Michael Levin1, Danijela Apostolovic2, Tilo Biedermann3, Scott P Commins4, Onyinye I Iweala5, Thomas A E Platts-Mills6, Eleonora Savi7, Marianne van Hage2, Jeffrey M Wilson6. 1. Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa. Electronic address: Michael.levin@uct.ac.za. 2. Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden. 3. Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany. 4. Departments of Medicine & Pediatrics, University of North Carolina, Chapel Hill, North Carolina. 5. Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina, Chapel Hill, North Carolina. 6. Division of Allergy & Clinical Immunology, University of Virginia, Charlottesville, Virginia. 7. Allergy Unit, Piacenza Hospital, Piacenza, Italy.
Abstract
OBJECTIVE: To review published studies on galactose α-1,3-galactose (α-gal), a carbohydrate epitope found on proteins and lipids in nonprimate mammals and present in foods (particularly organ or fat-rich red meat) and medications, where it causes delayed-onset and immediate-onset anaphylaxis. DATA SOURCES: A literature search for the terms galactose α-1,3-galactose and α-gal using PubMed and Embase was performed. STUDY SELECTIONS: Studies on α-gal were included in this review. RESULTS: Several species of ticks contain α-gal epitopes and possibly salivary adjuvants that promote high titer sensitization and clinical reactivity. Risk factors for α-gal syndrome include exposure to ticks of particular species. Age and sex differences seen in various cohorts possibly reflect the prevalence of these exposures that vary according to setting. CONCLUSION: The reason and mechanisms for delayed onset of food-related anaphylaxis and the preponderance of abdominal reactions are not clear but may involve the kinetics of allergen digestion and processing or immunologic presentation via a different mechanism from usual immediate-type food allergy.
OBJECTIVE: To review published studies on galactose α-1,3-galactose (α-gal), a carbohydrate epitope found on proteins and lipids in nonprimate mammals and present in foods (particularly organ or fat-rich red meat) and medications, where it causes delayed-onset and immediate-onset anaphylaxis. DATA SOURCES: A literature search for the terms galactose α-1,3-galactose and α-gal using PubMed and Embase was performed. STUDY SELECTIONS: Studies on α-gal were included in this review. RESULTS: Several species of ticks contain α-gal epitopes and possibly salivary adjuvants that promote high titer sensitization and clinical reactivity. Risk factors for α-gal syndrome include exposure to ticks of particular species. Age and sex differences seen in various cohorts possibly reflect the prevalence of these exposures that vary according to setting. CONCLUSION: The reason and mechanisms for delayed onset of food-related anaphylaxis and the preponderance of abdominal reactions are not clear but may involve the kinetics of allergen digestion and processing or immunologic presentation via a different mechanism from usual immediate-type food allergy.
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