• Jeffrey M Wilson, Alexander J Schuyler, Lisa Workman, Monica Gupta, Hayley R James, Jonathon Posthumus, Emily C McGowan, Scott P Commins, and Platts-Mills Thomas A E TAE Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va. Electronic address: tap2z@virginia.edu..
• Division of Allergy and Clinical Immunology, University of Virginia, Charlottesville, Va.
• J Allergy Clin Immunol Pract. 2019 Sep 1; 7 (7): 2348-2358.e4.

BackgroundRed meat allergy has historically been understood as a rare disease of atopic children, but the discovery of the "α-Gal syndrome," which relates to IgE to the oligosaccharide galactose-α-1,3-galactose (α-Gal), has challenged that notion.ObjectiveTo describe the clinical and immunologic characteristics of a large group of subjects with self-reported allergy to mammalian meat.MethodsThis was an observational study of 261 children and adults (range, 5-82 years) who presented for evaluation for allergic reactions to mammalian meat. Results were based on serum assays and a detailed questionnaire.Resultsα-Gal specific IgE ≥ 0.35 IU/mL was detected in 245 subjects and symptom onset occurred ≥2 hours after eating mammalian meat in 211 (81%). Component testing supported a diagnosis of α-Gal syndrome in 95%, pork-cat syndrome in 1.9%, and primary beef allergy in 1.1%. Urticaria was reported by 93%, anaphylaxis by 60%, and gastrointestinal symptoms by 64%. Levels of IgE and IgG specific to α-Gal were similar in subjects who reported early- or delayed-onset symptoms, and in those with and without anaphylaxis. Levels of α-Gal specific IgE and severity of reactions were similar among those with and without traditional atopy, and among children (n = 35) and adults (n = 226). Blood group B trended toward being under-represented among α-Gal-sensitized subjects; however, α-Gal specific IgE titers were high in symptomatic cases with B-antigen.ConclusionsThe α-Gal syndrome is a regionally common form of food allergy that has a characteristic but not universal delay in symptom onset, includes gastrointestinal symptoms, can develop at any time in life, and is equally common in otherwise nonatopic individuals.Copyright © 2019. Published by Elsevier Inc.

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