Reactions to Airborne Alpha-gal
A Guide for People With Alpha-gal Syndrome
Though not widely recognized, food hypersensitivity by inhalation can cause major morbidity in affected individuals. The exposure is usually more obvious and often substantial in occupational environments but frequently occurs in non-occupational settings, such as homes, schools, restaurants, grocery stores, and commercial flights. The exposure can be trivial, as in mere smelling or being in the vicinity of the food. The clinical manifestations can vary from a benign respiratory or cutaneous reaction to a systemic one that can be life-threatening. In addition to strict avoidance, such highly-sensitive subjects should carry self-injectable epinephrine and wear MedicAlert® identification. (115)
Patients do report symptoms with exposure to fumes from mammalian meats/fats being cooked; however, no blinded challenges have been published to definitively document the airborne (droplet) route of exposure. Interestingly, experience suggests fumes may pose a more potent risk to reactive patients than moderate levels of pet dander exposure (57).
There are no published data on the percentage of people with alpha-gal syndrome (AGS) who react after exposure to airborne alpha-gal, but the informal estimates of experts range from 10-30% (113, 114). People with AGS who react to airborne alpha-gal report that these reactions often start within minutes of exposure, progress quickly, and can be severe.
- Until you know whether you react to airborne alpha-gal, exercise caution around possible sources of exposure, especially barbecues and other types of cooking that generate aerosolized droplets of mammalian fat.
- If you experience dizziness, breathing difficulty or other symptoms, remove yourself immediately from the source of exposure!
- Some people with AGS report that fume reactions are the most dangerous reactions that they experience, leading rapidly to anaphylaxis, airway issues, drops in blood pressure, and/or unconsciousness.
Sources of Airborne Alpha-gal
Fumes (airborne droplets) from cooking meat
Suspended fat droplets in smoke or fumes from cooking meat, especially from grills, barbeques, and less often frying meat, are by far the most commonly reported airborne trigger of reactions (57).
Other possible sources of airborne exposure
People with AGS have also reported reactions to:
- Emissions from mammalian waste, especially from large quantities of waste on farms
- Fumes from cooking milk or dairy products
- Powdered dairy products
- Pet dander
- Dryer exhaust when dryer sheets made with lanolin are used
- Candles made with tallow or stearic acid from mammals
- Air fresheners, especially plug-in ones (some contain carrageenan)
There are also reports of reactions to perfumes, scents, and many other products. Because many people with AGS go on to develop mast cell disorders (see below), it isn’t clear in all cases if these reactions are related to AGS or mast cell issues. More research is needed.
In the majority of patients, food particle inhalation induces respiratory symptoms that can be nasal (rhinorrhea, sneezing, nasal congestion), ocular (tearing, redness, irritation), or lower respiratory (cough, wheeze). In addition, skin manifestations and even, although much more rarely, anaphylaxis can occur.
People with AGS have reported all of the following symptoms to meat fumes and other airborne exposures:
- Runny nose
- Hives, rash or flushing
- Angioedema (swelling)
- Nausea or other GI issues
- Tingling throat
- Breathing issues like coughing, wheezing, shortness of breath
- Changes in blood pressure or heart rate
- Brain fog or confusion
- A sense of impending doom
- Loss of Consciousness
- Other symptoms of anaphylaxis
Read about patients’ reactions to fumes from cooking meat and other sources of alpha-gal here.
Managing Reactions to Airborne Alpha-gal
People with AGS report that the following approaches to managing reactions to airborne alpha-gal have helped them:
- Remove yourself immediately from the source of exposure!
- Wash your hands and face as soon as possible after exposure.
- Seek the advice of your doctor. Drugs such as inhaled beta-agonists, and even omalizumab, can be helpful in the management of airborne alpha-gal reactions (57).
- Work with your doctor to develop a Food Allergy and Anaphylaxis Emergency Care Plan.
- Avoid situations where you might be exposed to airborne alpha-gal, such as barbecues and restaurants that grill meat.
- Buy some well-fitting N95 or similar masks. Cambridge masks are a popular, reusable option.
- If your physician is unable to help, consider making an appointment with Dr. Scott Commins at UNC. He has seen over 2,500 patients with AGS and is familiar with the full-spectrum of alpha-gal reactions, including fume reactions.
Patients who react to airborne alpha-gal report that high quality, well-fitting N95 or similar masks can help in situations where exposure to airborne particles of alpha-gal cannot be avoided.
One situation in which many people with alpha-gal syndrome wear, or at least bring, a mask is airplane travel. On a plane you may not be able to move away from the source of fumes. Some patients also find them helpful during hospitalization.
