Alpha-gal syndrome: challenges to understanding sensitization and clinical reactions to alpha-gal. (1st September 2020)

• Record Type: Journal Article
• Authors: de la Fuente, José; Cabezas-Cruz, Alejandro; Pacheco, Iván
• Is Part Of: Expert review of molecular diagnostics. Volume 20:Number 9(2020)
• Page Start: 905
• Page End: 911
• Publication Date: 2020-09-01
• Subjects: Alpha-gal -- antibody -- allergy -- interleukin -- tick -- mammalian meat; Molecular diagnosis -- Periodicals; 616.0758205
• DOI: 10.1080/14737159.2020.1792781
• Languages: English
• ISSNs: 1473-7159

Abstract

ABSTRACT: Introduction: The α-Gal syndrome (AGS) is a type of allergy characterized by an IgE antibody response against the carbohydrate Galα1-3Galβ1-4GlcNAc-R (α-Gal). Tick bites are recognized as the most important cause of anti-α-Gal IgE antibody increase in humans. Several risk factors have been associated with the development of AGS, but their integration into a standardized disease diagnosis has proven challenging. Areas covered: Herein we discuss the current AGS diagnosis based on anti-α-Gal IgE titers and propose an algorithm that considers all co-factors in the clinical history of α-Gal-sensitized patients to be incorporated into the AGS diagnosis. The need for identification of host-derived gene markers and tick-derived proteins for the diagnosis of the AGS is also discussed. Expert opinion: The current AGS diagnosis based on anti-α-Gal IgE titers has limitations because not all patients sensitized to α-Gal and with anti-α-Gal IgE antibodies higher than the cutoff (0.35 IU/ml) develop anaphylaxis to mammalian meat and AGS. The basophil activation test proposed to differentiate between patients with AGS and asymptomatic α-Gal sensitization cannot be easily implemented as a generalized clinical test. In coming years, the algorithm proposed here could be used in a mobile application for easier AGS diagnosis in the clinical practice.