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The red meat allergy syndrome in Sweden

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Summary

In the last decade, a novel type of food allergy presenting with severe allergic reactions several hours after consumption of red meat has been recognized. The allergic responses are due to IgE antibodies directed against the carbohydrate epitope galactose-α-1,3-galactose (α-Gal) found in mammalian meat. This review presents the red meat allergy syndrome in Sweden, discusses the features of the immune response to carbohydrates, and highlights the presence of heat stable α-Gal-containing proteins in meat.

The number of diagnosed red meat allergy cases in Sweden has increased significantly over the past few years. All patients have been tick bitten. Our recent work has shown that α-Gal is present in the European tick Ixodes ricinus (I. ricinus), thus potentially explaining the strong association between anti-α-Gal IgE and tick bites, with development of red meat allergy as a secondary phenomenon. Further studies using immunoproteomics have identified novel α-Gal-containing meat proteins that bound IgE from red meat allergic patients. Four of these proteins were stable to thermal processing pointing to the fact that the allergenicity of red meat proteins is preserved in cooked meat. In keeping with the fact that the α-Gal epitope is structurally related to the blood group B antigen, a positive association with the B-negative blood groups among our red meat allergic patients was noted. A selective IgE reactivity to the pure carbohydrate moiety was observed when investigating the specificity of the α-Gal immune response. IgE from red meat allergic patients does not recognize the other major mammalian carbohydrate, N-glycolylneuraminic acid (Neu5Gc), also present in high amounts in red meat. Furthermore, neither common cross-reactive carbohydrate determinants (CCDs) from plants nor venoms are targets of the IgE response in these patients.

Taken together, the α-Gal carbohydrate has shown to be a potentially clinically relevant allergen that should be taken into account in the diagnosis of food allergy. Many new findings in the field of red meat allergy have been obtained during the past years, but further efforts to understand the process of digestion, absorption, and delivery of α-Gal-containing molecules to the circulation are needed.

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Abbreviations

α-Gal:

Galactose-α-1,3-galactose

CCD:

Cross-reactive carbohydrate determinant

Ig:

Immunoglobulin

I. ricinus:

Ixodes ricinus

B. taurus:

Bos taurus

Neu5Gc:

N-glycolylneuraminic acid

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Author information

Authors and Affiliations

  1. Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden

    Danijela Apostolovic, Thi Anh Thu Tran, Sara Sánchez-Vidaurre, Carl Hamsten & Marianne van Hage MD, PhD

  2. Center of Excellence for Molecular Food Sciences, Faculty of Chemistry, University of Belgrade, Belgrade, Serbia

    Danijela Apostolovic

  3. Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden

    Maria Starkhammar

  4. Center for Inflammatory Diseases, Karolinska Institutet, Stockholm, Sweden

    Carl Hamsten

  5. Immunology and Allergy Unit, Department of Medicine, Solna Karolinska Institutet, Karolinska University Hospital Solna L2:04, SE-171 76, Stockholm, Sweden

    Marianne van Hage MD, PhD

Authors
  1. Danijela Apostolovic
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  2. Thi Anh Thu Tran
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  3. Maria Starkhammar
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  4. Sara Sánchez-Vidaurre
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  5. Carl Hamsten
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  6. Marianne van Hage MD, PhD
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Corresponding author

Correspondence to Marianne van Hage MD, PhD.

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Conflict of interest

The authors declare that there are no conflicts of interest.

Acknowledgements

This work was supported by grants from the Swedish Research Council, the Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Asthma and Allergy Association’s Research Foundation, the King Gustaf V 80th Birthday Foundation, the Hesselman Foundation, the Konsul Th. C. Bergh Foundation, the Magnus Bergvall Foundation, The Swedish Association for Allergology, The Center for Inflammatory Diseases, and Karolinska Institutet.

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Apostolovic D, Tran TAT, Starkhammar M, Sánchez-Vidaurre S, Hamsten C, van Hage M. The red meat allergy syndrome in Sweden. Allergo J Int 2016;25:49–54 DOI: 10.1007/s15007-016-1030-0

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Apostolovic, D., Tran, T.A.T., Starkhammar, M. et al. The red meat allergy syndrome in Sweden. Allergo J 25, 29–34 (2016). https://doi.org/10.1007/s15007-016-1044-7

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