Reviews and feature articleAnaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant
Section snippets
Role in producing clinical symptoms
The study of glycosylation on proteins as a target for IgE in relation to food antigens began in the 1970s when a Japanese group reported the structure of a protease from pineapple stem.3 It was subsequently shown that this protease, bromelain, carried an oligosaccharide with 2 structural features that had not been found in mammalian glycoproteins: core α1,3-fucose and xylose (Fig 1). In fact, xylose and core-3–linked fucose might be the most common carbohydrate epitopes recognized by human IgE
Prior evidence
As discussed, although IgE antibody to CCDs is known to be common, until recently, the clinical data were almost uniformly negative. Thus although patients are exposed to plant products (either inhaled or oral) that carry a CCD to which they have IgE antibodies, they do not report symptoms. In addition, investigation of sera from patients in Europe with chronic urticaria did not identify a significant number of cases with IgE antibodies to plant-derived CCDs (Rob Aalberse, personal
Evidence related to ticks
A recent report on 25 patients from Sydney, New South Wales, documents an association between tick bite reactions and red meat allergy.21 These 25 patients reported clinical reactions ranging from urticaria to anaphylaxis, and 10 (40%) of the 25 patients reported a delayed onset of 4 hours or longer after ingestion of mammalian meat.21 In this report from Australia by Van Nunen et al,21 nearly all of the patients described large local reactions to tick bites. Likewise, greater than 90% of
Commentary and future work
Although the oligosaccharide α-gal has only recently been recognized as a target for IgE antibodies, it has long been recognized as a significant factor in transplant immunology. In the 1930s, Karl Landsteiner recognized the existence of a blood group B–like substance on mammalian cells, which was the target of agglutinating antibodies in human sera. This substance was probably α-gal because blood group B antigen and the α-gal epitope differ only in that blood group B antigen has a
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Disclosure of potential conflict of interest: T. A. E. Platts-Mills has received research support from ImClone and Phadia. S. P. Commins has declared that he has no conflict of interest.