Peking Union Medical College Hospital

Alpha-gal syndrome.

Alpha-Gal Syndrome: An Underrated Serious Disease and a Potential Future Challenge.

Over the past decades, red meat allergy, also known as mammalian meat allergy, which manifests differently from classic food allergies, has been reported in different countries and regions, including China. The allergen of this disease is not a protein but an oligosaccharide: galactose-α-1,3-galactose, i.e., alpha-gal or α-gal. Therefore, this clinical syndrome is also called α-gal syndrome (AGS). It clinically manifests as delayed anaphylaxis, i.e., patients generally develop allergic symptoms 2-6 h after ingesting red meat. This clinical manifestation is believed to be related to sensitization to α-gal after tick bites. Sensitized individuals may also develop anaphylaxis after ingesting food and medicine or being exposed to medical equipment containing α-gal, such as cetuximab and gelatin. Here, the literature on AGS is reviewed for a better understanding of its pathogenesis, clinical diagnosis, and treatment.

Delayed Anaphylaxis to Red Meat Associated With Specific IgE Antibodies to Galactose.

A novel delayed anaphylactic reaction to red meat, associated with tick bites and IgE antibodies against galactose-α-1, 3-galactose (α-gal), was reported in 2009 in the US, Australia and Europe. In this case, serum specific IgE to galactose-α-1, 3-galactose (>100 kU/L) and IgE to multiple non-primate mammalian proteins were positive. However, the pathogenesis of this disease remains unclear. We report the first case in Asia of delayed anaphylactic reaction to red meat, which was induced by bites from the hard tick, Hematophagous ixodidae. We confirmed the increased concentration of IgE reactive epitopes in non-primate mammalian organs, which may be rich in α-gal proteins in lymphatic and endothelial tissues. All confirmed ticks associated with this disorder in the literature and in our case belonged to the hard tick family. We hypothesize that hard tick saliva is enriched with blood-type substances, such as oligosaccharides, from the non-primate mammal victim's blood after days to weeks of blood sucking, which sensitizes humans through the injection route while blood sucking.

Safety and efficacy of cetuximab combined with chemotherapy in Chinese patients with advanced non-small cell lung cancer.

The aim of this study was to evaluate safety and efficacy of cetuximab combined with chemotherapy in Chinese patients with advanced non-small cell lung cancer (NSCLC).   A retrospective analysis of clinical data was conducted in patients who were given cetuximab combined with chemotherapy in the department of respiratory medicine, Peking Union Medical College Hospital between June 2008 and July 2011. All patients signed the informed consent, and consented to offer clinical information.   Twenty-two patients were enrolled in this study. Nine patients were alive up to analysis, and the longest survival was 28.9 months. The objective response rate (ORR), disease control rate (DCR), median progression free survival (PFS), and estimated least median overall survival (OS) were 36.4%, 59.1%, 5.3 months and 10.1 months, respectively. Results for the 16 patients treated as first line setting were 50.0%, 62.5%, 6.0 months and 10.1 months, respectively. The common adverse events included skin toxicity (14, 63.6%), alanine aminotransferase elevation (7, 31.8%), hematological toxicity (5, 22.7%), allergy (1, 4.5%) and fever (5, 22.7%).   Cetuximab combined with chemotherapy for Chinese patients with advanced NSCLC had promising ORR, DCR, and PFS, especially in the first line subgroup. Serious adverse events had low incidence and were manageable.