Virginia Commonwealth University

Could alpha-gal syndrome be the cause of southern tick-associated rash illness (STARI)? : A simple study could answer that question.

A Review of Alpha-Gal Syndrome for the Infectious Diseases Practitioner.

Alpha-gal syndrome (AGS) is an emerging allergic disease caused by an immunoglobulin E (IgE) response to galactose-α-1,3-galactose (alpha-gal), a sugar found in mammalian meat. The initial IgE sensitization follows a bite from the (lone star) tick in the United States, although other tick species can also cause the disease. AGS presents with delayed symptoms, primarily gastrointestinal or allergic reactions like urticaria or anaphylaxis, hours after mammalian meat consumption. The nonspecificity of the symptoms can delay the diagnosis of AGS for years. Diagnosis relies on clinical evaluation and detection of alpha-gal-specific IgE in blood. As the lone star tick's range is expanding beyond the southern United States, AGS is gaining recognition in other regions. However, many healthcare providers remain unaware of the condition, leading to misdiagnosis. Infectious diseases physicians who frequently evaluate patients with tick exposure must be familiar with AGS, including tick identification, bite prevention, and knowledge of the alpha-gal-containing vaccines.

Demystifying α-gal syndrome: identification and risk management in the perioperative setting.

α-Gal syndrome is among a vexing perioperative consideration for anesthesiologists. Commonly referred to as 'red meat allergy', α-Gal syndrome is precipitated by a lone star tick bite resulting in the formation of immunoglobulin E (IgE) antibodies against the tick salivary glycoproteins and noncatarrhine mammalian tissue. Up to 20% of the population in the southeastern United States may test positive for IgE antibodies to α-Gal. Increasingly, recognition of α-Gal syndrome as an immune response to red meat consumption and certain drugs, many of which may be administered within the perioperative period, has led to greater awareness of the insidious nature of its presentation - from mild urticaria and gastrointestinal symptoms to severe anaphylaxis. With the increasing prevalence and identification of α-Gal syndrome, a safe and tailored perioperative process is needed to integrate a pathway that involves multidisciplinary communication, robust information sharing platform, and a structured peri-procedure management.

A new look at IgE beyond allergies.

Immunoglobulin E (IgE), though constitutively present at low levels, is most commonly studied in atopic disease where it plays a vital role in mast cell degranulation and in initiating a T helper 2 (Th2) response. With the advent of better detection assays, however, researchers are discovering the importance of IgE in actively contributing to many disease states and pathologies. This review will discuss the latest findings in IgE beyond its role in allergies and recently discovered roles for IgE in its cell-bound form on FcεRI-expressing effector cells like monocytes and dendritic cells. In terms of parasites, we will discuss helminth-induced IgE that appears to protect the worms from immune recognition and a tick-borne illness that elicits an IgE response against red meat. Next, we describe recent findings of how auto-reactive IgE can contribute to the progression of lupus and induce organ damage. Finally, we summarize the emerging roles of IgE in tumor surveillance and antibody-dependent cytotoxicity. We additionally discuss recent or ongoing clinical trials that either target harmful IgE or use the unique characteristics of the isotype.

A peculiar cause of anaphylaxis: no more steak? The journey to discovery of a newly recognized allergy to galactose-alpha-1,3-galactose found in mammalian meat.

In recent years, a newly recognized allergic disease has been uncovered, and seemingly idiopathic causes of anaphylaxis now have an explanation. Individuals bitten by the lone star tick may develop IgE antibodies to the carbohydrate galactose-α-1,3-galactose (alpha-gal). Upon exposure of sensitized subjects to mammalian meat containing alpha-gal on glycoproteins or glycolipids, delayed anaphylaxis may ensue, often three to six hours after ingestion.1 Many of these individuals have negative allergy skin prick tests to meat, further obscuring the diagnosis. With the recent development of IgE alpha-gal tests, the clinical diagnosis can be confirmed in the laboratory.