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Saadalla A, Jacela J, Poll R, Slev P. Immunoassay Testing of Alpha-Gal Specific Immunoglobulin-E: Data from a National Reference Laboratory. J Appl Lab Med 2024; 9:262-272. [PMID: 38424720 DOI: 10.1093/jalm/jfad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/24/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Immunoassay measurements of serum alpha-gal (AG) specific IgE (sIgE) enable antibody detection and quantification with high sensitivity and specificity and are essential for AG syndrome diagnosis and patient management. We here present and analyze results from over 15 000 patient serum samples tested using the ImmunoCAP (Thermo/Phadia) assay. METHODS AG-sIgE levels and positivity rates were correlated to patient age, gender, geographic location, repeat testing results, sIgE levels to co-tested red meat whole allergen extracts, and Rocky Mountain spotted fever (RMSF) serology performed on a subset of patient samples. RESULTS Of the tested samples, 36.7% contained detectable (>0.1 KUA/L) AG-sIgE. Antibody levels were higher in patients of older age, in samples submitted from lower midwestern and southern states, and during the June-December period of the year. Specific IgE to co-tested red meat whole allergens showed moderate to strong correlation to AG-sIgE and were of lower levels. Samples with positive RMSF IgG titers (≥1:64) were of overall higher AG-IgE levels. CONCLUSION Findings are consistent with the role of lone star ticks in AG syndrome pathogenesis. Levels of measured sIgE to AG are higher than co-tested sIgE to red meat whole allergen, consistent with the improved diagnostic performance of component-resolved testing.
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Affiliation(s)
- Abdulrahman Saadalla
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
- Immunology section, ARUP Laboratories, Salt Lake City, UT, United States
| | - Jessica Jacela
- Immunology section, ARUP Laboratories, Salt Lake City, UT, United States
| | - Rick Poll
- Immunology section, ARUP Laboratories, Salt Lake City, UT, United States
| | - Patricia Slev
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
- Immunology section, ARUP Laboratories, Salt Lake City, UT, United States
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2
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Perusko M, Grundström J, Eldh M, Hamsten C, Apostolovic D, van Hage M. The α-Gal epitope - the cause of a global allergic disease. Front Immunol 2024; 15:1335911. [PMID: 38318181 PMCID: PMC10838981 DOI: 10.3389/fimmu.2024.1335911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
The galactose-α-1,3-galactose (α-Gal) epitope is the cause of a global allergic disease, the α-Gal syndrome (AGS). It is a severe form of allergy to food and products of mammalian origin where IgE against the mammalian carbohydrate, α-Gal, is the cause of the allergic reactions. Allergic reactions triggered by parenterally administered α-Gal sources appear immediately, but those triggered via the oral route appear with a latency of several hours. The α-Gal epitope is highly immunogenic to humans, apes and old-world monkeys, all of which produce anti-α-Gal antibodies of the IgM, IgA and IgG subclasses. Strong evidence suggests that in susceptible individuals, class switch to IgE occurs after several tick bites. In this review, we discuss the strong immunogenic role of the α-Gal epitope and its structural resemblance to the blood type B antigen. We emphasize the broad abundance of α-Gal in different foods and pharmaceuticals and the allergenicity of various α-Gal containing molecules. We give an overview of the association of tick bites with the development of AGS and describe innate and adaptive immune response to tick saliva that possibly leads to sensitization to α-Gal. We further discuss a currently favored hypothesis explaining the mechanisms of the delayed effector phase of the allergic reaction to α-Gal. We highlight AGS from a clinical point of view. We review the different clinical manifestations of the disease and the prevalence of sensitization to α-Gal and AGS. The usefulness of various diagnostic tests is discussed. Finally, we provide different aspects of the management of AGS. With climate change and global warming, the tick density is increasing, and their geographic range is expanding. Thus, more people will be affected by AGS which requires more knowledge of the disease.
