

Red meat allergy has historically been understood as a rare disease of atopic children, but the discovery of the "α-Gal syndrome," which relates to IgE to the oligosaccharide galactose-α-1,3-galactose (α-Gal), has challenged that notion.

OBJECTIVE

To describe the clinical and immunologic characteristics of a large group of subjects with self-reported allergy to mammalian meat.

METHODS

This was an observational study of 261 children and adults (range, 5-82 years) who presented for evaluation for allergic reactions to mammalian meat. Results were based on serum assays and a detailed questionnaire.

RESULTS

α-Gal specific IgE ≥ 0.35 IU/mL was detected in 245 subjects and symptom onset occurred ≥2 hours after eating mammalian meat in 211 (81%). Component testing supported a diagnosis of α-Gal syndrome in 95%, pork-cat syndrome in 1.9%, and primary beef allergy in 1.1%. Urticaria was reported by 93%, anaphylaxis by 60%, and gastrointestinal symptoms by 64%. Levels of IgE and IgG specific to α-Gal were similar in subjects who reported early- or delayed-onset symptoms, and in those with and without anaphylaxis. Levels of α-Gal specific IgE and severity of reactions were similar among those with and without traditional atopy, and among children (n = 35) and adults (n = 226). Blood group B trended toward being under-represented among α-Gal-sensitized subjects; however, α-Gal specific IgE titers were high in symptomatic cases with B-antigen.

CONCLUSIONS

The α-Gal syndrome is a regionally common form of food allergy that has a characteristic but not universal delay in symptom onset, includes gastrointestinal symptoms, can develop at any time in life, and is equally common in otherwise nonatopic individuals.

Authors+Show Affiliations

Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.Allergy Partners of Fredericksburg, Fredericksburg, Va.Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.Division of Rheumatology, Allergy and Immunology, University of North Carolina, Chapel Hill, NC. Electronic address: scommins@email.unc.edu.Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va. Electronic address: tap2z@virginia.edu.

Pub Type(s)

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

Language

eng

PubMed ID

30940532

Citation

Wilson, Jeffrey M., et al. "Investigation Into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy." The Journal of Allergy and Clinical Immunology. in Practice, vol. 7, no. 7, 2019, pp. 2348-2358.e4.
Wilson JM, Schuyler AJ, Workman L, et al. Investigation into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy. J Allergy Clin Immunol Pract. 2019;7(7):2348-2358.e4.
Wilson, J. M., Schuyler, A. J., Workman, L., Gupta, M., James, H. R., Posthumus, J., McGowan, E. C., Commins, S. P., & Platts-Mills, T. A. E. (2019). Investigation into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy. The Journal of Allergy and Clinical Immunology. in Practice, 7(7), 2348-e4. https://doi.org/10.1016/j.jaip.2019.03.031
Wilson JM, et al. Investigation Into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy. J Allergy Clin Immunol Pract. 2019 Sep - Oct;7(7):2348-2358.e4. PubMed PMID: 30940532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigation into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy. AU - Wilson,Jeffrey M, AU - Schuyler,Alexander J, AU - Workman,Lisa, AU - Gupta,Monica, AU - James,Hayley R, AU - Posthumus,Jonathon, AU - McGowan,Emily C, AU - Commins,Scott P, AU - Platts-Mills,Thomas A E, Y1 - 2019/03/30/ PY - 2018/09/24/received PY - 2019/03/09/revised PY - 2019/03/13/accepted PY - 2019/4/4/pubmed PY - 2020/10/6/medline PY - 2019/4/4/entrez KW - Alpha-gal KW - Anaphylaxis KW - Food allergy KW - Galactose-α-1,3-galactose KW - Red meat SP - 2348 EP - 2358.e4 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract VL - 7 IS - 7 N2 - BACKGROUND: Red meat allergy has historically been understood as a rare disease of atopic children, but the discovery of the "α-Gal syndrome," which relates to IgE to the oligosaccharide galactose-α-1,3-galactose (α-Gal), has challenged that notion. OBJECTIVE: To describe the clinical and immunologic characteristics of a large group of subjects with self-reported allergy to mammalian meat. METHODS: This was an observational study of 261 children and adults (range, 5-82 years) who presented for evaluation for allergic reactions to mammalian meat. Results were based on serum assays and a detailed questionnaire. RESULTS: α-Gal specific IgE ≥ 0.35 IU/mL was detected in 245 subjects and symptom onset occurred ≥2 hours after eating mammalian meat in 211 (81%). Component testing supported a diagnosis of α-Gal syndrome in 95%, pork-cat syndrome in 1.9%, and primary beef allergy in 1.1%. Urticaria was reported by 93%, anaphylaxis by 60%, and gastrointestinal symptoms by 64%. Levels of IgE and IgG specific to α-Gal were similar in subjects who reported early- or delayed-onset symptoms, and in those with and without anaphylaxis. Levels of α-Gal specific IgE and severity of reactions were similar among those with and without traditional atopy, and among children (n = 35) and adults (n = 226). Blood group B trended toward being under-represented among α-Gal-sensitized subjects; however, α-Gal specific IgE titers were high in symptomatic cases with B-antigen. CONCLUSIONS: The α-Gal syndrome is a regionally common form of food allergy that has a characteristic but not universal delay in symptom onset, includes gastrointestinal symptoms, can develop at any time in life, and is equally common in otherwise nonatopic individuals. SN - 2213-2201 UR - https://www.unboundmedicine.com/medline/citation/30940532/Investigation_into_the_α_Gal_Syndrome:_Characteristics_of_261_Children_and_Adults_Reporting_Red_Meat_Allergy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(19)30314-9 DB - PRIME DP - Unbound Medicine ER -