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Alpha-Gal food allergy

Andreas J Bircher, Kathrin Scherer Hofmeier, Susanne Link, Ingmar Heijnen
Until recently, food allergies to mammalian meats have been considered to be very rare. The observation that patients not previously exposed to the monoclonal chimeric antibody cetuximab suffered from severe anaphylaxis upon first exposure, led to the identification of galactose-alpha-1,3-galactose as a new relevant carbohydrate allergen. These patients later often suffered from anaphylactic reactions to red meat. Epidemiological data indicated that bites by the tick Amblyomma americanum in the USA, later also by Ixodes species in other continents, resulted in sensitisation to alpha-gal...
November 21, 2016: European Journal of Dermatology: EJD
Scott P Commins
The syndrome of delayed allergic reactions to the carbohydrate galactose-alpha-1,3-galactose ("alpha-gal") has become increasingly recognized in allergy and immunology clinics regionally throughout the southeastern USA. Due to the increasing awareness of this unique food allergy, cases have been identified in the northeastern and central USA as well as in Central and South America, Europe, Asia, Scandinavia, and Australia. Clinically, alpha-gal allergy is characterized by reactions to non-primate mammalian meat (e...
September 2016: Current Allergy and Asthma Reports
Thomas A E Platts-Mills, Alexander J Schuyler, Elizabeth A Erwin, Scott P Commins, Judith A Woodfolk
Traditionally, the concept of allergy implied an abnormal response to an otherwise benign agent (eg, pollen or food), with an easily identifiable relationship between exposure and disease. However, there are syndromes in which the relationship between exposure to the relevant allergen and the "allergic" disease is not clear. In these cases the presence of specific IgE antibodies can play an important role in identifying the relevant allergen and provide a guide to therapy. Good examples include chronic asthma and exposure to perennial indoor allergens and asthma related to fungal infection...
June 2016: Journal of Allergy and Clinical Immunology
Onyinye I Iweala, A Wesley Burks
Food allergy is defined as an IgE-mediated hypersensitivity response to ingested food with allergic symptoms ranging from urticaria to life-threatening anaphylaxis. Food allergy is thought to develop because of (1) failed induction of tolerance upon initial exposure to food antigen or (2) breakdown of established tolerance to food antigen. We review current understanding of the pathogenesis, epidemiology, and natural history of food allergy, including the unconventional IgE-mediated food allergy to mammalian meat known as alpha-gal food allergy...
May 2016: Current Allergy and Asthma Reports
Scott P Commins, Maya R Jerath, Kelly Cox, Loren D Erickson, Thomas Platts-Mills
IgE-mediated hypersensitivity refers to immune reactions that can be rapidly progressing and, in the case of anaphylaxis, are occasionally fatal. To that end, identification of the associated allergen is important for facilitating both education and allergen avoidance that are essential to long-term risk reduction. As the number of known exposures associated with anaphylaxis is limited, discovery of novel causative agents is crucial to evaluation and management of patients with idiopathic anaphylaxis. Within the last 10 years several apparently separate observations were recognized to be related, all of which resulted from the development of antibodies to a carbohydrate moiety on proteins...
January 2016: Allergology International: Official Journal of the Japanese Society of Allergology
Kendall D Wagner, Matthew C Bell, Robert D Pesek, Joshua L Kennedy
Anaphylaxis and urticaria are commonly seen in both primary care and allergy clinics. Foods, drugs, and insects are frequent culprits for immediate reactions; however, the trigger for recurring and/or chronic episodes is often unclear. We present a 56-year-old male with recurrent symptoms of urticaria, angioedema, and anaphylaxis found to be triggered by sensitization to galactose-alpha 1, 3-galactose (alpha-gal), a novel food allergen.
November 2015: Journal of the Arkansas Medical Society
Thomas A E Platts-Mills, Alexander J Schuyler, Alice E W Hoyt, Scott P Commins
Hypersensitivity in the allergic setting refers to immune reactions, stimulated by soluble antigens that can be rapidly progressing and, in the case of anaphylaxis, are occasionally fatal. As the number of known exposures associated with anaphylaxis is limited, identification of novel causative agents is important in facilitating both education and other allergen-specific approaches that are crucial to long-term risk management. Within the last 10 years, several seemingly separate observations were recognized to be related, all of which resulted from the development of antibodies to a carbohydrate moiety on proteins where exposure differed from airborne allergens but which were nevertheless capable of producing anaphylactic and hypersensitivity reactions...
