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Review
. 2021 Dec 1;34(6):761-765.
doi: 10.1097/ACO.0000000000001066.

Demystifying α-gal syndrome: identification and risk management in the perioperative setting

Whitney Wolaver  1 , Shilen Thakrar  1 , Kelvin Thomas  1 , Hiral Thakrar  2 , Lawrence Schwartz  3 , Wilhelm Zuelzer  4 , John Butterworth 4th  1 , Kyle Hoelting  5
Affiliations
Review

Demystifying α-gal syndrome: identification and risk management in the perioperative setting

Whitney Wolaver et al. Curr Opin Anaesthesiol. .

Abstract

Purpose of review: α-Gal syndrome is among a vexing perioperative consideration for anesthesiologists. Commonly referred to as 'red meat allergy', α-Gal syndrome is precipitated by a lone star tick bite resulting in the formation of immunoglobulin E (IgE) antibodies against the tick salivary glycoproteins and noncatarrhine mammalian tissue.

Recent findings: Up to 20% of the population in the southeastern United States may test positive for IgE antibodies to α-Gal. Increasingly, recognition of α-Gal syndrome as an immune response to red meat consumption and certain drugs, many of which may be administered within the perioperative period, has led to greater awareness of the insidious nature of its presentation - from mild urticaria and gastrointestinal symptoms to severe anaphylaxis.

Summary: With the increasing prevalence and identification of α-Gal syndrome, a safe and tailored perioperative process is needed to integrate a pathway that involves multidisciplinary communication, robust information sharing platform, and a structured peri-procedure management.

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References

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    1. Platts-Mills TAE, Commins SP, Biedermann T, et al. On the cause and consequences of IgE to galactose-α-1,3-galactose: A report from the National Institute of Allergy and Infectious Diseases Workshop on Understanding IgE-Mediated Mammalian Meat Allergy. J Allergy Clin Immunol 2020; 145:1061–1071.
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    1. Dunkman WJ, Rycek W, Manning MW. What does a red meat allergy have to do with anesthesia? Perioperative management of Alpha-Gal Syndrome. Anesth Analg 2019; 129:1242–1248.
    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; 123:426–433.

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