Note that not all these masks will necessarily provide protection against airborne viruses and other airborne pathogens.
A reliable source of N95 masks
For the Skeptics
Unfortunately, it is not uncommon for patients with fume reactions to encounter skepticism, not just from their friends and family, but also from physicians, who may tell them that they are just experiencing anxiety. Alpha-gal syndrome is a recently discovered allergy with many paradigm-shifting features that are difficult for old-school allergists and other physicians to process. They are more comfortable dealing with protein allergies that follow the rules they learned in medical school. However, many come around if you are patient and provide information. These steps may help:
1. Encourage your physician to read expert Dr. Scott Commins’ Diagnosis and Management of Alpha-gal Syndrome: lessons from 2,500 patients in which he discusses reactions to airborne alpha-gal.
2. Australian expert Dr. Sheila van Nunen, who first recognized alpha-gal syndrome, has never published anything about fume reactions, but in this presentation (@ 1:09:20) she discusses them, states that they affect approximately 30% of patients, and describes their impact.
3. Explain that unlike protein allergens, the primary antigenic form of alpha-gal is thought to be lipids (fat). While proteins can be denatured by cooking and do not typically become aerosolized, alpha-gal is heat stabile (70) and, as all cooks know, fat is aerosolized during cooking. Aerosolized fat droplets can be inhaled deep into the lungs where they can trigger reactions, just like pollen, pet-dander, and other non-food allergens that your physician may be more familiar with. For reasons that aren’t clear, reactions to airborne alpha-gal tend to be more severe than reactions to these more familiar airborne allergens. However, a quick Google Scholar search will turn up numerous papers about anaphylactic reactions to various airborne allergens.
4. Document your reactions. Doctors are less likely to dismiss your reports of reactions if you have notes, photos, videos, eyewitness accounts, and other data. Some at-home blood pressure monitors will record readings. People with severe reactions to airborne alpha-gal have found that recording drops in blood pressure associated with fume reactions can be helpful when dealing with skeptical physicians.
Mast Cell Syndromes
Approximately 3-5% of patients also appear to develop signs/symptoms consistent with a mast cell syndrome, which could be related to mast cell releasing factors present in tick saliva or the significant increase in total IgE leading to increased mast cell reactivity. Alternatively, emergence of a plasmablast-like, IgE-secreting B cell compartment with specific expansion of CCR6+ cells in subjects within 3 weeks of an attached A. americanum or I. scapularis tick bite may explain the new-onset urticaria and possible mast cell activation symptoms (57).
3-5% of people with alpha-gal syndrome go on to develop symptoms consistent with a mast cell syndrome (57). In addition, AGS can unmask indolent systemic mastocytosis (62). If you begin to develop sensitivity to a wide range of airborne exposures, including scents, perfumes, etc., especially if it’s not clear that they all contain alpha-gal, this may be a red flag suggesting that a mast cell issue needs to be ruled out.
1. Commins SP, Satinover SM, Hosen J, Mozena J, Borish L, Lewis BD, Woodfolk JA, Platts-Mills TA. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Journal of Allergy and Clinical Immunology. 2009 Feb 1;123(2):426-33.
2. Commins S, Lucas S, Hosen J, Satinover SM, Borish L, Platts-Mills TA. Anaphylaxis and IgE antibodies to galactose-alpha-1, 3-galactose (alphaGal): insight from the identification of novel IgE ab to carbohydrates on mammalian proteins. Journal of Allergy and Clinical Immunology. 2008 Feb 1;121(2):S25.
3. Commins SP, James HR, Kelly LA, Pochan SL, Workman LJ, Perzanowski MS, Kocan KM, Fahy JV, Nganga LW, Ronmark E, Cooper PJ. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1, 3-galactose. Journal of Allergy and Clinical Immunology. 2011 May 1;127(5):1286-93.
4. Soh JY, Huang CH, Lee BW. Carbohydrates as food allergens. Asia Pacific Allergy. 2015 Jan 1;5(1):17-24.
5. Levin M, Apostolovic D, Biedermann T, Commins SP, Iweala OI, Platts-Mills TA, Savi E, van Hage M, Wilson JM. Galactose α-1, 3-galactose phenotypes: Lessons from various patient populations. Annals of Allergy, Asthma & Immunology. 2019 Jun 1;122(6):598-602.
6. Platts-Mills TA, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and management of patients with the α-Gal syndrome. The Journal of Allergy and Clinical Immunology: In Practice. 2020 Jan 1;8(1):15-23.
7. Commins SP. Invited commentary: alpha-gal allergy: tip of the iceberg to a pivotal immune response. Current allergy and asthma reports. 2016 Sep 1;16(9):61.
