Mammalian meat allergy emerges after tick bite: the alpha-gal syndrome

Alpha-gal syndrome (AGS) is a hypersensitivity reaction to mammalian meat that develops after tick bite exposure. AGS was first described in 2009 and testing for the allergy has become available in the last decade. We report the case of a 56-year-old farmer with a history of frequent lone star tick bites who presented with a 7-year history of diffuse urticaria occurring hours after eating red meat. AGS is likely underdiagnosed because of the unusual presentation of the allergy, historic lack of available testing, and deficiency of physician knowledge about the condition. Recognition of AGS is important both to help alleviate symptom burden and to avoid iatrogenesis. Patients with AGS should not receive products containing mammalian products, such as cat-gut suture, porcine-derived heart valves, and bovine-derived vaccines. Patients with AGS may present in a variety of clinical environments and physicians of all kinds should be able to recognise the symptoms.

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Non-infectious illness after tick bite

Microbiology Australia ◽

10.1071/ma18066 ◽

2018 ◽

Vol 39 (4) ◽

pp. 212 ◽

Cited By ~ 1

Author(s):

Miles H Beaman

Keyword(s):

Infectious Complications ◽

Tick Bite ◽

Tick Bites ◽

Meat Allergy ◽

Infectious Illness ◽

Local Reactions ◽

Mammalian Meat ◽

Tick Paralysis

Tick bites are common and may have non-infectious complications. Reactions range from local reactions to systemic syndromes, tick paralysis, mammalian meat allergy and tick anaphylaxis. Management revolves around prevention with vector avoidance and immediate removal of the tick if bitten. Treatment of bite reactions is usually symptomatic only with anti-histamines or corticosteroids. Adrenaline may be indicated for severe cases.

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Mammalian meat allergy following a tick bite: a case report

Oxford Medical Case Reports ◽

10.1093/omcr/omx098 ◽

2018 ◽

Vol 2018 (2) ◽

Cited By ~ 7

Author(s):

W Landon Jackson

Keyword(s):

Case Report ◽

Tick Bite ◽

Meat Allergy ◽

Mammalian Meat

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Tick Bites Induce Anti-α-Gal Antibodies in Dogs

Vaccines ◽

10.3390/vaccines7030114 ◽

2019 ◽

Vol 7 (3) ◽

pp. 114 ◽

Cited By ~ 2

Author(s):

Adnan Hodžić ◽

Lourdes Mateos-Hernández ◽

Michael Leschnik ◽

Pilar Alberdi ◽

Ryan Rego ◽

...

Keyword(s):

Enzyme Linked Immunosorbent Assay ◽

Tick Bites ◽

Gene Encoding ◽

Meat Allergy ◽

Organ Rejection ◽

Specific Igg ◽

Functional Inactivation ◽

Underlying Mechanisms ◽

Mammalian Meat ◽

Pathogenic Agents

Due to the functional inactivation of the gene encoding for the enzyme that is involved in the oligosaccharide galactose-α-1,3-galactose (α-Gal) synthesis, humans and Old-World primates are able to produce a large amount of antibodies against the glycan epitope. Apart from being involved in the hyperacute organ rejection in humans, anti-α-Gal antibodies have shown a protective effect against some pathogenic agents and an implication in the recently recognized tick-induced mammalian meat allergy. Conversely, non-primate mammals, including dogs, have the ability to synthetize α-Gal and, thus, their immune system is not expected to naturally generate the antibodies toward this self-antigen molecule. However, in the current study, we detected specific IgG, IgM, and IgE antibodies to α-Gal in sera of clinically healthy dogs by an indirect enzyme-linked immunosorbent assay (ELISA) for the first time. Furthermore, in a tick infestation experiment, we showed that bites of Ixodes ricinus induce the immune response to α-Gal in dogs and that the resulting antibodies (IgM) might be protective against Anaplasma phagocytophilum. These findings may help lead to a better understanding of the underlying mechanisms involved in mammalian meat allergy and tick-host-pathogen interactions, but they also open up the question about the possibility that dogs could develop an allergy to mammalian meat after tick bites, similar to that in humans.

