ALPHA-GAL INFORMATION

A project of the Alpha-gal Syndrome              Awareness Campaign

Alpha-gal Syndrome

The Epidemic You Never Heard of

Alpha-gal syndrome (AGS), or mammalian meat allergy,  is a tick-induced allergy to galactose-α-1,3-galactose (1). This sugar, commonly known as alpha-gal, is found in all mammals except for humans and some primates (2).

 

Products made from mammals can also contain alpha-gal. These include mammalian meat (like beef, pork, and lamb), milk and dairy products, gelatin, medications, medical products (like heparin and vaccines), personal care products (like lotion and make-up), and many other items. (3)

 

Reactions, which can be life-threatening, may be immediate, as in the case of injected drugs, or delayed from 2 to 10 hours, as is typical after the consumption of  mammalian meat (1).

In the U.S.,
lone star tick bites
are thought to be the primary source of sensitization (4).

Many other ticks in other parts of the world are also associated with alpha-gal syndrome (5).

While it is a growing epidemic, there is still lack of awareness about the alpha-gal syndrome leading to delay in diagnosis and misdiagnosis. This is a great website to explore more.

Prof. Akiko Iwasaki

See Prof Iwasaki’s alpha-gal syndrome Twitter thread here.

NEWS

Tick season is here. Protect yourself!

Avoiding tick bites

A guide for people with alpha-gal syndrome

Insect Shield

Buy permethrin treated clothing from Insect Shield or have them treat you own clothes.

Tick Encounter

Learn more from the Tick Encounter’s #BeReadyforTicks resource.

TickEase Tweezers

To remove ticks safely, you need pointy-tipped (not blunt-tipped) tweezers. TickEase is a popular brand..

Have you been bitten by a tick?

Do you get sick in the middle of the night after eating red meat?

Do you have unexplained anaphylactic reactions, hives, GI issues, or arthritis?

You may have alpha-gal syndrome.

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What is Alpha-gal Syndrome?

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Symptoms

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Diagnosis and Testing

New: an ICD code for alpha-gal syndrome

2022 ICD-10-CM Diagnosis Code

Z91.014

Fast facts about
alpha-gal syndrome

 

“In this unselected cohort from central Virginia, the prevalence of a-Gal sIgE was 15.1% but self-reported mammalian meat allergy was 2.2% (7).

Richards N., et al.

“…in the southeastern United States, approximately 3% of the general population exhibits anaphylaxis after consumption of mammalian meat (6).”

Bianchi J, et al.

“In certain geographic areas and in populations with high tick exposure, the level of sensitization can be 15-35% but this does not represent clinical AGS, which appears to occur in 1-8% of sensitized individuals (3).”

Scott P. Commins, MD, PhD

“In geographic areas where tick bites are common, AGS is likely under- recognized and under-diagnosed. We suggest testing for alpha-gal IgE in tick-endemic areas as part of the evaluation for cases of idiopathic anaphylaxis, recurrent urticaria and/or angioedema, as well as recurrent, episodic gastrointestinal cramping of unestablished cause (3).”

Scott P. Commins, MD, PhD

#1

trigger of anaphylaxis in adults (8,9)*

#1

cause of adult-onset food allergy (9)*

Up to 2-3%

of some populations (3, 6, 10)*

*most of the southeastern U.S. and other populations with high tick exposure, including areas of the Midwest and much of the eastern U.S.

15-35%

of the population in the southern U.S. and large areas of the Midwest and eastern U.S. is sensitized to alpha-gal (3)

Over 34,000

The number of Americans diagnosed has risen from 12 in 2009 to over 34,000 in 2019 in the U.S. alone (11), and many more cases are thought to be undiagnosed or misdiagnosed (3).

3-8 hours

typical delay of reactions after exposure (12)

Up to 60%

of cases have anaphylactic reactions (13,14,16)

30-40%

of cases have cardiac symptoms (17)

Up to 20%

of cases have GI symptoms alone (18)

More than 20,000

drugs, vaccines and medical products contain mammalian byproducts

Hundreds

of mammalian byproducts with obscure names like oleic acid are added to foods without being labeled as derived from mammals (see the Mammalian Byproducts Database)

7 years

average time to diagnosis due to lack of physician awareness (20)

Contact alphagalinformation@gmail.com with any questions. We would be happy to provide you with more information, including references.

Learn about the GI Variant of Alpha-gal Syndrome

CME Course: Alpha-Gal Allergy as a Cause of Intestinal Symptoms in a Gastroenterology Community Practice

Immunoglobulin E to alpha-gal may be an underrecognized but frequent cause of gastrointestinal tract symptoms in eastern North America in the habitat distribution of the Lone Star tick.

Isolated GI Alpha-Gal Meat Allergy: What Clinicians Need to Know

Sarah K. McGill, MD, MSc

ACOG Virtual Grand Rounds

August 19, 2021

Newly diagnosed? Start here!