8. Crispell G, Commins SP, Archer-Hartman SA, Choudhary S, Dharmarajan G, Azadi P, Karim S. Discovery of alpha-gal-containing antigens in North American tick species believed to induce red meat allergy. Frontiers in immunology. 2019 May 17;10:1056.
9. Monzón JD, Atkinson EG, Henn BM, Benach JL. Population and evolutionary genomics of Amblyomma americanum, an expanding arthropod disease vector. Genome biology and evolution. 2016 May 1;8(5):1351-60.
10. Raghavan RK, Peterson AT, Cobos ME, Ganta R, Foley D. Current and future distribution of the lone star tick, Amblyomma americanum (L.)(Acari: Ixodidae) in North America. PLoS One. 2019 Jan 2;14(1):e0209082.
11. Wilson JM, Platts-Mills TA. Red meat allergy in children and adults. Current opinion in allergy and clinical immunology. 2019 Jun 1;19(3):229-35.
12. Commins, SP. (2018). Retrieved from: More people developing red meat allergy from tick bites. CBS News
13. Flaherty MG, Threats M, Kaplan SJ. Patients’ Health Information Practices and Perceptions of Provider Knowledge in the Case of the Newly Discovered Alpha-gal Food Allergy. Journal of Patient Experience. 2020 Feb;7(1):132-9.
14. Flaherty MG, Kaplan SJ, Jerath MR. Diagnosis of life-threatening alpha-gal food allergy appears to be patient driven. Journal of primary care & community health. 2017 Oct;8(4):345-8.
15. Cabezas-Cruz A, Hodžić A, Román-Carrasco P, Mateos-Hernández L, Duscher GG, Sinha DK, Hemmer W, Swoboda I, Estrada-Peña A, De La Fuente J. Environmental and molecular drivers of the α-Gal syndrome. Frontiers in Immunology. 2019 May 31;10:1210.
16. Commins SP, Platts-Mills TA. Tick bites and red meat allergy. Current opinion in allergy and clinical immunology. 2013 Aug;13(4):354.
17. Stoltz LP, Cristiano LM, Dowling AP, Wilson JM, Platts-Mills TA, Traister RS. Could chiggers be contributing to the prevalence of galactose-alpha-1, 3-galactose sensitization and mammalian meat allergy?. The journal of allergy and clinical immunology. In practice. 2019 Feb;7(2):664.
18. Arkestål K, Sibanda E, Thors C, Troye-Blomberg M, Mduluza T, Valenta R, Grönlund H, van Hage M. Impaired allergy diagnostics among parasite-infected patients caused by IgE antibodies to the carbohydrate epitope galactose-α1, 3-galactose. Journal of Allergy and Clinical Immunology. 2011 Apr 1;127(4):1024-8.
19. Chinuki Y, Ishiwata K, Yamaji K, Takahashi H, Morita E. Haemaphysalis longicornis tick bites are a possible cause of red meat allergy in Japan. Allergy. 2016 Mar;71(3):421-5.
20. Hashizume H, Fujiyama T, Umayahara T, Kageyama R, Walls AF, Satoh T. Repeated Amblyomma testudinarium tick bites are associated with increased galactose-α-1, 3-galactose carbohydrate IgE antibody levels: a retrospective cohort study in a single institution. Journal of the American Academy of Dermatology. 2018 Jun 1;78(6):1135-41.
21. Bianchi, John (2019). Personal communication
22. Morisset M, Richard C, Astier C, Jacquenet S, Croizier A, Beaudouin E, Cordebar V, Morel‐Codreanu F, Petit N, Moneret‐Vautrin DA, Kanny G. Anaphylaxis to pork kidney is related to IgE antibodies specific for galactose‐alpha‐1, 3‐galactose. Allergy. 2012 May;67(5):699-704.
23. Fischer J, Hebsaker J, Caponetto P, Platts-Mills TA, Biedermann T. Galactose-alpha-1, 3-galactose sensitization is a prerequisite for pork-kidney allergy and cofactor-related mammalian meat anaphylaxis. Journal of allergy and clinical immunology. 2014 Sep 1;134(3):755-9.
24. 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 journal international. 2016 Mar 1;25(2):55-62.
25. McPherson TB, Liang H, Record RD, Badylak SF. Galα (1, 3) Gal epitope in porcine small intestinal submucosa. Tissue engineering. 2000 Jun 1;6(3):233-9.
26. Fujiwara M, Araki T. Immediate anaphylaxis due to beef intestine following tick bites. Allergology International. 2019;68(1):127-9.
