• Scott P Commins, Hayley R James, Libby A Kelly, Shawna L Pochan, Lisa J Workman, Matthew S Perzanowski, Katherine M Kocan, John V Fahy, Lucy W Nganga, Eva Ronmark, Philip J Cooper, and Thomas A E Platts-Mills.
• Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA, USA.
• J. Allergy Clin. Immunol. 2011 May 1; 127 (5): 1286-93.e6.

BackgroundIn 2009, we reported a novel form of delayed anaphylaxis to red meat that is related to serum IgE antibodies to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). Most of these patients had tolerated meat for many years previously. The implication is that some exposure in adult life had stimulated the production of these IgE antibodies.ObjectivesWe sought to investigate possible causes of this IgE antibody response, focusing on evidence related to tick bites, which are common in the region where these reactions occur.MethodsSerum assays were carried out with biotinylated proteins and extracts bound to a streptavidin ImmunoCAP.ResultsProspective studies on IgE antibodies in 3 subjects after tick bites showed an increase in levels of IgE to alpha-gal of 20-fold or greater. Other evidence included (1) a strong correlation between histories of tick bites and levels of IgE to alpha-gal (χ(2) = 26.8, P < .001), (2) evidence that these IgE antibodies are common in areas where the tick Amblyomma americanum is common, and (3) a significant correlation between IgE antibodies to alpha-gal and IgE antibodies to proteins derived from A americanum (r(s) = 0.75, P < .001).ConclusionThe results presented here provide evidence that tick bites are a cause, possibly the only cause, of IgE specific for alpha-gal in this area of the United States. Both the number of subjects becoming sensitized and the titer of IgE antibodies to alpha-gal are striking. Here we report the first example of a response to an ectoparasite giving rise to an important form of food allergy.Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

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