Invited Commentary: Alpha-Gal Allergy: Tip of the Iceberg to a Pivotal Immune Response


The syndrome of delayed allergic reactions to the carbohydrate galactose-alpha-1,3-galactose (“alpha-gal”) has become increasingly recognized in allergy and immunology clinics regionally throughout the southeastern USA. Due to the increasing awareness of this unique food allergy, cases have been identified in the northeastern and central USA as well as in Central and South America, Europe, Asia, Scandinavia, and Australia. Clinically, alpha-gal allergy is characterized by reactions to non-primate mammalian meat (e.g., beef, pork, lamb) that occur 3–6 h following exposure. The IgE response to alpha-gal is thought to develop after tick bites and can result in the loss of tolerance to foods that have been safely consumed for years. Although the initial description of alpha-gal allergy in 2009 was limited to red meat, this epitope is now identified in an expanded number of products, medications and foods—both labeled and unlabeled. Moreover, we are beginning to recognize that alpha-gal food allergy is the tip of the iceberg for this immune response.

This is a preview of subscription content, access via your institution.

Author information



Corresponding author

Correspondence to Scott P. Commins.

Ethics declarations

Conflict of Interest

Dr. Commins reports personal fees from Genentech, grants from NIH, and personal fees from Up-To-Date.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Commins, S.P. Invited Commentary: Alpha-Gal Allergy: Tip of the Iceberg to a Pivotal Immune Response. Curr Allergy Asthma Rep 16, 61 (2016).

Download citation


  • Alpha-gal
  • IgE
  • Red meat allergy
  • Delayed anaphylaxis
  • Anti-Gal
  • Tick bite and allergy