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Affiliation(s)
- Marija Perusko
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Innovative Centre of the Faculty of Chemistry, University of Belgrade, Belgrade, Serbia
| | - Jeanette Grundström
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eldh
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carl Hamsten
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Danijela Apostolovic
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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3
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Germán-Sánchez A, Alonso-Llamazares A, García-González F, Matala-Ahmed B, Melgar-Reyes CS, Antepara-Ercoreca I. Diagnostic validity of specific immunoglobulin E levels to alpha-gal in alpha-gal syndrome: a cross-sectional analysis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:102. [PMID: 38037176 PMCID: PMC10691071 DOI: 10.1186/s13223-023-00856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The diagnosis of Alpha-gal Syndrome (AGS) is based on the presence of symptoms after being exposed to potential sources of alpha-gal together with values of specific IgE (sIgE) to alpha-gal ≥ 0.1 kUA/L or ≥ 0.35 kUA/L. The aim of this study was to evaluate the diagnostic validity of sIgE levels to alpha-gal ≥ 0.1 kUA/L for identifying AGS. METHODS This was a cross-sectional analysis of adult patients with available data on sIgE levels to alpha-gal, classified into two groups according to the presence (Group 1) or absence (Group 2) of symptoms after being exposed to potential sources of alpha-gal. Values of sIgE to alpha-gal ≥ 0.1 kUA/l were considered a positive result. A descriptive analysis of internal and external validity parameters was performed in the entire population and adjusted by sex. RESULTS The study included 33 individuals in Group 1 and 65 in Group 2, with a mean age of around 47 years. The analysis of internal validity parameters revealed a high sensitivity, specificity, and positive probability ratio, with higher sensitivity in men and higher specificity in women. The analysis of external validity parameters showed a high negative predictive value and global value in all populations and both sexes. However, the positive predictive value was relatively high in men, but low in women. CONCLUSIONS Our results suggest that sIgE levels ≥ 0.1 kUA/L may be a useful tool for the diagnosis of AGS, although other factors and diagnostic techniques should also be considered.
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Affiliation(s)
- Adrián Germán-Sánchez
- Allergy Department, Basurto University Hospital, Bilbao, Spain.
- Allergy Department, Castellon University General Hospital, Avda/ Benicassim, 128, Castelló de la Plana 12004 (Castelló, Castellon, Spain.
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Anaphylaxis to Excipients in Current Clinical Practice: Evaluation and Management. Immunol Allergy Clin North Am 2022; 42:239-267. [PMID: 35469617 PMCID: PMC9907103 DOI: 10.1016/j.iac.2021.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Excipients are the inactive ingredients in a drug or product that help to stabilize, preserve, or enhance the pharmacokinetics and bioavailability of the active ingredients. Excipient allergy is rare and hence often missed or misdiagnosed due to lack of awareness of the need to carefully review all drug ingredients. For the patient, excipient allergy can be frightening and potentially disruptive to health care delivery. This narrative review provides a clinically oriented, international, collaborative perspective on excipient allergy testing, management of future health care safety, limitations in our testing modalities, and barriers to optimal care.
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Vanegas E, Felix M, Farfán Bajaña MJ, Robles-Velasco K, Panchana Lascano M, Crespo Shijin C, Hinostroza Logroño R, Greiding L, Cherrez-Ojeda I. An approach to a patient with suspected meat allergy due to underlying alpha gal syndrome in a resource-limited setting: A case report. JAAD Case Rep 2022; 21:173-175. [PMID: 35252518 PMCID: PMC8888892 DOI: 10.1016/j.jdcr.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Emanuel Vanegas
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
| | - Miguel Felix
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
| | - María José Farfán Bajaña
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
| | - Karla Robles-Velasco
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
| | | | - Carolina Crespo Shijin
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
| | - Romina Hinostroza Logroño
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
| | - Leonardo Greiding
- Instituto Argentino de Alergia e Inmunología, Buenos Aires, Argentina
| | - Iván Cherrez-Ojeda
- Respiralab Research Group, Guayaquil, Ecuador
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
- Correspondence to: Iván Cherrez-Ojeda, MD, MSc, Universidad Espíritu Santo, School of Medicine, Km. 2.5 vía La Puntilla, Samborondón, Guayas 0901952, Ecuador.