27. Caponetto P, Fischer J, Biedermann T. Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-α-1, 3-galactose. The Journal of Allergy and Clinical Immunology: In Practice. 2013 May 1;1(3):302-3.
28. Mullins RJ, James H, Platts-Mills TA, Commins S. Relationship between red meat allergy and sensitization to gelatin and galactose-α-1, 3-galactose. Journal of Allergy and Clinical Immunology. 2012 May 1;129(5):1334-42.
29. Kaman K, Robertson D. ALPHA-GAL ALLERGY; MORE THAN MEAT?. Annals of Allergy, Asthma & Immunology. 2018 Nov 1;121(5):S115.
30. Chung CH, Mirakhur B, Chan E, Le QT, Berlin J, Morse M, Murphy BA, Satinover SM, Hosen J, Mauro D, Slebos RJ. Cetuximab-induced anaphylaxis and IgE specific for galactose-α-1, 3-galactose. New England journal of medicine. 2008 Mar 13;358(11):1109-17.
31. Berg EA, Platts-Mills TA, Commins SP. Drug allergens and food—the cetuximab and galactose-α-1, 3-galactose story. Annals of Allergy, Asthma & Immunology. 2014 Feb 1;112(2):97-101.
32. Dunkman WJ, Rycek W, Manning MW. What does a red meat allergy have to do with anesthesia? Perioperative management of alpha-gal syndrome. Anesthesia & Analgesia. 2019 Nov 1;129(5):1242-8.
33. Pfützner W, Brockow K. Perioperative drug reactions–practical recommendations for allergy testing and patient management. Allergo journal international. 2018 Jun 1;27(4):126-9.
34. Dewachter P, Kopac P, Laguna JJ, Mertes PM, Sabato V, Volcheck GW, Cooke PJ. Anaesthetic management of patients with pre-existing allergic conditions: a narrative review. British journal of anaesthesia. 2019 Jul 1;123(1):e65-81.
35. Popescu FD, Cristea OM, IONICĂ FE, Vieru M. DRUG ALLERGIES DUE TO IgE SENSITIZATION TO α-GAL. magnesium. 2018;2017:47-8.
36. Swiontek K, Morisset M, Codreanu-Morel F, Fischer J, Mehlich J, Darsow U, Petitpain N, Biedermann T, Ollert M, Eberlein B, Hilger C. Drugs of porcine origin—A risk for patients with α-gal syndrome?. The Journal of Allergy and Clinical Immunology: In Practice. 2019 May 1;7(5):1687-90.
37. Vidal C, Mendez-Brea P, Lopez-Freire S, Gonzalez-Vidal T. Vaginal Capsules: An Unsuspected Probable Source of Exposure to α-Gal. Journal of investigational allergology & clinical immunology. 2016;26(6):388.
38. Muglia C, Kar I, Gong M, Hermes-DeSantis ER, Monteleone C. Anaphylaxis to medications containing meat byproducts in an alpha-gal sensitized individual. The journal of allergy and clinical immunology. In practice. 2015;3(5):796.
39. Akella K, Patel H, Wai J, Roppelt H, Capone D. Alpha Gal-Induced Anaphylaxis to Herpes Zoster Vaccination. Chest. 2017 Oct 1;152(4):A6.
40. Bakhtiar MF, Leong KW, Kwok FY, Hui MT, Tang MM, Joseph CT, Bathumana‐Appan PP, Nagum AR, ZHM Y, Murad S. P66: ALLERGIC REACTION TO BOVINE GELATIN COLLOID: THE ROLE OF IMMUNOGLOBULIN E TOWARDS GALACTOSE‐ALPHA‐1, 3‐GALACTOSE: IMPLICATIONS BEYOND RED MEAT ALLERGIES. Internal Medicine Journal. 2017 Sep;47:24-.
41. Bradfisch F, Pietsch M, Forchhammer S, Strobl S, Stege HM, Pietsch R, Carstens S, Schäkel K, Yazdi A, Saloga J. Case series of anaphylactic reactions after rabies vaccinations with gelatin sensitization. Allergo Journal International. 2019 Jun 1;28(4):103-6.
42. Stone CA, Commins SP, Choudhary S, Vethody C, Heavrin JL, Wingerter J, Hemler JA, Babe K, Phillips EJ, Norton AE. Anaphylaxis after vaccination in a pediatric patient: further implicating alpha-gal allergy. The Journal of Allergy and Clinical Immunology: In Practice. 2019 Jan 1;7(1):322-4.
43. Stone CA, Hemler JA, Commins SP, Schuyler AJ, Phillips EJ, Peebles RS, Fahrenholz JM. Anaphylaxis after zoster vaccine: Implicating alpha-gal allergy as a possible mechanism. Journal of Allergy and Clinical Immunology. 2017 May 1;139(5):1710-3.
