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. 2025 Jan;80(1):181-192.
doi: 10.1111/all.16235. Epub 2024 Jul 15.

Allergenic potency of various foods of mammalian origin in patients with α-Gal syndrome

Marija Perusko  1   2   3 , Jeanette Grundström  1   2 , Maria Eldh  1   2 , Annika Reinhardt  1   2 , Verena Fuhrmann  1   2 , Meltem Düzakin  4 , Carl Hamsten  1   2 , Maria Starkhammar  4 , Danijela Apostolovic  1   2 , Marianne van Hage  1   2
Affiliations

Allergenic potency of various foods of mammalian origin in patients with α-Gal syndrome

Marija Perusko et al. Allergy. 2025 Jan.

Abstract

Background: The α-Gal syndrome (AGS) is an emerging allergy to mammalian food caused by IgE-mediated reactions to the carbohydrate galactose-α-1,3-galactose (α-Gal). Mammalian food sources contain α-Gal, but the amount differs. The objective of this study was to investigate the allergenic potency of various foods of mammalian origin among AGS patients.

Methods: Twenty-six AGS patients were included. Food extracts from innards, lean meats, processed meat products, milk, and whey were analyzed. Immunoblot, ELISA, immunofluorescence, and basophil activation test were used to determine the α-Gal content, characterize IgE binding, and assess foods' allergenicity.

Results: The determined amount of α-Gal, IgE reactivity to food extracts, and food extract potencies to activate patients' basophils correlated well with each other. Pork and beef kidney showed the highest allergenicity. Beef liver and bacon showed allergenicity comparable to that of lean meats. Game meat seemed to have a higher allergenic potency than meats from farm-raised animals. The processed meat products liver pâté and black pudding, despite lower α-Gal content, demonstrated moderate allergenicity. Milk showed the lowest allergenicity. IgE reactivity to food extracts was highly similar for all patients and strongly dominated by the α-Gal epitope.

Conclusions: The allergenic potency of mammalian meat depends on the origin of the meat, the different cuts, and type of processing, with innards posing the greatest risk to AGS patients. Even processed mammalian meat constitutes a risk. Dairy products show the lowest risk. This study highlights the importance of analyzing even more foods to improve the management of AGS.

Keywords: allergenic potency; basophil activation; milk; pork kidney; α‐Gal syndrome.

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Conflict of interest statement

MvH has received lecture fees from Thermo Fisher Scientific and Astra Zeneca outside the submitted work. The rest of the authors report no conflict of interest.

Figures

FIGURE 1
FIGURE 1
IgE binding to food extracts among 23 AGS patients. (A) IgE binding to α‐Gal‐containing food extracts in direct ELISA. The results are presented as OD values at 450 nm. (B) AGS patients' IgE binding to deglycosylated food extracts. Food extracts were enzymatically deglycosylated in‐plate using green coffee bean α‐galactosidase and patients' IgE binding was subsequently determined.
FIGURE 2
FIGURE 2
Immunoblot analysis of food extracts. Detection of α‐Gal‐bearing proteins using the murine anti‐α‐Gal antibody (M86).
FIGURE 3
FIGURE 3
Detection of α‐Gal in foods of mammalian origin. (A) Determination of α‐Gal content in food extracts by ELISA using the murine anti‐α‐Gal antibody (M86). (B) Representative images of foods cryosections stained with M86 (green). (C) Estimation of α‐Gal content in the whole food cryosections by immunofluorescence staining represented as mean of the arithmetic mean intensity of the M86 staining ± SD, n = 6 for pork kidney, beef kidney and bacon, and n = 3 for all other foods.
FIGURE 4
FIGURE 4
Inhibition ELISA. (A) Inhibition of patients' IgE binding to α‐Gal‐HSA by food extracts. Serum pool or individual sera were pre‐incubated with three‐fold dilutions of food extracts and remaining α‐Gal‐specific IgE binding was determined. Percentage inhibition of IgE binding in relation to the concentration of the inhibitors is shown. (B) Correlation between food extract potencies to inhibit α‐Gal‐specific IgE binding (expressed as median IC50 values) and content of α‐Gal in food extracts.
FIGURE 5
FIGURE 5
Percentage of CD63+ basophils among three AGS patients activated by three‐fold serial dilutions of 14 food extracts. The results are presented as median with range.
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