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A novel Australian tick Ixodes (Endopalpiger) australiensis inducing mammalian meat allergy after tick bite

Asia Pacific Allergy ◽

10.5415/apallergy.2018.8.e31 ◽

2018 ◽

Vol 8 (3) ◽

Cited By ~ 17

Author(s):

Mackenzie Kwak ◽

Colin Somerville ◽

Sheryl van Nunen

Keyword(s):

Tick Bite ◽

Meat Allergy ◽

Mammalian Meat

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Mammalian Meat Allergy Accompanied by Venom Allergy: A Review of 12 Cases

Iranian Journal of Allergy Asthma and Immunology ◽

10.18502/ijaai.v18i5.1928 ◽

2019 ◽

Author(s):

Ali Kutlu ◽

Derya Unal

Keyword(s):

Black Sea ◽

Specific Ige ◽

The Black Sea ◽

Venom Allergy ◽

Black Sea Region ◽

Meat Allergy ◽

Prick Test ◽

Increased Risk ◽

History Of ◽

Mammalian Meat

There has recently been an increase in mammalian meat allergy (MMA) in the Black Sea Region of Turkey. It has been associated with the expansion of tick populations.Tick bites appear to result in sensitization to the carbohydrate allergen galactose-alpha–1, 3-galactose, which is present in many types of mammalian meats. In this study, we have emphasized that Ixodes ricinus named tick type which is implicated in meat allergy, is found in domestic animals of Black Sea Region of Turkey. A new concept has been recently raized; suggesting that having an alpha-gal allergy is associated with an increased risk of sensitization to multiple venom spesific immunoglobulin (Ig) E. Our aim is to evaluate the clinical characteristics of adult patients with MMA and its relationship with insect sting reactions in Turkey. Patients referring to the allergy outpatient clinic with possible MMA were interviewed regarding reactions to a stinging insect. Demographic features and detailed histories of the patients were recorded. Skin prick test (SPT) with commercial beef extract and venom allergens, as well as prick to prick tests with raw beef and cooked beef were performed. Serum total IgE and beef meat specific IgE were measured. Of 50 interviewed patients, 12 patients (4 male [33,3%] and 8 female [66,6%]) had a history of venom hypersensitivity reaction. The mean age was 36.50±13.35 years (range:18–61). History of other allergic diseases was present in 8 (66.6%) patients. Both venom and meat allergy were confirmed with SPT or prick to prick tests in these 12 patients. Among these patients sensitization to honey bee venom was more frequent (83%). MMA and venom allergy are influenced by the same environmental exposures. We believe that there may be shared immunologic factors and similar antigens; making venom allergic patients more susceptible to MMA.

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Alpha-gal Allergy in a 6-Year-Old Male: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.4557 ◽

2019 ◽

Vol 57 (219) ◽

Author(s):

Masanosuke Kinoshita ◽

Samuel Newton

Keyword(s):

Immunoglobulin E ◽

Past History ◽

Meat Products ◽

Amblyomma Americanum ◽

Tick Bites ◽

Delay In Diagnosis ◽

Delayed Onset ◽

History Of ◽

Mammalian Meat ◽

Pork Consumption

Alpha-gal allergy is a reaction where the immunoglobulin E antibody elicits a response to galactosealpha-1,3-galactose (alpha-gal) which is a mammalian oligosaccharide epitope found in nonprimate mammalian. After being exposed to a tick bite, particularly the Lone Star tick (Amblyomma americanum), an individual has been known to develop an alpha-gal allergy. Our patient presented with symptoms of delayed-onset allergy 3-8 hours after consuming mammalian meat products including beef and pork. These symptoms can include, but not limited to, the following: urticaria, angioedema, anaphylaxis, nausea, diarrhea, indigestion. Since symptoms do not present immediately, a delay in diagnosis can occur. Our patient highlights one of the few reported childhood cases with an alpha-gal allergy. We recommend a careful history, in particular, asking if the patient has a past history of tick bites and the appearance of allergy symptoms following beef or pork consumption.

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Delayed urticaria or anaphylaxis after consumption of red meat with evidence of alpha-gal sensitisation

BMJ Case Reports ◽

10.1136/bcr-2020-236923 ◽

2020 ◽

Vol 13 (12) ◽

pp. e236923

Author(s):

Maria Beatriz Garcia ◽

Andres F Gomez-Samper ◽

Elizabeth Garcia ◽

Augusto Peñaranda

Keyword(s):

Latin America ◽

Red Meat ◽

Amblyomma Americanum ◽

Food Allergies ◽

Tick Bites ◽

Ige Antibodies ◽

Meat Allergy ◽

Red Meat Allergy ◽

History Of

Food allergies to red meat, specifically to galactose-alpha-1,3-galactose (alpha-gal), a mammalian oligosaccharide, are considered to be very rare, especially in Asia and Latin America. Most of the cases reported are characterised by symptoms of delayed urticaria or anaphylaxis after the consumption of red meat. Sensitisation to red meat has been linked to the use of cetuximab or tick bites, especially from the Amblyomma americanum and Ixodes spp species. Here, we documented a case study from a Colombian male patient with symptoms of delayed urticaria and anaphylaxis with a history of tick bites in Colombia. The patient presented with IgE antibodies specific to alpha-gal, which is the most common epitope linked to red meat allergy induced by tick bites.