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What Do My Test Results Mean?

Management of Alpha-gal Syndrome

Alpha-gal Tolerance Levels

q

What Is Alpha-gal Found In?

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Checklist for the Newly Diagnosed

Avoiding Additional Tick Bites

GET HELP

Make an Appointment with an Expert

Find a Support Group

Patient Recommended Physicians

Find Someone Local to Talk To

LEARN MORE

Where does alpha-gal syndrome occur?

Publications Database

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References

General Overview

Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol. 2020;16(7):667-677.

Platts-Mills TAE, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and Management of Patients with the α-Gal Syndrome. J Allergy Clin Immunol Pract. 2020;8(1):15-23.e1.

Platts-Mills TAE, Commins SP, Biedermann T, et al. On the cause and consequences of IgE to galactose-α-1,3-galactose: A report from the National Institute of Allergy and Infectious Diseases Workshop on Understanding IgE-Mediated Mammalian Meat Allergy. J Allergy Clin Immunol. 2020;145(4):1061-1071.

Hilger C, Fischer J, Wölbing F, Biedermann T. Role and Mechanism of Galactose-Alpha-1,3-Galactose in the Elicitation of Delayed Anaphylactic Reactions to Red Meat. Curr Allergy Asthma Rep. 2019;19(1):3.

Specific References

1. Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123(2):426-433.

2. Galili U, Clark MR, Shohet SB, Buehler J, Macher BA. Evolutionary relationship between the natural anti-Gal antibody and the Gal alpha 1—-3Gal epitope in primates. Proc Natl Acad Sci U S A. 1987;84(5):1369-1373.

3. Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol. 2020;16(7):667-677.

4. Commins SP, James HR, Kelly LA, et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose.  J Allergy Clin Immunol. 2011;127(5):1286-1293.e6.

5. van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust. 2018;208(7):316-321.

6. Bianchi J, Walters A, Fitch ZW, Turek JW. Alpha-gal syndrome: Implications for cardiovascular disease. Global Cardiology Science and Practice. 2020;2019(3).

7. Richards NE, Richards RD Jr. Alpha-Gal Allergy as a Cause of Intestinal Symptoms in a Gastroenterology Community Practice. South Med J. 2021;114(3):169-173.

8. Pattanaik D, Lieberman P, Lieberman J, Pongdee T, Keene AT. The changing face of anaphylaxis in adults and adolescents. Ann Allergy Asthma Immunol. 2018;121(5):594-597.

9. Commins, SP. (2018). Retrieved from: More people developing red meat allergy from tick bites. CBS News

10. Richards N, Keshavarz B, Workman L, Patel J, Platts-Mills T, Wilson J. Prevalence of α-Gal IgE and Mammalian Meat Allergy in a COVID-19 Vaccine Employee Cohort. J Allergy Clin Immunol. 2022;149(2):AB207.

11. Binder AM, Commins SP, Altrich ML, et al. Diagnostic testing for galactose-alpha-1,3-galactose, United States, 2010 to 2018. Ann Allergy Asthma Immunol. 2021;126(4):411-416.e1.

12. Commins SP, James HR, Stevens W, et al. Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2014;134(1):108-115.

13. Fischer J, Yazdi AS, Biedermann T. Clinical spectrum of α-Gal syndrome: from immediate-type to delayed immediate-type reactions to mammalian innards and meat. Allergo J. 2016;25:55-62.

14. van Nunen S. Galactose-Alpha-1,3-Galactose, Mammalian Meat and Anaphylaxis: A World-Wide Phenomenon? Current Treatment Options in Allergy. 2014;1(3):262-277.

15. van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust. 2018;208(7):316-321.

16. Wilson JM, Schuyler AJ, Workman L, et al. Investigation into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy. J Allergy Clin Immunol Pract. 2019;7(7):2348-2358.e4.

17. McGintee, E. (2015). Retrieved from Meat Allergy Triggered by a Tick Bite with Erin McGintee, MD. Southampton Hospital’s Tick-Borne Disease Resource Center Symposium for Medical Professionals. 

18. Mabelane T, Basera W, Botha M, Thomas HF, Ramjith J, Levin ME. Predictive values of alpha-gal IgE levels and alpha-gal IgE: Total IgE ratio and oral food challenge-proven meat allergy in a population with a high prevalence of reported red meat allergy. Pediatr Allergy Immunol. 2018;29(8):841-849.

19. Platts-Mills TAE, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and Management of Patients with the α-Gal Syndrome. J Allergy Clin Immunol Pract. 2020;8(1):15-23.e1.

20. Flaherty MG, Kaplan SJ, Jerath MR. Diagnosis of Life-Threatening Alpha-Gal Food Allergy Appears to Be Patient Driven. J Prim Care Community Health. 2017;8(4):345-348.

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