Anaphylaxis after vaccination in a pediatric patient: further implicating alpha-gal allergy

Stone, Cosby A.; Commins, Scott P.; Choudhary, Sunil K.; Vethody, Chandra; Heavrin, Jill L.; Wingerter, Jared; Hemler, Jonathan A.; Babe, Kenneth S.; Phillips, Elizabeth; Norton, Allison E.

doi:10.1016/j.jaip.2018.06.005

Cited by 55 publications

(32 citation statements)

References 7 publications

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“…Alpha-gal allergy has been associated with other medications and medical products, besides thyroid replacement medications (Table 3) (13)(14)(15)(16)(17)(18)(19). The correct diagnosis of an alpha-gal allergy starts with a good history; making sure to ask about tick exposure and delayed reactions to nonprimate mammalian meat, gelatin injections, or heavy creams, and then likely includes an anti-alpha-gal IgE immunoassay and/or skin prick testing (15).…”

Section: Discussionmentioning

confidence: 99%

“…Cetuximab (13) a Heparin (14) Intravenous colloids (15) Vaccinations, specifically MMR, varicella, DTaP, DTaP/IPV, and live attenuated herpes zoster (16,17) Prosthetic heart valves that are animal derived (18) Antivenom (19) Abbreviations: DTaP = diphtheria, tetanus, and pertussis; DTaP/IPV = diphtheria, tetanus, and pertussis, and polio; MMR = measles, mumps, and rubella. a Numbers in brackets refer to references listed at the end of the manuscript.…”

Section: Table 3 Common Drugs/agents Associated With Alpha-gal Allergmentioning

confidence: 99%

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A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism

Slayden

Shakir

Hoang

2020

AACE Clinical Case Reports

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Objective: The galactose-alpha-1,3-galactose (alpha-gal) allergy, an IgE-mediated response to nonprimate meat, has a singular pathogenesis linked to tick bites and a delayed allergic presentation, which makes it especially cumbersome to diagnose and manage. As a large array of enteral medications contain ingredients derived from meat byproducts, this can affect the care of alpha-gal patients across multiple medical disciplines. Our objective is to present a patient with an alpha-gal allergy, which can complicate hypothyroidism treatment selection. Methods: In this case of difficulty tailoring thyroid replacement therapy secondary to the alpha-gal allergy, the diagnostic studies included IgE immunoassays for alpha-gal as well as thyroid function tests. Results: A 45-year-old woman with postoperative hypothyroidism and a history of an alpha-gal allergy (diagnosed after an anaphylactic reaction to beef) could not be immediately started on any common thyroid hormone replacement formulation because of our concern regarding the possible presence of nonprimate mammalian meat byproduct components in the thyroid hormone medication. After consulting allergy and immunology specialists and compounding pharmacists and contacting multiple drug companies in an effort to confirm the nature of the inactive ingredients in their thyroid hormone products, she was prescribed a plant-based compounded levothyroxine preparation with good clinical results. Conclusion: This case emphasizes the importance of recognizing various risk factors and common drugs which may be associated with the alpha-gal allergy. It is not known how to best tailor enteral medications for patients with an alpha-gal allergy. Further research and pharmaceutical attention to this allergy are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Table 3 Common Drugs/agents Associated With Alpha-gal Allergmentioning

confidence: 99%

A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism

Slayden

Shakir

Hoang

2020

AACE Clinical Case Reports

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“…Sensitized subjects can react to all the products containing Alpha-gal . Recently, this was described in an episode of anaphylaxis after vaccination containing gelatin was given to a sensitized pediatric patient [137].…”

Section: Mammalian Meatmentioning

confidence: 99%

Component-Resolved Diagnosis in Food Allergies

Calamelli¹,

Liotti²,

Beghetti

et al. 2019

Medicina

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Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.

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“…Both varicella and MMR vaccines contain significant quantities of gelatine (per dose: 12,500 mg in 0.5 mL and 14,500 mg in 0.5 mL, respectively). Moreover, DTaP/IPV, MMR, and varicella vaccines also include bovine serum ingredient in unreported amounts [47].…”

Section: Risk Of Ige-mediated Allergy To Gelatinecontaining Vaccines In α-Gal Syndromementioning

confidence: 99%

“…The α-Gal is not expressed in the human tissues, therefore this epitope is highly immunogenic. In all nonimmunocompromised human subjects, IgG antibodies against α-Gal are present, their continuous production being a response to intestinal bacteria expressing α-Gal [6,18,23,24,46,47,52,57]. The α-Gal molecule is present in considerable amounts in red meat, such as pork, beef, mutton, horse and offal (e.g.…”

Section: Introductionmentioning

confidence: 99%

DRUG ALLERGIES DUE TO IgE SENSITIZATION TO α-GAL

Popescu¹

2019

FARMACIA

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Serum specific IgE antibodies for non-primate mammalian carbohydrate galactose-α-1,3-galactose (α-Gal) are associated to α-Gal syndrome: delayed allergy to red meat manifested as anaphylaxis, angioedema or urticaria after ingestion of beef, pig or lamb meat, immediate-onset anaphylaxis at first parenteral exposure to drugs significantly containing α-Gal. IgE-mediated drug allergy in the α-Gal syndrome was reported for some therapeutic monoclonal antibodies, such as cetuximab, snake antivenom, and varicella-zoster vaccine, but there are risks also for colloid plasma volume substitutes, vaccines containing gelatine of porcine/bovine animal origin as an excipient, and drugs with porcine pancreatin or bovine-origin magnesium stearate. RezumatAnticorpii IgE specifici serici pentru carbohidratul galactoză-α-1,3-galactoză (α-Gal) al mamiferelor non-primate sunt asociați cu sindromul α-Gal: alergie tardivă la carnea roșie manifestată ca anafilaxie, angioedem sau urticarie după ingerarea de carne de vită, porc sau miel, anafilaxie imediată la prima expunere parenterală la medicamente care conțin în mod semnificativ α-Gal. Alergia mediată de IgE la medicamente în sindromul α-Gal a fost raportată pentru anumiți anticorpi monoclonali terapeutici, cum ar fi cetuximabul, antiveninul de șarpe și vaccinul varicelo-zosterian, dar există riscuri și pentru substituenții plasmatici coloidali de volum, vaccinuri care conțin gelatină de origine animală porcină/bovină ca excipient și medicamente cu pancreatină porcină sau stearat de magneziu de origine bovină.

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Anaphylaxis after vaccination in a pediatric patient: further implicating alpha-gal allergy

Cited by 55 publications

References 7 publications

A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism

A Bull in a Pill Shop: Alpha-Gal Allergy Complicating Treatment Options for Postprocedural Hypothyroidism

Component-Resolved Diagnosis in Food Allergies

DRUG ALLERGIES DUE TO IgE SENSITIZATION TO α-GAL

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