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Review
. 2020 Jul;16(7):667-677.
doi: 10.1080/1744666X.2020.1782745. Epub 2020 Jul 8.

Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients

Scott P Commins  1
Affiliations
Review

Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients

Scott P Commins. Expert Rev Clin Immunol. 2020 Jul.

Abstract

Introduction: Alpha-gal Syndrome (AGS) is a unique allergy to non-primate mammalian meat (and derived-products) that is associated with tick bites and is due to a specific IgE antibody to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). AGS has many novel features that broaden the paradigm of food allergy, including that reactions are delayed 3-6 hours after exposure and patients have frequently tolerated red meat for many years prior to the development of allergic reactions. Due to the ubiquitous inclusion of mammal-derived materials in foods, medications, personal products and stabilizing compounds, full avoidance is difficult to achieve.

Areas covered: This review describes the author's experience with diagnosis, management, and design of appropriate avoidance for patients with AGS and provides clinicians with practical advice for care of these patients.

Expert opinion: The number of patients with AGS is rising and may have exceeded awareness of the diagnosis amongst healthcare providers. In summarizing experience gained to thus far, we hope to create a resource for identifying and managing this unique allergic syndrome.

Keywords: Alpha gal allergy; IgE; anaphylaxis; food allergy; galactose; red meat; tick.

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Conflict of interest statement

Declaration of interest

The author declares research grants from NIH and CDC; a member of Genentech speaker’s bureau; has received royalties from UpToDate

Figures

Figure 1 –
Figure 1 –
Diagnostic algorithm for alpha-gal syndrome
See this image and copyright information in PMC

References

    1. Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009. February;123(2):426–33. - PMC - PubMed
    1. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med. 2008. March 13;358(11):1109–17. - PMC - PubMed
    1. Commins SP, Jerath MR, Cox K, et al. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016. January;65(1):16–20. - PMC - PubMed
    1. 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. July;134(1):108–15. - PMC - PubMed

    1. Flaherty MG, Kaplan SJ, Jerath MR. Diagnosis of Life-Threatening Alpha-Gal Food Allergy Appears to Be Patient Driven. J Prim Care Community Health. 2017. October;8(4):345–348.

      *The authors interviewed patients with AGS and found that an average of 7 years passed between onset of symptoms and diagnosis of AGS.

Publication types

Supplementary concepts