April 2015: Current Allergy and Asthma Reports
Atsuo Urisu, Y Kondo, I Tsuge
Egg allergy is one of the most frequent food allergies in infants and young children. The prevalence of egg allergy is estimated to be between 1.8 and 2% in children younger than 5 years of age. The reactions are mainly mediated by IgE and partially by non-IgE or are a mix of both types. Egg white contains more than 20 different proteins and glycoproteins. Ovomucoid (Gal d 1), ovalbumin (Gal d 2), conalbumin (ovotransferrin) (Gal d 3) and lysozyme (Gal d 4) have been identified as major allergens in hen's egg...
2015: Chemical Immunology and Allergy
Thanh D Dang, Clare E N Mills, Katrina J Allen
IgE-mediated egg allergy presents as one of the most common food allergies in children and is a food which is widely consumed all over the world. Measurement of egg white-specific IgE levels has been shown to be a poor predictor of clinical phenotypes of egg allergy, including to raw egg white, but particularly to baked or cooked egg. Egg white and yolk contain more than 20 different glycoproteins, including ovomucoid, ovalbumin, ovotransferrin, alpha-livetin, and the newly identified Gal d 6. Recent developments in component-resolved diagnostic technology, including microarrays, have enabled us to improve the way in which we diagnose food allergy...
November 2014: Pediatric Allergy and Immunology
Scott P Commins, Hayley R James, Whitney Stevens, Shawna L Pochan, Michael H Land, Carol King, Susan Mozzicato, Thomas A E Platts-Mills
BACKGROUND: In 2009, we reported a novel form of delayed anaphylaxis to red meat related to serum IgE antibodies to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal). Although patients were remarkably consistent in their description of a 3- to 6-hour delay between eating mammalian meat and the appearance of symptoms, this delay has not been demonstrated under observed studies. OBJECTIVES: We sought to formally document the time course of clinical symptoms after the ingestion of mammalian meat in subjects with IgE to alpha-gal and to monitor ex vivo for the appearance of markers of an allergic reaction...
July 2014: Journal of Allergy and Clinical Immunology
S Michel, K Scherer, I A F M Heijnen, A J Bircher
Severe hypersensitivity reactions to red meat with delay of several hours in patients with IgE to alpha-gal (galactose-alpha-1,3-galactose) have been reported. The diagnosis of meat allergy is difficult, because of the limited sensitivity of skin prick tests and specific IgE tests to meat extracts. These circumstances have been explained by the delayed expression of alpha-gal due to digestive processes. Because of the low sensitivity of skin prick tests to meat, we studied the possibility to perform skin prick tests with cetuximab, which carries the alpha-gal epitope...
March 2014: Allergy
D G Ebo, M Faber, V Sabato, J Leysen, A Gadisseur, C H Bridts, L S De Clerck
BACKGROUND: Recent observations have disclosed that the galactose-alpha (1,3)-galactose (alpha-gal) moiety of non-primate glycoproteins can constitute a target for meat allergy. OBJECTIVE: To describe adults with allergic reactions to mammalian meat, dairy products and gelatin. To investigate whether patients could demonstrate sensitization to activated recombinant human coagulation factor VII ectapog alpha that is produced in baby hamster kidney cells. METHODS: Ten adults with mammalian meat, dairy products and gelatin allergies were examined using quantification of specific IgE and/or skin prick test for red meat, milk, milk components, gelatin, cetuximab and eptacog alpha...
May 2013: Acta Clinica Belgica
Scott P Commins, Thomas A E Platts-Mills
PURPOSE OF REVIEW: A novel form of anaphylaxis has been described that is due to IgE antibody (Ab) directed against a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal). Ongoing work regarding the cause and distribution of this IgE response is reviewed. RECENT FINDINGS: Our recent work has identified a novel IgE Ab response that has been associated with two distinct forms of anaphylaxis: immediate-onset anaphylaxis during first exposure to intravenous cetuximab and delayed-onset anaphylaxis 3-6 h after ingestion of mammalian food products (e...
August 2013: Current Opinion in Allergy and Clinical Immunology
Susan E Wolver, Diane R Sun, Scott P Commins, Lawrence B Schwartz
In recent years, a newly recognized allergic disease has been uncovered, and seemingly idiopathic causes of anaphylaxis now have an explanation. Individuals bitten by the lone star tick may develop IgE antibodies to the carbohydrate galactose-α-1,3-galactose (alpha-gal). Upon exposure of sensitized subjects to mammalian meat containing alpha-gal on glycoproteins or glycolipids, delayed anaphylaxis may ensue, often three to six hours after ingestion.1 Many of these individuals have negative allergy skin prick tests to meat, further obscuring the diagnosis...
