Alpha-Gal Syndrome



What is Alpha-Gal Syndrome?

Alpha-Gal Syndrome (AGS) is caused by an allergic reaction to the carbohydrate galactose-α-1,3-galactose (alpha-gal) found in tick saliva. Certain ticks carry alpha-gal in their saliva and transmit this carbohydrate through a tick bite. Humans do not make alpha-gal. Other non-primate mammals do. This syndrome occurs when the human immune system creates anti-alpha-gal IgE antibodies after exposure to mammalian meats that contain alpha-gal.


Key Facts
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  • Alpha-gal is present in non-primate mammalian meat, such as beef, pork, and lamb.
  • Reactions typically occur 3-8 hours after consuming mammalian products. However, the first reaction can happen weeks
    to months after the tick bite that transmitted the alpha-gal containing tick saliva.
  • Ticks that carry alpha-gal:
    • Amblyomma americanum (lone star tick) in the US
    • Amblyomma cajennense in Central America
    • Haemaphysalis longicornis in Asia (this species in the US does not carry alpha-gal)
  • Only a small percentage of people bitten by these ticks develop AGS. However, the risk increases with the number of tick bites received.
  • Alpha-gal syndrome is the leading cause of anaphylaxis in adults.
​

Common Triggers
​
  • Mammalian meats such as beef, pork, lamb, bison, venison, goat.
  • Dairy products, gelatin, fats, lard, suet
  • Foods with mammalian byproducts
  • Carrageenan (from red algae, but containing alpha-gal epitope)
  • Flounder eggs
  • “Natural flavorings”
  • Drugs, medical products, personal care, and household items with mammalian ingredients


​Symptoms
​
  • After consuming mammalian meat/products, you may experience the following symptoms:
  • 90% of people experience skin symptoms like hives or flushing.
  • Typical first symptom: itching of palms and soles of feet, may be with rash or swelling
  • Itching or swelling in mouth, lips, face, tongue, or throat; throat closing
    • Anaphylaxis is seen in 60% of cases (can be life-threatening)
  • Cardiac symptoms: low blood pressure, lightheadedness, dizziness, fainting, rapid or weak pulse (30-40% of people)
  • Respiratory symptoms: shortness of breath, wheezing, chest tightness, cough, hoarseness, trouble breathing
  • Gastrointestinal symptoms: abdominal pain, diarrhea, nausea, vomiting, heartburn (20% of people have GI symptoms
    alone)
  • Runny nose, sneezing, headaches 


Diagnosis and Management
​
  • Blood test: Alpha-gal IgE
  • There is no FDA approved treatment.
  • The allergy may resolve over time.
  • Symptom management: antihistamines for allergic reactions
  • Diet change: avoid alpha-gal containing products like mammalian meat, products that come from mammals, including
           some medications and skin products
  • Resource for checking medications: utilize VeganMed to look up specific medications and supplements to determine if they are free from animal-derived ingredients. This resource is invaluable for preventing an inadvertent allergic reaction and in trying to determine whether any medications or supplements may be causing a reaction. Please consult with your healthcare provider before stopping any medications.​


​Mammalian Meat and Products to Avoid
​
  • Mammalian meats: beef, pork, lamb, bison, venison, goat, horse, rabbit, squirrel, kangaroo, antelope, buffalo, camel, guinea pig, bats, whales
  • Mammalian fats: lard, tallow, suet
  • Internal organs of mammals
  • Products derived from mammals: bones, gelatin, collagen, broth, bouillon, stock, gravy, blood pudding
  • Some people must avoid dairy products, natural flavors, carrageenan, flounder eggs
  • Some people must avoid medications containing alpha-gal: Cetuximab, monoclonal antibodies, pancreatic enzymes,
          hormone replacement, stearic acid, glycerin, vaccines using gelatin
  • ​Skin products with mammal-derived ingredients such as gelatin or lanolin
​
There is a range in severity of reaction to items on the avoidance list.

For a comprehensive list of products to avoid and for more information, visit the invaluable resource Alpha-Gal Information.


Emerging Treatments

Soliman Auricular Allergy Treatment (SAAT): Involves placing a small needle in the ear for 3 weeks, which has shown to provide symptom remission in 96% of patients for at least 9 months.


References
1. Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol. 2020 Jul;16(7):667-677. doi: 10.1080/1744666X.2020.1782745.
2. Bernal M, Huecker M, Shreffler J, Mittel O, Mittel J, Soliman N. Successful Treatment for Alpha Gal Mammal Product Allergy Using Auricular Acupuncture: A Case Series. Med Acupunct. 2021;33(5):343-348. doi:10.1089/acu.2021.0010

This information is crucial for managing Alpha-Gal Syndrome effectively. If you have any further questions or need additional guidance, please consult your healthcare provider.