44. Pattanaik D, Lieberman P, Lieberman J, Pongdee T, Keene AT. The changing face of anaphylaxis in adults and adolescents. Annals of Allergy, Asthma & Immunology. 2018 Nov 1;121(5):594-7.
45. Ankersmit HJ, Copic D, Simader E. When meat allergy meets cardiac surgery: A driver for humanized bioprosthesis. The Journal of thoracic and cardiovascular surgery. 2017 Oct 1;154(4):1326-7.
46. Hawkins RB, Frischtak HL, Kron IL, Ghanta RK. Premature bioprosthetic aortic valve degeneration associated with allergy to galactose‐alpha‐1, 3‐galactose. Journal of cardiac surgery. 2016 Jul;31(7):446-8.
47. Kleiman AM, Littlewood KE, Groves DS. A&A Practice. 2017 Apr 1;8(7):175-7.
48. Mozzicato SM, Tripathi A, Posthumus JB, Platts-Mills TA, Commins SP. Porcine or bovine valve replacement in three patients with IgE antibodies to the mammalian oligosaccharide galactose-alpha-1, 3-galactose. The journal of allergy and clinical immunology. In practice. 2014 Sep;2(5):637.
49. Mangold A, Szerafin T, Hoetzenecker K, Hacker S, Lichtenauer M, Niederpold T, Nickl S, Dworschak M, Blumer R, Auer J, Ankersmit HJ. Alpha-Gal specific IgG immune response after implantation of bioprostheses. The Thoracic and cardiovascular surgeon. 2009 Jun;57(04):191-5.
50. Fischer J, Eberlein B, Hilger C, Eyer F, Eyerich S, Ollert M, Biedermann T. Alpha‐gal is a possible target of IgE‐mediated reactivity to antivenom. Allergy. 2017 May;72(5):764-71.
51. Rizer J, Brill K, Charlton N, King J. Acute hypersensitivity reaction to Crotalidae polyvalent immune Fab (CroFab) as initial presentation of galactose-α-1, 3-galactose (α-gal) allergy. Clinical Toxicology. 2017 Aug 9;55(7):668-9.
52. Farooque S, Kenny M, Marshall SD. Anaphylaxis to intravenous gelatin‐based solutions: a case series examining clinical features and severity. Anaesthesia. 2019 Feb;74(2):174-9.
53. Lied GA, Lund KB, Storaas T. Intraoperative anaphylaxis to gelatin-based hemostatic agents: a case report. Journal of asthma and allergy. 2019;12:163.
54. Tobacman JK. The common food additive carrageenan and the alpha-gal epitope. Journal of Allergy and Clinical Immunology. 2015 Dec 1;136(6):1708-9.
55. Tarlo SM, Dolovich J, Listgarten C. Anaphylaxis to carrageenan: A pseudo–latex allergy. Journal of allergy and clinical immunology. 1995 May 1;95(5):933-6.
56. Steinke JW, Platts-Mills TAE, Schuyler A, Commins SP. Reply to “The common food additive carrageenan and the alpha-gal epitope”. Journal of Allergy and Clinical Immunology. 2015 Oct 28;136(6):1709-10
57. Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Review of Clinical Immunology. 2020 Jul 9:1-1.
58. Galili, U., & Avila, J. L. (Eds.). (2012). α–Gal and Anti–Gal: α1, 3–Galactosyltransferase, α–Gal Epitopes, and the Natural Anti–Gal Antibody Subcellular Biochemistry (Vol. 32). Springer Science & Business Media.
59. Fischer J, Lupberger E, Hebsaker J, Blumenstock G, Aichinger E, Yazdi AS, Reick D, Oehme R, Biedermann T. Prevalence of type I sensitization to alpha‐gal in forest service employees and hunters. Allergy. 2017 Oct;72(10):1540-7.
60. SAT0456 SERO-REACTIVITY TO GALACTOSE-ALPHA-1,3-GALACTOSE AND CLINICAL PRESENTATIONS OF PATIENTS SEEN IN A RHEUMATOLOGY OUTPATIENT PRACTICE. Annals of the Rheumatic Diseases 2019 Jun 15;78:1317-8.
61. Bianchi J, Walters A, Fitch ZW, Turek JW. Alpha-gal syndrome: Implications for cardiovascular disease. Global Cardiology Science and Practice. 2020 Feb 9;2019(3).