February 2013: Journal of General Internal Medicine
U Jappe
The association between the carbohydrate galactose-[alpha]-1,3-galactose (α-Gal) and anaphylaxis was first documented after severe hypersensitivity reactions to cetuximab, a chimeric mouse-human IgG1 monoclonal antibody approved for targeted therapy of carcinomas of colon, as well as of the head and neck region. α-Gal is a ubiquitous glycan moiety expressed on cells and tissue of non-primate mammals. Since this epitope is not expressed in humans, it is very immunogenic for them. α-Gal is located on the Fab portion of cetuximab and thus on the murine part of the chimera...
April 2012: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
Hana Saleh, Scott Embry, Andromeda Nauli, Seif Atyia, Guha Krishnaswamy
OBJECTIVE: While most allergic responses to food are directed against protein epitopes and occur within 30 minutes of ingesting the allergen, recent studies suggest that delayed reactions may occur, sometimes mediated by IgE antibodies directed against carbohydrate moieties. The objective of this review is to summarize the clinical features and management of delayed hypersensitivity reactions to mammalian meat mediated by IgE antibodies to galactose-alpha 1,3-galactose (alpha-gal), an oligosaccharide...
2012: Clinical and Molecular Allergy: CMA
Scott P Commins, Hayley R James, Libby A Kelly, Shawna L Pochan, Lisa J Workman, Matthew S Perzanowski, Katherine M Kocan, John V Fahy, Lucy W Nganga, Eva Ronmark, Philip J Cooper, Thomas A E Platts-Mills
BACKGROUND: In 2009, we reported a novel form of delayed anaphylaxis to red meat that is related to serum IgE antibodies to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). Most of these patients had tolerated meat for many years previously. The implication is that some exposure in adult life had stimulated the production of these IgE antibodies. OBJECTIVES: We sought to investigate possible causes of this IgE antibody response, focusing on evidence related to tick bites, which are common in the region where these reactions occur...
May 2011: Journal of Allergy and Clinical Immunology
L Sundman, U Saarialho-Kere, J Vendelin, K Lindfors, G Assadi, K Kaukinen, M Westerholm-Ormio, E Savilahti, M Mäki, H Alenius, M D'Amato, V Pulkkinen, J Kere, P Saavalainen
Neuropeptide S receptor 1 (NPSR1) was recently found to be genetically associated with inflammatory bowel disease in addition to asthma and related traits. Epithelia of several organs express NPSR1 isoforms A and B, including the intestine and the skin, and NPSR1 appears to be upregulated in inflammation. In this study, we used cell lines and tissue samples to characterize the expression of NPSR1 and its ligand neuropeptide S (NPS) in inflammation. We used polyclonal and monoclonal antibodies to investigate the expression of NPS and NPSR1 in intestinal diseases, such as celiac disease and food allergy, and in cutaneous inflammatory disorders...
January 2010: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Scott P Commins, Shama M Satinover, Jacob Hosen, Jonathan Mozena, Larry Borish, Barrett D Lewis, Judith A Woodfolk, Thomas A E Platts-Mills
BACKGROUND: Carbohydrate moieties are frequently encountered in food and can elicit IgE responses, the clinical significance of which has been unclear. Recent work, however, has shown that IgE antibodies to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate commonly expressed on nonprimate mammalian proteins, are capable of eliciting serious, even fatal, reactions. OBJECTIVE: We sought to determine whether IgE antibodies to alpha-gal are present in sera from patients who report anaphylaxis or urticaria after eating beef, pork, or lamb...
February 2009: Journal of Allergy and Clinical Immunology
Benedikte Jacobsen, Karin Hoffmann-Sommergruber, Tilde Thordahl Have, Nicolai Foss, Peter Briza, Christina Oberhuber, Christian Radauer, Stefano Alessandri, Andre C Knulst, Montserrat Fernandez-Rivas, Vibeke Barkholt
Egg proteins represent one of the most important sources evoking food allergic reactions. In order to improve allergy diagnosis, purified and well-characterized proteins are needed. Although the egg white allergens Gal d 1, 2, 3 and 4 (ovomucoid, ovalbumin, ovotransferrin, and lysozyme) are commercially available, these preparations contain impurities, which affect exact in vitro diagnosis. The aim of the present study was to set up further purification protocols and to extend the characterization of the physicochemical and immunological properties of the final batches...
November 2008: Molecular Nutrition & Food Research
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