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Diagnostik des α‑Gal-Syndroms

Aktuelle Standards, Fallstricke und Perspektiven

Diagnostics of alpha-gal syndrome

Current standards, pitfalls and perspectives

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Zusammenfassung

Das α-Gal-Syndrom basiert auf einer Sensibilisierung auf das Kohlenhydratepitop Galactose-α-1,3-Galactose (α-Gal). Das Allergen findet sich in Säugetierfleisch und Innereien, aber auch weiteren Lebensmitteln und Medizinprodukten tierischen Ursprungs. Allergische Reaktionen treten bei Betroffenen, abhängig von der individuellen Toleranzschwelle und dem Einfluss von Kofaktoren, in der Regel mit einer zeitlichen Latenz zum Allergenkontakt auf. Für die Verdachtsdiagnose eines α-Gal-Syndroms können bereits anamnestische Hinweise im Patientengespräch richtungsweisend sein. Zur weiteren Objektivierung bedarf es besonderer Kenntnisse für die Durchführung und Interpretation der weiteren In-vitro- und In-vivo-Diagnostik: Während Prick-Tests mit kommerziellen Fleisch-Gesamtextraten häufig diagnostisch unzuverlässig sind, lässt sich bei Betroffenen regelhaft allergenspezifisches IgE (α-Gal) nachweisen. Zellbasierte Tests, wie z.B. der Basophilenaktivierungstest, finden bislang dagegen nur für experimentelle Fragestellungen Anwendung. Zur Beurteilung der klinischen Relevanz einer bestehenden Sensibilisierung sollte eine stationäre Provokationstestung, z.B. mit gekochtem Schweinefleisch oder Schweineniere und Berücksichtigung von Kofaktoren, angestrebt werden.

Abstract

α-Gal syndrome results from sensitization to the carbohydrate epitope galactose-α-1,3-galactose (α‑gal). The allergen occurs in mammalian meat and innards, but also in other foods and medical products of animal origin. Allergic reactions generally occur delayed after allergen intake with a latency period, depending on the individual tolerance threshold and the influence of cofactors. Details in the patient’s medical history can help to establish the suspected diagnosis of α‑gal syndrome. Confirmation of the diagnosis requires the expertise of specialists, experienced with the implementation and interpretation of in vitro and in vivo diagnostic tests. Whereas skin prick testing with commercial whole-meat extracts often does not provide reliable results, allergen-specific IgE (α-gal) is generally detectable in affected patients. Cell-based tests such as the basophil activation test are currently only employed in an experimental setting. To evaluate, whether a sensitization is clinically relevant, an in-patient oral food challenge should be performed, using for example cooked pork or porcine kidney in addition to suspected cofactors.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie am Biederstein, Technische Universität München, Biedersteinerstr. 29, 80802, München, Deutschland

    Andreas B. Weins, B. Eberlein & T. Biedermann

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  1. Andreas B. Weins
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  2. B. Eberlein
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  3. T. Biedermann
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Correspondence to Andreas B. Weins.

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Interessenkonflikt

A.B. Weins, B. Eberlein und T. Biedermann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Weins, A.B., Eberlein, B. & Biedermann, T. Diagnostik des α‑Gal-Syndroms. Hautarzt 70, 36–43 (2019). https://doi.org/10.1007/s00105-018-4288-1

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