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Outcomes of Multidisciplinary Care for Pediatric Post-Concussive Symptoms

Neurology ◽

10.1212/01.wnl.0000581004.98313.0c ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S18.1-S18

Author(s):

Jillian O’Neil ◽

Sean Rose ◽

Ashley Davidson ◽

Kathleen Shiplett ◽

Anthony Castillo ◽

...

Keyword(s):

Aerobic Exercise ◽

Psychological Intervention ◽

Multidisciplinary Treatment ◽

Symptom Burden ◽

Multidisciplinary Care ◽

Exercise Session ◽

Symptom Improvement ◽

Final Visit ◽

Post Injury ◽

History Of

ObjectiveTo evaluate the effectiveness of a multidisciplinary treatment approach for adolescents experiencing prolonged recovery from concussion.BackgroundAlthough most youth recover from a concussion within 2–4 weeks, an estimated 14% of those injured remain symptomatic at 3 months post-injury. For those experiencing protracted recovery, the 2017 Berlin Concussion in Sport Group Consensus Statement recommends multidisciplinary collaborative care. While recent research utilizing progressive aerobic exercise among adolescents with concussion has shown promise for reduction in symptom burden, limited evidence exists for multidisciplinary care.Design/MethodsParticipants included 39 adolescents (77% female, 87% Caucasian) referred to the Nationwide Children’s Hospital Complex Concussion Clinic. All patients included had persistent (≥30 days post-injury) post-concussion symptoms (SCAT-5 symptom score ≥10). The sample ranged in age from 11-20 years (mean = 15.0, SD = 2.0) and median days since injury was 60 (range = 30–161). 31% of participants had a history of one or more previous concussions, 54% had a history of anxiety or depression, and 26% had a history of ADHD or a learning disorder. The multidisciplinary treatment included sessions with Neurology (mean number of sessions = 2.5), Neuropsychology (mean = 2.1), Physical Therapy (mean = 3.6), and Athletic Training sessions involving graded physical exercise (mean = 4.0), with an average treatment duration of 57.4 days. SCAT-5 symptom rating scales were completed at each visit.ResultsSymptom burden among participants significantly decreased between their initial visit (mean = 49.6, SD = 19.2) and final exercise session (mean = 12.8, SD = 14.1); p < 0.001. Gender did not predict symptom ratings at treatment onset, though males (mean = 5.6) had significantly lower symptom scores than females (mean = 15.0) at their final visit (p < 0.05). Demographic factors and premorbid psychological history did not predict rate of symptom improvement.ConclusionsHigh rates of premorbid psychological problems are evident in children referred for treatment of PCS. Multidisciplinary care involving graded aerobic exercise and psychological intervention shows promise, though specific factors associated with treatment response remain to be elucidated.

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Lyme Disease: Acute Focal Meningoencephalitis in a Child

PEDIATRICS ◽

10.1542/peds.82.6.931 ◽

1988 ◽

Vol 82 (6) ◽

pp. 931-934

Author(s):

HENRY M. FEDER ◽

EDWIN L. ZALNERAITIS ◽

LOUIS REIK

Keyword(s):

Nervous System ◽

Case Report ◽

Lyme Disease ◽

Signs And Symptoms ◽

Brain Parenchyma ◽

Tick Bite ◽

System Involvement ◽

History Of ◽

Csf Pleocytosis ◽

The Brain

Nervous system involvement in Lyme disease was originally described as meningitis, cranial neuritis, and radiculoneuritis,1-3 but Lyme disease can also involve the brain parenchyma. We describe a child whose first manifestation of Lyme disease was an acute, focal meningoencephalitis with signs and symptoms such as fever, headache, slurred speech, hemiparesis, seizure, and CSF pleocytosis. CASE REPORT A 7-year-old boy was hospitalized Aug 27, 1985, because of hemiparesis. Six weeks prior to admission he had vacationed at Old Lyme, CT. There was no history of rash or tick bite. He had been well until eight hours prior to admission when fever and headache developed.

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