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Clinical and Molecular Allergy
Published in: Clinical and Molecular Allergy 1/2012

Open Access 01-12-2012 | Review

Anaphylactic Reactions to Oligosaccharides in Red Meat: a Syndrome in Evolution

Authors: Hana Saleh, Scott Embry, Andromeda Nauli, Seif Atyia, Guha Krishnaswamy

Published in: Clinical and Molecular Allergy | Issue 1/2012

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Abstract

Objective

While most allergic responses to food are directed against protein epitopes and occur within 30 minutes of ingesting the allergen, recent studies suggest that delayed reactions may occur, sometimes mediated by IgE antibodies directed against carbohydrate moieties. The objective of this review is to summarize the clinical features and management of delayed hypersensitivity reactions to mammalian meat mediated by IgE antibodies to galactose-alpha 1,3-galactose (alpha-gal), an oligosaccharide.

Methods

A PubMed search was conducted with MeSH terms: galactosyl-(1,3) galactose, oligosaccharides, cetuximab, allergy/hypersensitivity, and anaphylaxis. Reported cases with alpha-gal-mediated reactions were reviewed. This research study was approved by the Institutional Review Board of East Tennessee State University.

Results

Thirty-two cases of adults presenting with red-meat induced allergy thought to be related to oligosaccharides have been reported in the literature so far, making this a rare and evolving syndrome. Most of these patients demonstrated delayed reactions to beef, as was seen in the case reported by us in this manuscript. IgE specific to alpha-gal was identified in most patients with variable response to skin testing with beef and pork. Inhibition studies in some cases showed that the IgE antibodies to beef were directed towards alpha-gal in the meat rather than the protein. The patients often reported history of tick bites, the significance of which is unclear at present. Reactions to cetuximab, a monoclonal antibody, are mediated by a similar mechanism, with IgE antibodies directed against an alpha-gal moiety incorporated in the drug structure.

Conclusion

Alpha-gal is an oligosaccharide recently incriminated in delayed anaphylactic reactions to mammalian meats such as to beef, pork, and lamb. It appears that anaphylactic reactions to the anti-cancer biological agent, cetuximab, may be linked mechanistically to the same process. More studies are required to understand the underlying molecular basis for these delayed reactions in specific, and their broader implications for host defense in general.
Appendix
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Metadata
Title
Anaphylactic Reactions to Oligosaccharides in Red Meat: a Syndrome in Evolution
Authors
Hana Saleh
Scott Embry
Andromeda Nauli
Seif Atyia
Guha Krishnaswamy
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Clinical and Molecular Allergy / Issue 1/2012
Electronic ISSN: 1476-7961
DOI
https://doi.org/10.1186/1476-7961-10-5

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