Chinuki Y

[PORK-CAT SYNDROME WITH ALLERGIC SYMPTOMS DUE TO THE INGESTION OF COW'S MILK].

We present a case of a 9-year-old girl with pork-cat syndrome (PCS) who experienced repeated episodes of urticaria and gastrointestinal symptoms after ingesting pork, beef, and milk since she was 7 years old. Her family has had a cat since she was born. Antigen-specific IgE tests showed high values against Fel d 1, Fel d 2, Sus s 1, Bos d 6, beef, pork, milk, dog dander, and cat dander. However, an antigen-specific IgE test performed in infancy was negative for cow's milk. The skin prick test was positive for raw pork, raw beef, and milk, but these reactions were attenuated by heating. Immunoblot analysis showed that the patient's serum IgE bound to a protein in pork that had the same molecular weight (67kDa) as cat dander extracts, and also cross-reactivity between these two proteins was confirmed by an inhibition test, leading to the diagnosis of PCS. Similar cross-reactivity was confirmed for beef, milk, and cat dander extracts. We experienced a case of PCS, in which allergies to cow's milk appeared not only due to meat such as pork and beef, but also to cow's milk sensitized by the rearing of cats.

[TWO CASES OF α-GAL SYNDROME CAUSED BY INGESTION OF WILD BOAR MEAT].

α-Gal syndrome (AGS) is an allergic reaction to galactose-α-1,3-galactose (α-gal) found in the salivary glands of ticks, mammalian meat excluding primates, and some antibody preparations, such as cetuximab. We report two cases of AGS diagnosed after ingestion of wild boar meat. Patient 1, a male in his 70s, developed anaphylactic shock about 3 h after eating wild boar meat. He was transported to our acute and critical care center in Nagasaki University Hospital because he had difficulty in moving. Patient 2, a female in her 60s, developed a skin rash about 2.5 h after ingesting wild boar meat. After visiting our department to investigate the cause of the disease, the sera of both patients were found to be positive for α-gal specific IgE antibody and were diagnosed with AGS caused by ingestion of wild boar meat. Reports of AGS diagnosed after ingestion of wild boar meat are rare in Japan. Compared with other prefectures, the consumption of wild boar meat in Nagasaki is relatively high in Japan. In the past 10 years, four cases of AGS were diagnosed at our department, half of which were caused by the ingestion of wild boar meat, the ratio is possibly higher than that in other prefectures in Japan.

IgE Antibodies to Galactose-α-1,3-galactose, an Epitope of Red Meat Allergen, Cross-react With a Novel Flounder Roe Allergen.

Cohort study of subclinical sensitization against galactose-α-1,3-galactose in Japan: Prevalence and regional variations.

Sensitization to galactose-α-1,3-galactose (α-Gal) leads to the development of α-Gal syndrome, which includes red meat allergy and cetuximab-induced anaphylaxis. Since tick bites represent the main cause of α-Gal sensitization, it was speculated that sensitization to α-Gal occurs throughout Japan. However, few cohort studies have investigated α-Gal sensitization in Japan. Therefore, we aimed to elucidate the subclinical sensitization rate to α-Gal in Japan. Sera were obtained from 300 participants without food or cetuximab allergy at Shimane University Hospital (Shimane prefecture), Tokyo Medical and Dental University Hospital (Tokyo metropolis), and Tohoku University Hospital (Miyagi prefecture). ImmunoCAP-bovine thyroglobulin (BTG), ImmunoCAP-beef, and IgE immunoblotting with cetuximab were performed to detect α-Gal-specific IgE. Clinical information was collected from participants using a questionnaire. The overall positivity rate of ImmunoCAP-BTG was 4.0% without significant inter-institute differences, whereas that for ImmunoCAP-beef was 9.7% with a significant inter-institute difference. Tokyo Medical and Dental University Hospital (19.0%) had the highest positivity rate. The positivity rate based on cetuximab IgE immunoblotting was 2.7%, without any significant inter-institute differences. The overall positivity rate for both ImmunoCAP-BTG and cetuximab immunoblotting was 2.0%, with a significant inter-institute difference; 5.0% of Shimane University Hospital was the highest. Two cases showed sensitization against the non-α-Gal epitope of cetuximab. The overall positivity rate for both ImmunoCAP-beef and cetuximab immunoblotting was 1.3%, without significant inter-institute differences. Male sex was associated with positive beef-specific IgE. The prevalence of subclinical sensitization to α-Gal is estimated at 2.0%-4.0% in Japan and may be higher in rural areas, supporting an association between tick bites and α-Gal sensitization. In contrast, the prevalence of subclinical sensitization to beef is 9.7% in Japan and is highest in Tokyo Metropolis, suggesting the presence of another IgE-binding epitope apart from α-Gal and another sensitization route in the sensitization to beef IgE.

Corrigendum to "Fatal anaphylaxis due to alpha-gal syndrome after initial cetuximab administration: The first forensic case report" [Legal Med. 51 (2021) 101878].