Alpha-gal allergy after a tick bite in Austria

Abstract

Summary Tick bites can cause the alpha-gal syndrome, which is characterized by delayed anaphylactic reactions mainly to red meat and offal due to IgE antibodies against mammalian galactose-alpha-1.3-galactose carbohydrate (alpha-gal). Ixodes ricinus bites are considered the primary cause of IgE antibody responses specific for alpha-gal in Europe. This article reports on a 51-year-old Austrian male who acquired a tick bite in Austria in spring 2017, which, within 48 h, resulted in prolonged inflammation of the skin area around the bite. The patient experienced an allergic reaction 3 months later approximately 8 h after eating a medium rare steak for dinner. The symptoms included an itchy rash on both sides of the torso and on both arms which persisted for several hours. In spring 2018, the patient suffered another tick bite. The patient’s skin reaction was similar to that of the previous year. In the following months, the patient experienced five episodes of severe allergic reactions, each during the night after having eaten beef for dinner. The symptoms included pruritic urticarial rash involving the entire body along with swollen hands, diarrhea, vomiting and in some episodes even shortness of breath. At the request of the patient, specific IgE antibodies against alpha-gal were determined, revealing a highly positive result (>100 kU/l). This brief report aims to raise awareness that recurrent delayed anaphylactic reactions to food can develop after tick bites.

Alpha-gal syndrome: the first report in Poland

“…Extended interviews with patients with a history of alpha-gal hypersensitivity revealed that previous exposure to a tick bite might have been the causative factor [ 4 - 6 ]. This association was confirmed by subsequent studies [ 7 ].…”

“…On the other hand, the delayed onset of a food-induced alpha-gal allergic reaction might potentially be explained by the difference in time needed for the epitope-rich molecules to reach the bloodstream. The digestion of alpha-gal-rich glycoproteins and glycolipids, together with their resorption in chylomicrons and very low-density lipoproteins, may take quite a long time [ 4 ]. Therefore, the first symptoms of red meat allergy may develop even several hours after consumption (ranging from 3 to 7 hours).…”

“…It is also postulated to use new multiplexed methods such as the FABER test for this purpose [ 17 ]. The use of skin prick tests is not recommended, as they are not considered reliable [ 4 ]. Although various commercially available meat extracts are used in diagnostic workup, they may provide false-negative results [ 3 ].…”

“…The syndrome was first described in 2008 in the Southeastern United States and causally linked to bites from ticks [1]. Subsequently, there have been case reports in Australia, South Africa, Asia (Japan, South Korea), and in a few European countries (e.g., Sweden, Norway, France, Italy, Spain, Germany, Switzerland, and Austria) [1][2][3][4][5][6]. However, to our best knowledge, no cases have been reported so far in Central-Eastern Europe.…”

Unknown biological materials brought to the emergency department

“…In this study, we saw that 35.6% of the creatures brought to the emergency department had been brought for removal from the body (87% of them were ticks). Tick bites cause many serious diseases including allergic reactions, Lyme disease, and Crimean-Congo hemorrhagic fever 10 , 11 ) . Therefore, requests to remove creatures stuck to any part of the body are natural.…”