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. 2018 May;73(5):1131-1134.
doi: 10.1111/all.13366. Epub 2017 Dec 27.

Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis

M C Carter  1 , K N Ruiz-Esteves  1 , L Workman  2 , P Lieberman  3 , T A E Platts-Mills  2 , D D Metcalfe  1
Affiliations

Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis

M C Carter et al. Allergy. 2018 May.

Abstract

IgE antibodies (Ab) specific to galactose-α-1,3-galactose (alpha-gal) are responsible for a delayed form of anaphylaxis that occurs 3-6 hours after red meat ingestion. In a unique prospective study of seventy participants referred with a diagnosis of idiopathic anaphylaxis (IA), six (9%) were found to have IgE to alpha-gal. Upon institution of a diet free of red meat, all patients had no further episodes of anaphylaxis. Two of these individuals had indolent systemic mastocytosis (ISM). Those with ISM had more severe clinical reactions but lower specific IgE to alpha-gal and higher serum tryptase levels, reflective of the mast cell burden. The identification of alpha-gal syndrome in patients with IA supports the need for routine screening for this sensitivity as a cause of anaphylaxis, where reactions to alpha-gal are delayed and thus may be overlooked.

Keywords: alpha-galactose; anaphylaxis; clonal; mastocytosis.

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Conflict of interest statement

CONFLICTS OF INTEREST

Dr. Lieberman reports personal fees from kaleo, personal fees from mylan, outside the submitted work; Dr. Platts-Mills reports grants from Thermo Fisher Scientific/Phadia, outside the submitted work; The other authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Specific anti-alpha-gal IgE correlation with total IgE and serum tryptase. A, Total IgE vs alpha-gal levels. Patients with co-occurring clonal disease (triangles) tend to have lower levels of both IgE and alpha-gal titers, rs = .77 (B). Alpha-gal/IgE ratios vs serum tryptase (sTryp) levels. There is a trend for positive and negative correlations for figures (A) and (B), respectively. Patients with clonal disease (triangles) had lower alpha-gal/IgE ratios but higher tryptase levels, rs = −.60
See this image and copyright information in PMC

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