A Peculiar Cause of Anaphylaxis: No More steak?
The Journey to Discovery of a Newly Recognized Allergy to Galactose-alpha-1,3-galactose Found in Mammalian Meat
Clinical Practice: Clinical Vignettes
First Online: 20 July 2012 Received: 28 February 2012 Revised: 15 May 2012 Accepted: 08 June 2012 DOI:
Cite this article as: Wolver, S.E., Sun, D.R., Commins, S.P. et al. J GEN INTERN MED (2013) 28: 322. doi:10.1007/s11606-012-2144-z
In recent years, a newly recognized allergic disease has been uncovered, and seemingly idiopathic causes of anaphylaxis now have an explanation. Individuals bitten by the lone star tick may develop IgE antibodies to the carbohydrate galactose-α-1,3-galactose (alpha-gal). Upon exposure of sensitized subjects to mammalian meat containing alpha-gal on glycoproteins or glycolipids, delayed anaphylaxis may ensue, often three to six hours after ingestion.
Many of these individuals have negative allergy skin prick tests to meat, further obscuring the diagnosis. With the recent development of IgE alpha-gal tests, the clinical diagnosis can be confirmed in the laboratory. 1
Wolver and Sun contributed equally to this paper.
Commins SP, Satinover SM, Hosen J, et al.
Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123(2):426–33.
Chung CH, Mirakhur B, Chan E, et al.
Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med. 2008;358(11):1109–17.
Commins SP, James HR, Kelly LA, et al.
The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2011;127(5):1286,93.e6.
Commins SP, Platts–Mills TA.
Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant. J Allergy Clin Immunol. 2009;124(4):652–7.
Qian J, Liu T, Yang L, Daus A, Crowley R, Zhou Q.
Structural characterization of N-linked oligosaccharides on monoclonal antibody cetuximab by the combination of orthogonal matrix-assisted laser desorption/ionization hybrid quadrupole-quadrupole time-of-flight tandem mass spectrometry and sequential enzymatic digestion. Anal Biochem. 2007;364(1):8–18.
O’Neil BH, Allen R, Spigel DR, et al.
High incidence of cetuximab-related infusion reactions in Tennessee and North Carolina and the association with atopic history. J Clin Oncol. 2007;25(24):3644–8.
Chiggers, HYG-2100-98 [Internet]. Columbus, Ohio: Ohio State University Extension; 2007 [updated October 08, 2007; cited 4/30/2012]. Available from:
Commins SP, Platts–Mills TA.
Allergenicity of carbohydrates and their role in anaphylactic events. Curr Allergy Asthma Rep. 2010;10(1):29–33.
Nunez R, Carballada F, Gonzalez-Quintela A, Gomez-Rial J, Boquete M, Vidal C. Delayed mammalian meat-induced anaphylaxis due to galactose-alpha-1,3-galactose in 5 european patients. J Allergy Clin Immunol. 2011;128(5):1122,4.e1. Copyright information
© Society of General Internal Medicine 2012