Tolerance of porcine pancreatic enzymes despite positive skin testing in alpha-gal allergy

Stone, Cosby A.; Choudhary, Sunil K.; Patterson, Megan F.; Rukasin, Christine; Coleman, David T.; Commins, Scott P.

doi:10.1016/j.jaip.2019.12.004

Cited by 15 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alpha-gal hypersensitivity is not only associated with food-related symptoms but also other exposures including gelatin or porcine/bovine containing bioprosthetic heart valves, medications (e.g., heparin) and vaccines can elucidate symptoms [81]. However, the amount of alpha-gal that is present in certain medications and safety of them in alpha-gal allergic patients is currently unknown [82].…”

Section: Alpha-gal Allergymentioning

confidence: 99%

IgE-mediated food allergy throughout life

Çelebioğlu¹,

Akarsu²,

Şahiner³

2021

Turk J Med Sci

View full text Add to dashboard Cite

Food allergy (FA) is an increasing problem throughout the world. In the last two decades, the frequency of FA has increased in both children and adults. The prevalence differs according to the research methodology, age and geographic regions, ranging between 2.0 to 10.0%. The most common form of FA is IgE mediated FA. In this form, patients may present with life-threatening condition as anaphylaxis or milder conditions like urticaria, angioedema, sneezing and nausea alone. The gold standard in the diagnosis of FA is oral provocation tests. Epidermal skin prick tests and specific IgE measurements as well as component resolved diagnostic techniques are helpful in the diagnosis and follow-up of patients. In this review, the epidemiology, diagnosis, follow-up and prognosis of Ig-E mediated FA in children and adults are discussed and some specific forms of FA such as pollen food allergy syndrome, alpha-gal allergy and food dependent exercise induced anaphylaxis are explained.

show abstract

Section: Alpha-gal Allergymentioning

confidence: 99%

IgE-mediated food allergy throughout life

Çelebioğlu¹,

Akarsu²,

Şahiner³

2021

Turk J Med Sci

View full text Add to dashboard Cite

show abstract

“…Similar to previously reported studies, we show that alpha-gal continues to be present in Zenpep, Pancreatin, Armour Thyroid, and EnteraGam. 34 , 35 Furthermore, these all interact with AGS serum and may lead to adverse reactions clinically. This is important because medications are harder to selectively avoid and symptoms may be inappropriately attributed to patients’ underlying medical issue (eg, pancreatitis, inflammatory bowel, or hypothyroid).…”

Section: Discussionmentioning

confidence: 99%

Allergic response to medical products in patients with alpha-gal syndrome

Kuravi

Sorrells²,

Nellis³

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

Self Cite

View full text Add to dashboard Cite

Background: Galactose-a-1,3-galactose (alpha-gal) is a carbohydrate that is ubiquitously expressed in all mammals except for primates and humans. Patients can become sensitized to this antigen and develop alpha-gal syndrome (AGS), or a red meat allergy. Symptoms range from generalized gastroenteritis and malaise to anaphylaxis, and in endemic areas, the prevalence can be as high as 20%. Although AGS patients commonly avoid alpha-gal by avoiding meat, patients have also developed symptoms due to animal-derived medical products and devices. With the rise in transcatheter aortic valve replacement, we investigate the immunogenicity of common cardiac materials and valves.Objective: To assess the in vitro immunoglobulin E response toward common medical products, including cardiac patch materials and bioprosthetic valves in patients with AGS.Methods: Immunoblot and immunohistochemistry techniques were applied to assess immunoglobulin E reactivity to various mammalian derived tissues and medical products for patients with AGS.Results: AGS serum showed strong reactivity to all of the commercially available, nonhuman products tested, including various decellularized cardiac patch materials and bioprosthetic aortic valves. AGS serum did not react to tissues prepared using alpha-gal knockout pigs.Conclusions: Despite commercial decellularization processes, alpha-gal continues to be present in animal-derived medical products, including bioprosthetic valves. Serum from patients with AGS demonstrates a strong affinity for these products in vitro. This may have serious potential implications for sensitized patients undergoing cardiac surgery, including early valve failure and accelerated coronary artery disease.

show abstract

“…However, there are case reports of patients with alpha-gal syndrome who have tolerated porcine-derived pancreatic enzyme replacement therapy. 114,115 In addition, there are case reports describing both anaphylaxis 116,117 and tolerance 118 to vaccines with gelatin excipients. Thus, the general recommendation is to avoid alpha-gal-containing medications whenever possible, favoring preparations that come in tablet form rather than gelatin capsules.…”

Section: Management Of Alpha-gal Syndrome Allergic Reactions and Anap...mentioning

confidence: 99%

“…In general, patients with alpha-gal syndrome should also avoid oral medications and supplements of porcine and bovine origin such as commercially available non-FDA approved thyroid hormone supplements (Armour thyroid) and medications encased in mammal-derived gelatin capsules. However, there are case reports of patients with alpha-gal syndrome who have tolerated porcine-derived pancreatic enzyme replacement therapy . In addition, there are case reports describing both anaphylaxis and tolerance to vaccines with gelatin excipients.…”

Section: Treatment Of Patients With Food Allergiesmentioning

confidence: 99%

Management of Food Allergies and Food-Related Anaphylaxis

Iglesia,

Kwan,

Virkud

et al. 2024

JAMA

View full text Add to dashboard Cite

ImportanceAn estimated 7.6% of children and 10.8% of adults have IgE-mediated food-protein allergies in the US. IgE-mediated food allergies may cause anaphylaxis and death. A delayed, IgE-mediated allergic response to the food-carbohydrate galactose-α-1,3-galactose (alpha-gal) in mammalian meat affects an estimated 96 000 to 450 000 individuals in the US and is currently a leading cause of food-related anaphylaxis in adults.ObservationsIn the US, 9 foods account for more than 90% of IgE-mediated food allergies—crustacean shellfish, dairy, peanut, tree nuts, fin fish, egg, wheat, soy, and sesame. Peanut is the leading food-related cause of fatal and near-fatal anaphylaxis in the US, followed by tree nuts and shellfish. The fatality rate from anaphylaxis due to food in the US is estimated to be 0.04 per million per year. Alpha-gal syndrome, which is associated with tick bites, is a rising cause of IgE-mediated food anaphylaxis. The seroprevalence of sensitization to alpha-gal ranges from 20% to 31% in the southeastern US. Self-injectable epinephrine is the first-line treatment for food-related anaphylaxis. The cornerstone of IgE-food allergy management is avoidance of the culprit food allergen. There are emerging immunotherapies to desensitize to one or more foods, with one current US Food and Drug Administration–approved oral immunotherapy product for treatment of peanut allergy.Conclusions and RelevanceIgE-mediated food allergies, including delayed IgE-mediated allergic responses to red meat in alpha-gal syndrome, are common in the US, and may cause anaphylaxis and rarely, death. IgE-mediated anaphylaxis to food requires prompt treatment with epinephrine injection. Both food-protein allergy and alpha-gal syndrome management require avoiding allergenic foods, whereas alpha-gal syndrome also requires avoiding tick bites.

show abstract

Tolerance of porcine pancreatic enzymes despite positive skin testing in alpha-gal allergy

Cited by 15 publications

References 9 publications

IgE-mediated food allergy throughout life

IgE-mediated food allergy throughout life

Allergic response to medical products in patients with alpha-gal syndrome

Management of Food Allergies and Food-Related Anaphylaxis

Contact Info

Product

Resources

About