(food allergy to the alpha-gal)

Very rare. The galactose-α-1, 3-galactose is an oligosaccharide present as a surface antigen in tissue of most mammals except primates and humans. Human sensibilization (and thus production of antibodies) is caused by a bite of the single star tick (lone star), Amblyoma americanum, mainly present in the South-East of the USA or of the Ixodes ricinus tick in Europa.

These antibodies can be at the origin of IgE-dependent allergic reactions:

-        immediate during a cetuximab infusion (murine monoclonal antibodies used in oncology)

-        immediate during the administration of IV colloids containing modified gelatin made of bovine bone collagen

-        delayed (> 2 h) after administration of products contaminated by tissue of non-primates mammals: heparin, etc ...

-        delayed (urticaria, diarrhea, etc.) 3 to 6 hours after eating red meat from mammal (food allergy).

In addition to some bioprostheses (valves, pericardial patch, mesh for hernia repair, etc ...), animal tissues are used for many products as adjuvants like gelatin, glycerin (the glycerol from propofol can be from animal or vegetal origin: to be checked), lactic  and stearic acids.

 

Anesthetic implications: 

• risk factors: history of delayed food allergy, activities in the countryside (professional or leisure), frequent tick bites, cetuximab allergy, non-B blood type 
• if a patient known to be allergic to alpha-gal is being managed, seek the advice of the hospital pharmacist and

1.        check the absence of animal proteins in the medicinal products to be used:

-        colloids based on gelatin, intralipid        

-        paracetamol and ibuprofen in liquid or capsule form        

-        gabapentin, haloperidol        

-        local hemostatic agents (Gelfoam®, Surgicel®, etc) and biological glues (thrombin sprays)

2.        the administration of a premedication based on corticosteroids and antihistamines H1 and H2 has not proven its usefulness

3.        be cautious when using heparin (bovine or ovine origin) (use bivalirudine for ECC or fondaparinux for thromboprophylaxis if in doubt), recombinant human proteins produced on non-primate mammalian cells or a cardiac bioprosthesis.        

References : 

-         Peters C, Jarlot S, Pirson F.
Anaphylaxie peranesthésique à la gélatine associée à une allergie alimentaire à l’alpha-gal.
Anesth Réanim 2016; 2: 123-5.

-        Kleinman AM, Littlewood KE, Groves DS.
Delayed anaphylaxis to mammalian meat following tick exposure and its impact on anesthetic management for cardiac surgery: a case report.
A&A Case Reports 2017; 8: 125-7.

-        Dunkman WJ, Rycek W, Manning MW.
What does a read met allergy have to do with anesthesia? Perioperative management of Alpha-Gal syndrome.
Anesth Analg  2019; 129:1242-8

-        Dewachter P, Kopac P, Laguna JJ, Mertes PM et al.
Anaesthetic management of patients with pre-existing allergic conditions: a narrative review.
Br J Anaesth 2019; 123 (1): e65-81.

-        Nourian MM, Stone CA Jr, Siegrist KK, Riess ML.
Perioperative implications of patients with alpha gal allergies.
J Clin Anesth 2023 ; 86 : 111056

Updated: March 2023