62. Carter MC, Ruiz‐Esteves KN, Workman L, Lieberman P, Platts‐Mills TA, Metcalfe DD. Identification of alpha‐gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis. Allergy. 2018 May;73(5):1131-4.
63. 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.
64. I-TICK Surveillance. Retrieved from: https://twitter.com/ITickUIUC/status/1282799807996854278
65. Wickner PG, Commins SP. The first 4 Central American cases of delayed meat allergy with galactose-alpha-1, 3-galactose positivity clustered among field biologists in Panama. Journal of Allergy and Clinical Immunology. 2014 Feb 1;133(2):AB212.
66. Ohshita N, Ichimaru Y, Gamoh S, Tsuji K, Kishimoto N, Tsutsumi YM, Momota Y. Management of infusion reactions associated with cetuximab treatment: A case report. Molecular and Clinical Oncology. 2017 Jun 1;6(6):853-5.
67. Stein D, Schuyler A, Commins S, Behm B, Chitnavis M. P-002 YI First Dose IgE-Mediated Allergy to Infliximab Due to Galactose-α-1, 3-Galactose Allergy. Inflammatory Bowel Diseases. 2016 Mar 1;22:S9-10.
68. Van Tine BA, Govindarajan R, Attia S, Somaiah N, Barker SS, Shahir A, Barrett E, Lee P, Wacheck V, Ramage SC, Tap WD. Incidence and management of olaratumab infusion-related reactions. Journal of oncology practice. 2019 Nov;15(11):e925-33.
69. Venturini M, Lobera T, Sebastián A, Portillo A, Oteo JA. IgE to α-Gal in Foresters and Forest Workers From La Rioja, North of Spain. Journal of investigational allergology & clinical immunology. 2018;28(2):106.
70. Apostolovic D, Tran TA, Hamsten C, Starkhammar M, Cirkovic Velickovic T, van Hage M. Immunoproteomics of processed beef proteins reveal novel galactose‐α‐1, 3‐galactose‐containing allergens. Allergy. 2014 Oct;69(10):1308-15.
71. Khora SS, Navya P. Bioactive Polysaccharides from Marine Macroalgae. Encyclopedia of Marine Biotechnology. 2020 Aug 4.
72. Gowda DC, Glushka J, Halbeek HV, Thotakura RN, Bredehorst R, Vogel CW. N-linked oligosaccharides of cobra venom factor contain novel α (1-3) galactosylated Lex structures. Glycobiology. 2001 Mar 1;11(3):195-208.
73. Hodžić A, Mateos-Hernández L, Fréalle E, Román-Carrasco P, Alberdi P, Pichavant M, Risco-Castillo V, Le Roux D, Vicogne J, Hemmer W, Auer H. Infection with Toxocara canis Inhibits the Production of IgE Antibodies to α-Gal in Humans: Towards a Conceptual Framework of the Hygiene Hypothesis?. Vaccines. 2020 Jun;8(2):167.
74. Taguchi T, Kitajima K, Muto Y, Inoue S, Khoo KH, Morris HR, Dell A, Wallace RA, Selman K, Inoue Y. A precise structural analysis of a fertilization-associated carbohydrate-rich glycopeptide isolated from the fertilized eggs of euryhaline killi fish (Fundulus heteroclitus). Novel penta-antennary N-glycan chains with a bisecting N-acetylglucosaminyl residue. Glycobiology. 1995 Sep 1;5(6):611-24.
75. Shao Y, Yu Y, Pei CG, Qu Y, Gao GP, Yang JL, Zhou Q, Yang L, Liu QP. The expression and distribution of α-Gal gene in various species ocular surface tissue. International journal of ophthalmology. 2012;5(5):543.
76. Chauhan PS, Saxena A. Bacterial carrageenases: an overview of production and biotechnological applications. 3 Biotech. 2016 Dec 1;6(2):146.
78. van Nunen S. Galactose-alpha-1, 3-galactose, mammalian meat and anaphylaxis: a world-wide phenomenon?. Current Treatment Options in Allergy. 2014 Sep 1;1(3):262-77.
79. Wilson JM, Nguyen AT, Schuyler AJ, Commins SP, Taylor AM, Platts-Mills TA, McNamara CA. IgE to the mammalian oligosaccharide galactose-α-1, 3-galactose is associated with increased atheroma volume and plaques with unstable characteristics—brief report. Arteriosclerosis, thrombosis, and vascular biology. 2018 Jul;38(7):1665-9.
80. Wilson JM, McNamara CA, Platts-Mills TA. IgE, α-Gal and atherosclerosis. Aging (Albany NY). 2019 Apr 15;11(7):1900.
81. Tina Merritt, MD, personal communication.
82. Hodgeman N, Horn CL, Paredes A. An Unusual Mimicker of Irritable Bowel Disease: 1855. American Journal of Gastroenterology. 2019 Oct 1;114(2019 ACG Annual Meeting Abstracts):S1039.
