The online version of this article (doi:10.1186/1476-7961-10-5) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
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)12948_2011_105_MOESM1_ESM.DOC
Additional file 2:Table 2. Meat Allergy Types and Features. (DOC 25 KB)12948_2011_105_MOESM2_ESM.DOC
Additional file 3:Table 3. Diagnostic features of alpha-gal-related food allergy. (DOC 50 KB)12948_2011_105_MOESM3_ESM.DOC
Additional file 4:Table 4. Summary of reported cases with alpha-gal allergy in USA and Europe. (DOC 41 KB)12948_2011_105_MOESM4_ESM.DOC
Additional file 5:Table 5. Acute Management and Prevention of Anaphylaxis*. (DOC 31 KB)12948_2011_105_MOESM5_ESM.DOC
Authors’ original file for figure 112948_2011_105_MOESM6_ESM.jpeg
Authors’ original file for figure 212948_2011_105_MOESM7_ESM.jpeg
Authors’ original file for figure 312948_2011_105_MOESM8_ESM.jpeg
Authors’ original file for figure 412948_2011_105_MOESM9_ESM.jpeg
Authors’ original file for figure 512948_2011_105_MOESM10_ESM.jpeg
Authors’ original file for figure 612948_2011_105_MOESM11_ESM.pdf
Food allergies and food intolerances. Both are on the rise--and it's important to know the difference. Harv Womens Health Watch. 2011, 18 (9): 4-6.
Kurowski K, Boxer RW: Food allergies: detection and management. Am Fam Physician. 2008, 77 ( 12): 1678-1686. PubMed
Theler B, Brockow K, Ballmer-Weber BK: Clinical presentation and diagnosis of meat allergy in Switzerland and Southern Germany. Swiss Med Wkly. 2009, 139 (17-18): 264-270. PubMed
Fuentes AV, Sanchez MI, Perez MA, Baeza ML, de Barrio FM: Allergy to mammal's meat in adult life: immunologic and follow-up study. J Investig Allergol Clin Immunol. 2005, 15 ( 3): 228-231.
Savi E, Rossi A, Incorvaia C: Cat-pork syndrome: a case report with a thee years follow-up. Eur Ann Allergy Clin Immunol. 2006, 38 ( 10): 366-368. PubMed
Drouet M, Sabbah A, Le SJ: Fatal anaphylaxis after eating wild boar meat in a patient with pork-cat syndrome. Allerg Immunol (Paris). 2001, 33 ( 4): 163-165.
Couturier P, Basset-Stheme S, Sainte-Laudy J: [Pork-cat syndrome in a 16-month-old child]. Allerg Immunol (Paris). 1999, 31 (2): 60.
Drouet M, Sabbah A: The pork/cat syndrome or crossed reactivity between cat epithelia and pork meat. Monogr Allergy. 1996, 32: 164-173. PubMed
Drouet M, Lauret MG, Sabbah A: [The pork-cat syndrome: effect of sensitization to cats on sensitization to pork meat. Apropos of a case]. Allerg Immunol (Paris). 1994, 26 ( 8): 305-306.
Drouet M, Lauret MG, Sabbah A: [The pork-cat syndrome: effect of sensitivity to cats on that to pork meat. Based on an observation]. Allerg Immunol (Paris). 1994, 26 ( 7): 261-262.
Sabbah A, Rousseau C, Lauret MG, Drouet M: The pork-cat syndrome: RAST inhibition test with Feld One. Allerg Immunol (Paris). 1994, 26 ( 7): 259-260.
Drouet M, Boutet S, Lauret MG: The pork-cat syndrome or crossed allergy between pork meat and cat epithelia (1). Allerg Immunol (Paris). 1994, 26 ( 5): 166-168. 171-172.
Van Nunen SA, O'Connor KS, Clarke LR, Boyle RX, Fernando SL: An association between tick bite reactions and red meat allergy in humans. Med J Aust. 2009, 190 ( 9): 510-511. PubMed
Krishnaswamy G, Ajitawi O, Chi DS: The human mast cell: an overview. Methods Mol Biol. 2006, 315: 13-34. PubMed
Cetuximab approved by FDA for treatment of head and neck squamous cell cancer. Cancer Biol Ther. 2006, 5 (4): 340-342.
Baselga J, Pfister D, Cooper MR: Phase I studies of anti-epidermal growth factor receptor chimeric antibody C225 alone and in combination with cisplatin. J Clin Oncol. 2000, 18 ( 4): 904-914. PubMed
Argiris A, Feinstein TM, Wang L et al: Invest New Drugs: phase I and pharmacokinetic study of dasatinib and cetuximab in patients with advanced solid malignancies, 2011.
Patel D, Guo X, Ng S: IgG isotype, glycosylation, and EGFR expression determine the induction of antibody-dependent cellular cytotoxicity in vitro by cetuximab. Hum Antibodies. 2010, 19 ( 4): 89-99. PubMed
Patel DD, Goldberg RM: Cetuximab-associated infusion reactions: pathology and management. Oncology (Williston Park). 2006, 20 ( 11): 1373-1382.
Chung CH, O'Neil BH: Infusion reactions to monoclonal antibodies for solid tumors: immunologic mechanisms and risk factors. Oncology (Williston Park). 2009, 23 (2 Suppl 1): 14-17.
George TJ Jr, Laplant KD, Walden EO: Managing cetuximab hypersensitivity-infusion reactions: incidence, risk factors, prevention, and retreatment. J Support Oncol. 2010, 8 ( 2): 72-77. PubMed
Thien FC: 3. Drug hypersensitivity. Med J Aust. 2006, 185 ( 6): 333-338. PubMed
Lewis MA, Hendrickson AW, Moynihan TJ: Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin. 2011, [Epub ahead of print].
Salit RB, Bishop MR: The evolving world of tumor lysis syndrome. Oncology (Williston Park). 2011, 25 ( 4): 378-380.
Barbaud A, Granel F, Waton J, Poreaux C: How to manage hypersensitivity reactions to biological agents?. Eur J Dermatol. 2011, 21 ( 5): 667-674. PubMed
van Bueren JJ, Rispens T, Verploegen S: Anti-galactose-alpha-1, 3-galactose IgE from allergic patients does not bind alpha-galactosylated glycans on intact therapeutic antibody Fc domains. Nat Biotechnol. 2011, 29 ( 7): 574-576. 10.1038/nbt.1912 CrossRef
Miller MK: Massive tick (Ixodes holocyclus) infestation with delayed facial-nerve palsy. Med J Aust. 2002, 176 ( 6): 264-265. PubMed
- Anaphylactic Reactions to Oligosaccharides in Red Meat: a Syndrome in Evolution
- BioMed Central
Neu im Fachgebiet HNO
Mail Icon II