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Tick-human interactions: from allergic klendusity to the α-Gal syndrome. Biochem J 2021; 478:1783-1794. [PMID: 33988703 DOI: 10.1042/bcj20200915] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/06/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
Ticks and the pathogens they transmit, including bacteria, viruses, protozoa, and helminths, constitute a growing burden for human and animal health worldwide. The ability of some animal species to acquire resistance to blood-feeding by ticks after a single or repeated infestation is known as acquired tick resistance (ATR). This resistance has been associated to tick-specific IgE response, the generation of skin-resident memory CD4+ T cells, basophil recruitment, histamine release, and epidermal hyperplasia. ATR has also been associated with protection to tick-borne tularemia through allergic klendusity, a disease-escaping ability produced by the development of hypersensitivity to an allergen. In addition to pathogen transmission, tick infestation in humans is associated with the α-Gal syndrome (AGS), a type of allergy characterized by an IgE response against the carbohydrate Galα1-3Gal (α-Gal). This glycan is present in tick salivary proteins and on the surface of tick-borne pathogens such as Borrelia burgdorferi and Anaplasma phagocytophilum, the causative agents of Lyme disease and granulocytic anaplasmosis. Most α-Gal-sensitized individuals develop IgE specific against this glycan, but only a small fraction develop the AGS. This review summarizes our current understanding of ATR and its impact on the continuum α-Gal sensitization, allergy, and the AGS. We propose that the α-Gal-specific IgE response in humans is an evolutionary adaptation associated with ATR and allergic klendusity with the trade-off of developing AGS.
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Garcia MB, Gomez-Samper AF, Garcia E, Peñaranda A. Delayed urticaria or anaphylaxis after consumption of red meat with evidence of alpha-gal sensitisation. BMJ Case Rep 2020; 13:13/12/e236923. [PMID: 33372012 PMCID: PMC7771198 DOI: 10.1136/bcr-2020-236923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Maria Beatriz Garcia
- Allergology Service, Fundacion Santa Fé de Bogotá, Bogotá, Colombia,Allergology Service, Unimeq, Bogotá, Colombia,School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Elizabeth Garcia
- Allergology Service, Fundacion Santa Fé de Bogotá, Bogotá, Colombia,Allergology Service, Unimeq, Bogotá, Colombia,School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Augusto Peñaranda
- School of Medicine, Universidad de los Andes, Bogotá, Colombia,Otolaryngology Department, Fundación Santa Fé de Bogotá, Bogotá, Colombia,Otolaryngology Service, Unimeq, Bogotá, Colombia
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8
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Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol 2020; 16:667-677. [PMID: 32571129 PMCID: PMC8344025 DOI: 10.1080/1744666x.2020.1782745] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Alpha-gal Syndrome (AGS) is a unique allergy to non-primate mammalian meat (and derived-products) that is associated with tick bites and is due to a specific IgE antibody to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). AGS has many novel features that broaden the paradigm of food allergy, including that reactions are delayed 3-6 hours after exposure and patients have frequently tolerated red meat for many years prior to the development of allergic reactions. Due to the ubiquitous inclusion of mammal-derived materials in foods, medications, personal products and stabilizing compounds, full avoidance is difficult to achieve. AREAS COVERED This review describes the author's experience with diagnosis, management, and design of appropriate avoidance for patients with AGS and provides clinicians with practical advice for care of these patients. EXPERT OPINION The number of patients with AGS is rising and may have exceeded awareness of the diagnosis amongst healthcare providers. In summarizing experience gained to thus far, we hope to create a resource for identifying and managing this unique allergic syndrome.
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Affiliation(s)
- Scott P Commins
- Division of Allergy, Immunology and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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9
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Kiewiet MBG, Apostolovic D, Starkhammar M, Grundström J, Hamsten C, van Hage M. Clinical and Serological Characterization of the α-Gal Syndrome—Importance of Atopy for Symptom Severity in a European Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2027-2034.e2. [DOI: 10.1016/j.jaip.2020.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
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10
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Hodžić A, Mateos-Hernández L, de la Fuente J, Cabezas-Cruz A. Delayed hypersensitivity reaction to mammalian galactose-α-1,3-galactose (α-Gal) after repeated tick bites in a patient from France. Ticks Tick Borne Dis 2019; 10:1057-1059. [PMID: 31176665 DOI: 10.1016/j.ttbdis.2019.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
Abstract
The α-Gal syndrome is a tick-associated and emerging IgE-mediated hypersensitivity reaction directed against the carbohydrate Galα1-3Galβ1-(3)4GlcNAc-R (α-Gal) epitope after red meat intake. Herein, we describe a clinical case of a 44-year-old French patient who suffered from recurrent anaphylactic reactions after mammalian meat consumption for five years before the final diagnosis of the α-Gal syndrome was established in 2018. The patient also reported multiple tick bites prior to symptom onset. This unique type of allergy has increasingly been reported across the world, but it is still unknown in many European countries. Therefore, the present clinical case should increase awareness among primary care practitioners and further improve the early diagnosis of the α-Gal syndrome in affected individuals.
