Trauma, Hemostasis, Coagulopathy, Resuscitation (11)Blood transfusion and management (10)Food Allergy and Anaphylaxis Research (8)Hemoglobin structure and function (6)Coronary Interventions and Diagnostics (3)
Miller MJ, Price C, Shields TC, Zarpak R, Lee P, et al.
Systematic reviews •
Tick bites may expose individuals to a carbohydrate not found in humans, galactose-alpha-1,3-galactose (alpha-gal). A spectrum of disorders may result from IgE-mediated hypersensitivity reactions to alpha-gal, including alpha-gal syndrome (AGS), an allergy to meat or meat-derived products usually presenting 2-6 h after consuming the product plus positive alpha-gal specific IgE testing for the oligosaccharide. Reports of anaphylaxis in group O recipients of group B plasma in the absence of other risk factors for severe allergic reactions to blood transfusion could be alpha-gal sensitization; the allergen galactose-alpha-1,3-galactose (Gal-alpha-1-3Galβ1-(3)4GlcNAc-R) is antigenically similar to the B blood group antigen (Gal-alpha-1-3(Fuc-alpha-1,2)Gal). The potential cross-reactivity of alpha-gal specific IgE to B type red blood cells may pose a safety consideration for blood donation and transfusion. This scoping review protocol will be used to research all publications on alpha-gal sensitization to (1) describe characteristics of all known cases of transfusion-related alpha-Gal syndrome (TRAGS) and hypersensitivity reactions to infusions of mammalian red meat-derived medical products besides blood components that may resemble TRAGS; (2) identify studies that explore possible relationships between alpha-gal sensitization and blood group that may be relevant to understanding TRAGS; (3) describe which clinical, laboratory, and epidemiologic parameters used to diagnose AGS food allergy are also appropriate to diagnose TRAGS; and (4) identify which diagnostic assays exist for AGS and how they are used for AGS and/or TRAGS. Using peer-reviewed search strategies, our study team will perform a scoping review with no date or language limit of all literature relevant to the research objectives in PubMed, Scopus, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, including title, abstract, full-text screening, and data collection using Covidence. This study involves published data predominantly from humans (and, rarely, animal) studies of diagnostic assays in development for use in humans. It does not require institutional review board or ethics approval. We intend to disseminate our findings to specialists in allergy, immunology, hematology, and blood banking and to patients or blood donors experiencing symptoms of alpha-gal sensitization. Open Science Framework (osf.io) (DOI: https://doi.org/10.17605/OSF.IO/WDZT6 ).
Miller MJ, Zarpak R, Lee P, Osterwind Z, Lenz M, et al.
Journal of translational medicine •
BACKGROUND: Tick bites may expose individuals to a carbohydrate not found in humans, galactose-alpha-1,3-galactose (alpha-gal), including allergy to mammalian red meat or red meat-derived products presenting 2–6 hours after consuming the product plus positive alpha-gal specific IgE testing that may indicate alpha-gal syndrome (AGS). Anaphylaxis in group O recipients of group B blood products in the absence of other risk factors for allergic transfusion reactions could be transfusion-related alpha-gal syndrome (TRAGS); galactose-alpha-1,3-galactose (Gal-alpha1-3 Galβ1-(3)4GlcNAc-R) is similar to the B blood group antigen (Gal-alpha1-3(Fuc-alpha-1,2)Gal). OBJECTIVES: To review scientific and grey literature with no date or language limit to: 1) describe characteristics of all known cases of transfusion-related alpha-gal syndrome (TRAGS) and hypersensitivity reactions to infusions of mammalian red meat-derived medical products besides blood components that may resemble TRAGS; 2) identify studies that explore possible relationships between alpha-gal sensitization and blood group that may be relevant to understanding TRAGS; 3) describe which clinical, laboratory, and epidemiologic parameters used to diagnose AGS food allergy are also appropriate to diagnose TRAGS; and 4) identify which diagnostic assays exist for AGS and how they are used for AGS and/or TRAGS. METHODS: Using search strategies peer-reviewed by biomedical librarians we performed a scoping review of literature in five medical databases, charted in Microsoft Excel and Covidence software. RESULTS: Of 11732 studies imported for screening, 3858 duplicates were removed and 7874 papers were screened. Title and abstract screening excluded 7383 papers. Full-text screening excluded 380 papers. Of the included papers, 20/111 (18%) addressed risk for alpha-gal allergy by blood group and 18/111 diagnostics (16%). CONCLUSION: A comprehensive literature review showed a possible association between alpha-gal allergy and blood group. Further guidance is needed regarding potential clinical implications.
Alpha-gal syndrome (AGS) is a potentially life-threatening acquired meat allergy associated with tick bites. The allergen Galactose-α-1,3-Galactose is antigenically similar to the B blood group antigen. B blood group status offers some protection against development of the allergy. Although not preferred practice, transfusion of plasma and platelets from group B donors is believed to be safe for group O recipients. Anaphylactic transfusion reactions were reported for three patients in two Washington DC hospitals from Nov 2022 to February 2023. A chart review was performed for all three patients. Patients or family members were interviewed, and IgE levels to alpha-gal were measured in two of the three patients. One reaction was acutely fatal. All reactions were to blood group B Plasma or Platelets in blood group O recipients. One patient had two prior anaphylactic reactions to group O RBCs and group B Plasma in a previous admission. All patients came from southern Maryland where AGS is an emerging problem. Two patients had histories of tick bites, previously unexplained gastrointestinal complaints, and abnormal elevated levels of IgE to alpha gal. Two patients had cat allergies. AGS is an emerging problem which may have implications for blood transfusion practice. Avoidance of blood group B antigen containing components may be prudent in non-blood group B patients with established AGS. Investigation for AGS should be considered in the evaluation of anaphylactic transfusion reactions.