Reviews and feature article
Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant

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Anaphylaxis is a severe allergic reaction that can rapidly progress and occasionally be fatal. In instances in which the triggering allergen is not obvious, establishing the cause of anaphylaxis is pivotal to long-term management. Assigning cause is limited, however, by the number of known exposures associated with anaphylaxis. Therefore identification of novel causative agents can provide an important step forward in facilitating new, allergen-specific approaches to management. In contrast to the view that carbohydrate-directed IgE has minimal, if any, clinical significance, recent data suggest that IgE antibodies to carbohydrate epitopes can be an important factor in anaphylaxis that might otherwise appear to be idiopathic. Here we review the evidence relating to carbohydrates in food allergy and anaphylaxis and discuss the implications of 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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  • Cited by (0)

    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.

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