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Affiliation(s)
- Adnan Hodžić
- Institute of Parasitology, Department of Pathobiology, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210 Vienna, Austria.
| | - Lourdes Mateos-Hernández
- UMR BIPAR, INRA, ANSES, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 14 rue Pierre et Marie Curie, 94706 Maisons-Alfort, France
| | - Jose de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos IREC-CSIC-UCLM-JCCM, Ronda de Toledo s/n, 13005 Ciudad Real, Spain; Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, 74078 Stillwater, OK, USA
| | - Alejandro Cabezas-Cruz
- UMR BIPAR, INRA, ANSES, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 14 rue Pierre et Marie Curie, 94706 Maisons-Alfort, France.
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11
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Abstract
PURPOSE OF REVIEW To highlight recent advances in our understanding of the clinical features, prevalence, and pathophysiology of red meat allergy. RECENT FINDINGS Allergic reactions to red (i.e. mammalian) meat have historically been considered rare and described primarily in young atopic children. It is now clear that red meat allergy is not uncommon in some parts of the world in other age groups. Strikingly, the majority of these cases relate to specific IgE to galactose-α-1,3-galactose, an oligosaccharide of nonprimate mammals. The mechanism of sensitization in this syndrome relates to bites of certain hard ticks and the clinical reactions often have a delay of 3 to 6 h. An additional form of red meat allergy relates to inhalant sensitization to mammalian proteins. The best characterized example involves cat-sensitized patients with specific IgE to cat serum albumin who can react to ingested pork because of cross-sensitization to pork serum albumin. SUMMARY Red meat allergy is more common than previously appreciated and relates to at least three different forms that are distinguished by mechanisms of sensitization and have characteristic clinical and immunologic features.
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Affiliation(s)
- Jeffrey M. Wilson
- Division of Allergy and Immunology, University of Virginia, Charlottesville, VA, 22908
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12
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Kim SR, Park KH, Lee JH, Kim BJ, Hwang JH, Lim KJ, Park JW. Validation of PROTIA™ Allergy-Q 64 Atopy® as a Specific IgE Measurement Assay for 10 Major Allergen Components. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:422-432. [PMID: 30912330 PMCID: PMC6439187 DOI: 10.4168/aair.2019.11.3.422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Component-resolved diagnostics (CRD) is expected to provide additional diagnostic information in allergic patients. PROTIA™ Allergy-Q 64 Atopy®, a recently developed CRD-based multiplex specific immunoglobulin E (sIgE) assay, can quantitatively measure sIgE to major allergen components. METHODS The sIgE detection by PROTIA™ Allergy-Q 64 Atopy® and ImmunoCAP® assays was compared using the sera of 125 Korean allergic patients. Group 1 and 2 allergens of house dust mites (HDMs; Dermatophagoides farinae (Der f) 1 and Der f 2 in PROTIA™ Allergy-Q 64 Atopy®, Dermatophagoides pteronyssinus (Der p) 1 and Der p 2 in ImmunoCAP®), Bet v 1, Fel d 1, Que a 1, ω-5 gliadin, α-lactalbumin, β-lactoglobulin, casein and α-Gal were measured by both assays. RESULTS Comparing the results from the 2 assays, the agreement rate for all the 10 allergens was > 88% (group 1 HDM allergen, 100%; group 2 HDM allergen, 94.6%; Bet v 1, 97.4%; Fel d 1, 90.5%; Que a 1, 89.2%; α-lactalbumin, 96%; β-lactoglobulin, 88%; casein, 88%; ω-5 gliadin, 96%; α-Gal, 100%). Correlation analysis indicated that, all the 10 allergen sIgEs showed more than moderate positive correlation (Pearson correlation coefficients > 0.640). Additionally, intra-class comparison showed more than high correlation for all the 10 allergens (Spearman's rank correlation coefficients > 0.743). CONCLUSIONS PROTIA™ Allergy-Q 64 Atopy® is reliable and comparable to the ImmunoCAP® assay for component-resolved diagnosis.