83. Bensinger A, Green P. Mammalian Meat Allergy Masquerading as IBS-D: 1846. American Journal of Gastroenterology. 2019 Oct 1;114(2019 ACG Annual Meeting Abstracts):S1036-7.
84. 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. Pediatric Allergy and Immunology. 2018 Dec;29(8):841-9.
85. Armstrong P, Binder A, Amelio C, Kersh G, Biggerstaff B, Beard C, Petersen L, Commins S. Descriptive Epidemiology of Patients Diagnosed with Alpha-gal Allergy—2010–2019. Journal of Allergy and Clinical Immunology. 2020 Feb 1;145(2):AB145.
86. Pointreau Y, Commins SP, Calais G, Watier H, Platts-Mills TA. Fatal infusion reactions to cetuximab: role of immunoglobulin E–mediated anaphylaxis. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2012 Jan 20;30(3):334.
87. van Nunen S. Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance. Asia Pacific Allergy. 2015 Jan 1;5(1):3-16.
88. van Nunen S, O’Connor K, Fernando S, Clarke L, Boyle R. THE ASSOCIATION BETWEEN IXODES HOLOCYCLUS TICK BITE REACTIONS AND RED MEAT ALLERGY: P17. Internal Medicine Journal. 2007 Nov 1;37.
89. Van Nunen SA, O’Connor KS, Clarke LR, Boyle RX, Fernando SL. An association between tick bite reactions and red meat allergy in humans. The Medical journal of Australia. 2009 May 4;190(9):510-1.
90. Meat Allergy Tirggered by a Tick Bite with Eri McGintee retrieved from: https://youtu.be/hj96Vvr1WhQ
91. Fischer J, Huynh HN, Hebsaker J, Forchhammer S, Yazdi AS. Prevalence and Impact of Type I Sensitization to Alpha-Gal in Patients Consulting an Allergy Unit. International Archives of Allergy and Immunology. 2020;181(2):119-27.
92. Platts-Mills TA, Commins SP, Biedermann T, van Hage M, Levin M, Beck LA, Diuk-Wasser M, Jappe U, Apostolovic D, Minnicozzi M, Plaut M. On the cause and consequences of IgE to galactose-α-1, 3-galactose: a Report from the National Institute of Allergy and Infectious Disease Workshop on Understanding IgE-Mediated Mammalian Meat Allergy. Journal of Allergy and Clinical Immunology. 2020 Feb 10.
93. Takahashi H, Chinuki Y, Tanaka A, Morita E. Laminin γ‐1 and collagen α‐1 (VI) chain are galactose‐α‐1, 3‐galactose–bound allergens in beef. Allergy. 2014 Feb;69(2):199-207.
94. Hilger C, Fischer J, Swiontek K, Hentges F, Lehners C, Eberlein B, Morisset M, Biedermann T, Ollert M. Two galactose‐α‐1, 3‐galactose carrying peptidases from pork kidney mediate anaphylactogenic responses in delayed meat allergy. Allergy. 2016 May;71(5):711-9.
95. Iweala OI, Choudhary SK, Addison CT, Batty CJ, Kapita CM, Amelio C, Schuyler AJ, Deng S, Bachelder EM, Ainslie KM, Savage PB. Glycolipid-mediated basophil activation in alpha-gal allergy. Journal of Allergy and Clinical Immunology. 2020 Feb 20.
96. Iweala O, Brennan PJ, Commins SP. Serum IgE specific for alpha-Gal sugar moiety can bind glycolipid. Journal of Allergy and Clinical Immunology. 2017 Feb 1;139(2):AB88.
97. Iweala OI, Choudhary SK, Addison CT, Batty CJ, Kapita CM, Amelio C, Schuyler AJ, Deng S, Bachelder EM, Ainslie KM, Savage PB. Glycolipid-mediated basophil activation in alpha-gal allergy. Journal of Allergy and Clinical Immunology. 2020 Feb 20.
98. Villalta D, Pantarotto L, Da Re M, Conte M, Sjolander S, Borres MP, Martelli P. High prevalence of sIgE to Galactose‐α‐1, 3‐galactose in rural pre‐Alps area: a cross‐sectional study. Clinical & Experimental Allergy. 2016 Feb;46(2):377-80.
99. 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. Proceedings of the National Academy of Sciences. 1987 Mar 1;84(5):1369-73.
