A Case of α-Gal-Unrelated Red Meat-Induced Urticaria Treated by Omalizumab

A 70-year-old healthy woman was referred to our hospital for chronic urticaria. She did not have a history of allergy, asthma, and rhinitis. She was initially diagnosed with α-gal-related urticaria based on an episode of delayed-type urticaria after eating red meat. The results of the intracutaneous allergen test for beef and pork were negative. Fluorenzyme immunoassays specific for IgE against α-gal, beef, and pork were also negative. She was diagnosed with an α-gal-unrelated red meat allergy following the reproduction of urticaria by a food challenge test. The patient was unresponsive to several drugs, including antihistamines or immunosuppressants. However, omalizumab administration suppressed her symptoms. <b><i>Key Clinical Message:</i></b> The diagnosis of red meat allergy may require a repeatability test by consuming red meat even though serum α-gal IgE antibody might be negative. The α-gal-unrelated red meat urticaria may be responsive to omalizumab.

Red meat causing delayed anaphylactic airway edema: a case report

<p class="abstract">The goals of emergency management of angioedema include prevention of spontaneous eruption, maintaining and securing the airway and to stop the progression of the disease. Laryngeal edema is one of the life-threatening complications of angioedema that can be managed by endotracheal intubation or emergency tracheostomy or cricothyrotomy. Recently, delayed onset food induced anaphylactic reactions are being recognised widely due to better clinical knowledge and technology that can substantiate the diagnosis. The classical finding of anaphylaxis to only proteins have been disproved and delayed onset food allergy (i.e.) 3-6 hours after ingestion of food has been attributed to specific carbohydrate moieties in glycolipids and glycoproteins such as Galactose-α-1,3-galactose found in red meat (beef, pork and lamb). Even though it is seen rarely in the Indian population, it should be a part of the diagnostic algorithm in order to prevent fatal complications. Hereby reporting 39 years old male with undiagnosed red meat allergy presented with features of foreign body sensation throat and laryngeal oedema and managed conservatively with steroids and nebulisation.</p>

The first reported cases of meat allergy following tick bites in the UK

Allergic reactions frequently involve the production of immunoglobulin E (IgE) antibodies to proteins. However, reactions directed against carbohydrate moieties are increasingly being recognised. Tick bites can contribute to the development of immunoglobulin E to the galactose-1,3-galactose (alpha-gal) moiety on tick salivary proteins. These IgE molecules can cross-react with alpha-gal found in red meats, causing Type I IgE-mediated hypersensitivity reactions to these foods. We present three cases of delayed reactions to beef, pork and lamb in patients with prior tick bites and in the presence of a positive-specific IgE to alpha-gal. Patients were advised to avoid red meat consumption and to carry emergency treatment in the form of anti-histamines with or without adrenaline autoinjector devices. This is the first published report of red meat allergy caused by tick bites suffered in the UK.

Idiopathic Anaphylaxis: a Perplexing Diagnostic Challenge for Allergists

Purpose of Review The aim of this systematic review is to present the proposed theories of pathogenesis for idiopathic anaphylaxis (IA), to discuss its classification, its diagnostic approach, and management. Recent Findings IA represents a major diagnostic challenge and is diagnosed when excluding the possible identifiable triggers of anaphylaxis. The current research, however, revealed that certain conditions including mastocytosis, mast cell activation syndromes, and hereditary alpha tryptasemia can masquerade and overlap with its symptomatology. Also, newly identified galactose-alpha-1,3-galactose mammalian red meat allergy has recently been recognized as underlying cause of anaphylaxis in some cases that were previously considered as IA. Summary IA comprises a heterogenous group of conditions where, in some cases, inherently dysfunctional mast cells play a role in pathogenesis. The standard trigger avoidance strategies are ineffective, and episodes are unpredictable. Therefore, prompt recognition and treatment as well as prophylaxis are critical. The patients should always carry an epinephrine autoinjector.

Delayed urticaria or anaphylaxis after consumption of red meat with evidence of alpha-gal sensitisation

Food allergies to red meat, specifically to galactose-alpha-1,3-galactose (alpha-gal), a mammalian oligosaccharide, are considered to be very rare, especially in Asia and Latin America. Most of the cases reported are characterised by symptoms of delayed urticaria or anaphylaxis after the consumption of red meat. Sensitisation to red meat has been linked to the use of cetuximab or tick bites, especially from the Amblyomma americanum and Ixodes spp species. Here, we documented a case study from a Colombian male patient with symptoms of delayed urticaria and anaphylaxis with a history of tick bites in Colombia. The patient presented with IgE antibodies specific to alpha-gal, which is the most common epitope linked to red meat allergy induced by tick bites.