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Affiliation(s)
- Sung Ryeol Kim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | - Jung Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
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13
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Mabelane T, Basera W, Botha M, Thomas HF, Ramjith J, Levin ME. Predictive values of alpha-gal IgE levels and alpha-gal IgE: Total IgE ratio and oral food challenge-proven meat allergy in a population with a high prevalence of reported red meat allergy. Pediatr Allergy Immunol 2018; 29:841-849. [PMID: 30144162 DOI: 10.1111/pai.12969] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe meat allergy with anaphylaxis may be caused by sensitization to alpha-gal. Levels of alpha-gal sensitization that correlate with high risk of meat allergy are currently unknown. We have identified an area with a high prevalence of reported red meat allergy which offered the opportunity to evaluate the diagnostic value of IgE antibody tests. METHODS To determine levels of alpha-gal IgE and alpha-gal:total IgE ratio in a large cohort of subjects with challenge-proven meat allergy compared with control subjects from the same environment, we conducted fieldwork assessing 131 participants who reported adverse reactions to meat, and 26 control subjects, by questionnaires, IgE sensitization to alpha-gal and oral food challenge to beef sausage. RESULTS Eighty-four participants were diagnosed with alpha-gal allergy. Alpha-gal IgE ranged between 0.7 and 344.5 kU/L. Alpha-gal:total IgE ratio ranged from 0.1% to 67.6%. Logistic regression analysis showed both alpha-gal IgE and alpha-gal:total IgE ratio strongly correlated with meat allergy, with AUC of 0.95. The values giving the best correct classification were IgE of 2.00 kU/L and ratio of 0.75%. The value above which there is a 95% probability of meat allergy is IgE>5.5 kU/L and ratio of 2.12%. CONCLUSION Alpha-gal allergy in a population with a high prevalence of reported red meat allergy showed a more rapid onset of symptoms than previously described and a high prevalence of isolated subjective gastrointestinal manifestations. Cutoff values are described for levels of sensitization to alpha-gal IgE and alpha-gal:total IgE ratio that are highly likely to result in clinically significant meat allergy.
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Affiliation(s)
- Tshegofatso Mabelane
- Department of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Wisdom Basera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Maresa Botha
- Department of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Heidi Facey Thomas
- Department of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - Jordache Ramjith
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael E Levin
- Department of Paediatric Allergology, University of Cape Town, Cape Town, South Africa.,Invivo Planetary Health, Group of the Worldwide Universities Network (WUN)
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14
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Brestoff JR, Tesfazghi MT, Zaydman MA, Jackups R, Kim BS, Scott MG, Gronowski AM, Grossman BJ. The B antigen protects against the development of red meat allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1790-1791.e3. [PMID: 29510233 DOI: 10.1016/j.jaip.2018.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/21/2018] [Accepted: 02/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan R Brestoff
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo.
| | - Merih T Tesfazghi
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo
| | - Mark A Zaydman
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo
| | - Ronald Jackups
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo
| | - Brian S Kim
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Mo; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Mo; Center for the Study of Itch, Washington University School of Medicine, St. Louis, Mo
| | - Mitchell G Scott
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo
| | - Ann M Gronowski
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo
| | - Brenda J Grossman
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo
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Sim DW, Lee JS, Park KH, Jeong KY, Ye YM, Lee JH, Park JW. Accurate assessment of alpha-gal syndrome using cetuximab and bovine thyroglobulin-specific IgE. Mol Nutr Food Res 2017; 61. [PMID: 28497612 DOI: 10.1002/mnfr.201601046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 12/20/2022]
Abstract
SCOPE IgE against galactose-α-1,3-galactose (α-Gal) causes alpha-gal syndrome. Bovine thyroglobulin (BTG) and cetuximab share this epitope. We aimed to determine the utility of specific IgE (sIgE) against cetuximab as compared to BTG for diagnosing alpha-gal syndrome. METHODS AND RESULTS Twelve patients with alpha-gal syndrome, 11 patients with immediate beef or pork allergy, 18 asymptomatic individuals with meat sensitization, and 10 non-atopic subjects were enrolled. We checked the levels of sIgE against BTG and cetuximab using the streptavidin CAP assay. Additionally, IgE reactivity to BTG and cetuximab was assessed by immunoblotting. All alpha-gal syndrome patients had a high concentration of sIgE against BTG, and cetuximab. In contrast to alpha-gal syndrome, patients with immediate allergic reactions to meat consumption and those with asymptomatic sensitization had significantly lower concentration of BTG and cetuximab sIgE, and a high prevalence of sIgE against bovine or porcine serum albumin. Although the concentration of sIgE against alpha-gal was lower in individuals with asymptomatic sensitization, IgE immunoblotting showed the presence of sIgE against α-Gal in this group. CONCLUSION Differentiation of alpha-gal syndrome from patients with immediate allergy to meat consumption or asymptomatic sensitization requires quantification of cetuximab- or BTG-induced sIgE via detection of IgE for α-gal.
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Affiliation(s)
- Da Woon Sim
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Sun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yong Jeong
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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