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. 2012 Apr 1;185(7):723-30.
doi: 10.1164/rccm.201111-2017OC. Epub 2012 Jan 26.

Galactose-α-1,3-galactose-specific IgE is associated with anaphylaxis but not asthma

Scott P Commins  1 , Libby A Kelly, Eva Rönmark, Hayley R James, Shawna L Pochan, Edward J Peters, Bo Lundbäck, Lucy W Nganga, Philip J Cooper, Janelle M Hoskins, Saju S Eapen, Luis A Matos, Dane C McBride, Peter W Heymann, Judith A Woodfolk, Matthew S Perzanowski, Thomas A E Platts-Mills
Affiliations

Galactose-α-1,3-galactose-specific IgE is associated with anaphylaxis but not asthma

Scott P Commins et al. Am J Respir Crit Care Med. .

Abstract

Rationale: IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal) are common in the southeastern United States. These antibodies, which are induced by ectoparasitic ticks, can give rise to positive skin tests or serum assays with cat extract.

Objectives: To evaluate the relationship between IgE antibodies to α-gal and asthma, and compare this with the relationship between asthma and IgE antibodies to Fel d 1 and other protein allergens.

Methods: Patients being investigated for recurrent anaphylaxis, angioedema, or acute urticaria underwent spirometry, exhaled nitric oxide, questionnaires, and serum IgE antibody assays. The results were compared with control subjects and cohorts from the emergency department in Virginia (n = 130), northern Sweden (n = 963), and rural Kenya (n = 131).

Measurements and main results: Patients in Virginia with high-titer IgE antibodies to α-gal had normal lung function, low levels of exhaled nitric oxide, and low prevalence of asthma symptoms. Among patients in the emergency department and children in Kenya, there was no association between IgE antibodies to α-gal and asthma (odds ratios, 1.04 and 0.75, respectively). In Sweden, IgE antibodies to cat were closely correlated with IgE antibodies to Fel d 1 (r = 0.83) and to asthma (P < 0.001).

Conclusions: These results provide a model of an ectoparasite-induced specific IgE response that can increase total serum IgE without creating a risk for asthma, and further evidence that the main allergens that are causally related to asthma are those that are inhaled.

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Figures

Figure 1.
Figure 1.
Galactose-α-1,3-galactose (α-Gal)–specific IgE antibody titers. Numbers in gray denote the number of subjects in each group with no detectable IgE antibodies to α-gal. Note that α-gal IgE titers are sometimes markedly elevated. IgE titers do not differ between subjects living with or without cats. Prevalence of IgE antibodies to α-gal was significantly higher (P < 0.001) among patients with anaphylaxis, angioedema, or acute urticaria, and the mean IgE antibody titer among positives was significantly higher than among the random control subjects (P < 0.001). Bars represent the geometric mean of the positive values for each group.
Figure 2.
Figure 2.
Total serum IgE correlates with the titer of IgE specific for galactose-α-1,3-galactose(α-gal) among the anaphylaxis–urticaria group. Those subjects whose α-gal–specific IgE antibodies make up at least 10% (or 30%) of their total serum IgE fall on or above the green (or blue) line.
Figure 3.
Figure 3.
Objective measures of asthma support our clinical observation that galactose-α-1,3-galactose(α-gal)–positive anaphylaxis–urticaria subjects are no more likely to have asthma than the clinic control group, and that living with cats has no impact. Arithmetic means with standard deviation are displayed. (A) Exhaled nitric oxide among α-gal–positive anaphylaxis–urticaria subjects is significantly lower than that of the asthma group and no different from the clinic control group. (B) The ratio of FEV1 to FVC among α-gal–positive anaphylaxis–urticaria subjects is significantly higher than the asthma group and no different from the clinic control group.
Figure 4.
Figure 4.
The meaning of a positive IgE antibody assay to cat epithelium varies by geographic location. (A and C) In northern Sweden, IgE to cat epithelium is tightly correlated with having IgE antibodies to Fel d 1, not galactose-α-1,3-galactose(α-gal). (B and D) The opposite is true in rural Kenya, where IgE to cat epithelium is correlated with having IgE antibodies to α-gal, not Fel d 1.
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