100. Wilson JM, Platts-Mills TA. The oligosaccharide galactose-α-1, 3-galactose and the α-Gal syndrome: insights from an epitope that is causal in immunoglobulin E-mediated immediate and delayed anaphylaxis. Eur Med J. 2018;3:89-98.
101. Zurbano-Azqueta L, Antón-Casas E, Duque-Gómez S, Jiménez-Gómez I, Fernández-Pellón L, López-Gutiérrez J. Alpha-gal syndrome. Allergy to red meat and gelatin. Revista Clínica Española (English Edition). 2021 Oct 14.
102. Christian RA, Stabile KJ, Gupta AK, Leckey Jr BD, Cardona DM, Nowinski RJ, Kelly JD, Toth AP. Histologic Analysis of Porcine Dermal Graft Augmentation in Treatment of Rotator Cuff Tears. The American journal of sports medicine. 2021 Oct 15:03635465211049434.
103. Kuravi KV, Sorrells LT, Nellis JR, et al. Allergic response to medical products in patients with alpha-gal syndrome. J Thorac Cardiovasc Surg. Published online April 9, 2021. doi:10.1016/j.jtcvs.2021.03.100
104. Chinuki Y, Morita E, Takahashi H. IgE antibodies to galactose-a-1,3-galactose, an epitope of red meat allergen, cross-react with a novel flounder roe allergen. J Investig Allergol Clin Immunol. Published online October 15, 2021:0.
105. Shao Y, Yu Y, Pei C-G, et al. The expression and distribution of α-Gal gene in various species ocular surface tissue. Int J Ophthalmol. 2012;5(5):543.
106. Murangi T, Prakash P, Moreira BP, et al. Ascaris lumbricoides and ticks associated with sensitisation to Galactose α1,3-galactose and elicitation of the alpha-gal syndrome. J Allergy Clin Immunol. Published online July 29, 2021. doi:10.1016/j.jaci.2021.07.018
107. Mateos-Hernández L, Risco-Castillo V, Torres-Maravilla E, et al. Gut Microbiota Abrogates Anti-α-Gal IgA Response in Lungs and Protects against Experimental Aspergillus Infection in Poultry. Vaccines (Basel). 2020;8(2). doi:10.3390/vaccines8020285
108. Aspergillus oryzae, Wikipedia
109. Murugan AVM, Oliveira T, Alagesan K, et al. Evolutionary Glycomics: A Comprehensive Study of Vertebrate Host Serum/Plasma Glycome Using Orthogonal Glycomics Techniques. The FASEB Journal. 2021;35(S1). doi:10.1096/fasebj.2021.35.S1.04538
110. Gowda DC, Glushka J, van Halbeek H, Thotakura RN, Bredehorst R, Vogel C-W. N-linked oligosaccharides of cobra venom factor contain novel α (1-3) galactosylated Lex structures. Glycobiology. 2001;11(3):195-208.
111. Ramasamy R. Mosquito vector proteins homologous to α1-3 galactosyl transferases of tick vectors in the context of protective immunity against malaria and hypersensitivity to vector bites. Parasit Vectors. 2021;14(1):303.
112. Fukunaga T, Tanaka N, Furumoto T, et al. Substrate specificities of α1,2- and α1,3-galactosyltransferases and characterization of Gmh1p and Otg1p in Schizosaccharomyces pombe. Glycobiology. Published online April 28, 2021. doi:10.1093/glycob/cwab028
113. van Nunen, S. Mammalian Meat Allergy after Tick Bite and Tick Anaphylaxis in Australia. International Tick Symposium (2018). 2018. Retrieved from https://www.youtube.com/watch?v=C4fzZO9UlzE&list=LLcoL9fUr713IGKBwo-CELVw&index=21 @1:09:00
114. Scott Commins, MD, PhD, personal communication
115. Ramirez DA, Bahna SL. Food hypersensitivity by inhalation. Clin Mol Allergy. 2009;7(1):1-6.
All the information on alphagalinformation.org is provided in good faith, but we, the creators and authors of the Alpha-gal Information website offer no representation or warranty, explicit or implied, of the accuracy, adequacy, validity, reliability, availability, or completeness of any information on this site. Under no circumstances should we have any liability for any loss or damage incurred by you as a result of relying on information provided here. We are not physicians or medical professionals, researchers, or experts of any kind. Information provided in this website may contain errors and should be confirmed by a physician. Information provided here is not medical advice. It should not be relied upon for decisions about diagnosis, treatment, diet, food choice, nutrition, or any other health or medical decisions. For advice about health or medical decisions including, but not limited to, diagnosis, treatment, diet, and health care consult a physician.
READ FULL DISCLAIMER>