Delayed mammalian meat–induced anaphylaxis due to galactose-α-1,3-galactose in 5 European patients

SummaryIn the last decade, a novel type of food allergy presenting with severe allergic reactions several hours a er consumption of red meat has been recognized.e allergic responses are due to IgE antibodies directed against the carbohydrate epitope galactose-α-1,3-galactose (α-Gal) found in mammalian meat.is review presents the red meat allergy syndrome in Sweden, discusses the features of the immune response to carbohydrates, and highlights the presence of heat stable α-Gal-containing proteins in meat.e number of diagnosed red meat allergy cases in Sweden has increased signi cantly over the past few years. All patients have been tick bitten. Our recent work has shown that α-Gal is present in the Euro pean tick Ixodes ricinus (I. ricinus), thus potentially explaining the strong association between anti-α-Gal IgE and tick bites, with development of red meat allergy as a secondary phenomenon. Further studies using immunoproteomics have identi ed novel α-Gal-containing meat proteins that bound IgE from red meat allergic patients. Four of these proteins were stable to thermal processing pointing to the fact that the allergenicity of red meat proteins is preserved in cooked meat. In keeping with the fact that the α-Gal epitope is structurally related to the blood group B antigen, a positive association with the B-negative blood groups among our red meat allergic patients was noted. A selective IgE reactivity to the pure carbohydrate moiety was observed when investigating the speci city of the α-Gal immune response. IgE from red meat allergic patients does not recognize the other major mammalian carbohydrate, N-glycolylneuraminic acid (Neu5Gc), also present in high amounts in red meat. Furthermore, neither common cross-reactive carbohydrate determinants (CCDs) from plants nor venoms are targets of the IgE response in these patients.Taken together, the α-Gal carbohydrate has shown to be a potentially clinically relevant allergen that should be taken into account in the diagnosis of food allergy. Many new ndings in the eld of red meat allergy have been obtained during the past years, but further e orts to understand the process of digestion, absorption, and delivery of α-Gal-containing molecules to the circulation are needed. e red meat allergy syndrome in Sweden. Allergo Cite this as

show abstract

“…In Europe, a history of tick bites had been reported in four of ve patients from Northern Spain with IgE antibodies to α-Gal [12].…”

Section: Association With Tick Bitesmentioning

confidence: 99%

The red meat allergy syndrome in Sweden

Apostolović¹,

Tran²,

Starkhammar³

et al. 2016

Allergo J

View full text Add to dashboard Cite

show abstract

“…Commins et al [38] presented evidence that tick bites are possibly the only cause of anti-Gal IgE antibody production. A correlation between tick bites and IgE antibodies specific for α-gal was observed in the United States, Australia [38] and Europe [39]. These anti-Gal IgE antibodies are specific not only to red meat but also to cow's milk, which might explain the previously reported sensitivity to beef in children allergic to cow's milk.…”

Section: Sialylation α-13-galactosylation and Nutritionmentioning

confidence: 83%

“Lost sugars” — reality of their biological and medical applications

Talafová¹,

Nahálka²

2012

Open Life Sciences

View full text Add to dashboard Cite

The glycan chains attached to cell surfaces or to single proteins are highly dynamic structures with various functions. The glycan chains of mammals and of some microorganisms often terminate in sialic acids or α-1,3-galactose. Although these two sugars are completely distinct, there are several similarities in their biological and medical importance. First, one type of sialic acid, N-glycolylneuraminic acid, and the galactose bound by an α-1,3-linkage to LacNAc, that forms an α-gal epitope, were both eliminated in human evolution, resulting in the production of antibodies to these sugars. Both of these evolutionary events have consequences connected with the consumption of foods of mammalian origin, causing medical complications of varying severity. In terms of ageing, sialic acids prevent the clearance of glycoproteins and circulating blood cells, whereas cryptic α-gal epitopes on senescent red blood cells contribute to their removal from circulation. The efficiency of therapeutic proteins can be increased by sialylation. Another common feature is the connection with microorganisms since sialic acids and α-gal epitopes serve as receptors on host cells and can also be expressed on the surfaces of some microorganisms. Whereas, the sialylation of IgG antibodies may help to treat inflammation, the expression of the α-gal epitope on microbial antigens increases the immunogenicity of the corresponding vaccines. Finally, sialic acids and the α-gal epitope have applications in cancer immunotherapy. N-glycolylneuraminic acid is a powerful target for cancer immunotherapy, and the α-gal epitope increases the efficiency of cancer vaccines. The final section of this article contains a brief overview of the methods for oligosaccharide chain synthesis and the characteristics of sialyltransferases and α-1,3-galactosyltransferase.

show abstract

“…Since the article in 2009 linking IgE alpha-gal to anaphylaxis from mammalian meat, 4 cases of meat-induced, delayed anaphylaxis have been reported in Texas, Georgia, South Carolina, Mississippi, Kentucky, Oklahoma, West Virginia and Spain, in addition to the original five southeast states. 1,3,9 The alpha-gal story is truly a paradigm-shifting phenomenon for three distinct reasons. First, anaphylaxis occurred with the primary exposure to the glycoprotein cetuximab.…”

Section: Discussionmentioning

confidence: 99%

A Peculiar Cause of Anaphylaxis: No More steak?

et al. 2012

View full text Add to dashboard Cite

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 (alphagal). 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. With the recent development of IgE alpha-gal tests, the clinical diagnosis can be confirmed in the laboratory.

show abstract

Delayed mammalian meat–induced anaphylaxis due to galactose-α-1,3-galactose in 5 European patients

Cited by 70 publications

References 10 publications

The red meat allergy syndrome in Sweden

The red meat allergy syndrome in Sweden

“Lost sugars” — reality of their biological and medical applications

A Peculiar Cause of Anaphylaxis: No More steak?

Contact Info

Product

Resources

About