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01.12.2012 | Review | Ausgabe 1/2012 Open Access

Clinical and Molecular Allergy 1/2012

Anaphylactic Reactions to Oligosaccharides in Red Meat: a Syndrome in Evolution

Clinical and Molecular Allergy > Ausgabe 1/2012
Hana Saleh, Scott Embry, Andromeda Nauli, Seif Atyia, Guha Krishnaswamy
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7961-10-5) contains supplementary material, which is available to authorized users.

Competing Interests

The authors declare that they have no competing interests.

Authors' Contributions

HS reviewed the literature, generated references, organized the manuscript, and illustrated the figures. SE assisted with manuscript review and corrections. AN assisted in section involving mechanism of delay and role of chylomicrons. SA assisted in section involving mechanism of delay and role of chylomicrons. GK organized the manuscript, edited figures and tables, assisted in discussion, generated references, and participated in the editing and final approval of the manuscript. All authors read and approved the final manuscript.



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.


A PubMed search was conducted with MeSH terms: galactosyl-(1,3) galactose, oligosaccharides, cetuximab, allergy/hypersensitivity, and anaphylaxis. Reported cases with alpha-gal-mediated reactions were reviewed. This research study was approved by the Institutional Review Board of East Tennessee State University.


Thirty-two cases of adults presenting with red-meat induced allergy thought to be related to oligosaccharides have been reported in the literature so far, making this a rare and evolving syndrome. Most of these patients demonstrated delayed reactions to beef, as was seen in the case reported by us in this manuscript. IgE specific to alpha-gal was identified in most patients with variable response to skin testing with beef and pork. Inhibition studies in some cases showed that the IgE antibodies to beef were directed towards alpha-gal in the meat rather than the protein. The patients often reported history of tick bites, the significance of which is unclear at present. Reactions to cetuximab, a monoclonal antibody, are mediated by a similar mechanism, with IgE antibodies directed against an alpha-gal moiety incorporated in the drug structure.


Alpha-gal is an oligosaccharide recently incriminated in delayed anaphylactic reactions to mammalian meats such as to beef, pork, and lamb. It appears that anaphylactic reactions to the anti-cancer biological agent, cetuximab, may be linked mechanistically to the same process. More studies are required to understand the underlying molecular basis for these delayed reactions in specific, and their broader implications for host defense in general.
Additional file 1:Table 1. Common food allergens. (DOC 30 KB)
Additional file 2:Table 2. Meat Allergy Types and Features. (DOC 25 KB)
Additional file 3:Table 3. Diagnostic features of alpha-gal-related food allergy. (DOC 50 KB)
Additional file 4:Table 4. Summary of reported cases with alpha-gal allergy in USA and Europe. (DOC 41 KB)
Additional file 5:Table 5. Acute Management and Prevention of Anaphylaxis*. (DOC 31 KB)
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