Food, drug, insect sting allergy, and anaphylaxis
Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose

Part of this work has been presented in abstract form in the last 5 years at meetings of the American Academy of Allergy, Asthma & Immunology and of the Australasian Society for Clinical Immunology and Allergy.
https://doi.org/10.1016/j.jaci.2012.02.038Get rights and content

Background

We have observed patients clinically allergic to red meat and meat-derived gelatin.

Objective

We describe a prospective evaluation of the clinical significance of gelatin sensitization, the predictive value of a positive test result, and an examination of the relationship between allergic reactions to red meat and sensitization to gelatin and galactose-α-1,3-galactose (α-Gal).

Methods

Adult patients evaluated in the 1997-2011 period for suspected allergy/anaphylaxis to medication, insect venom, or food were skin tested with gelatin colloid. In vitro (ImmunoCAP) testing was undertaken where possible.

Results

Positive gelatin test results were observed in 40 of 1335 subjects: 30 of 40 patients with red meat allergy (12 also clinically allergic to gelatin), 2 of 2 patients with gelatin colloid–induced anaphylaxis, 4 of 172 patients with idiopathic anaphylaxis (all responded to intravenous gelatin challenge of 0.02-0.4 g), and 4 of 368 patients with drug allergy. Test results were negative in all patients with venom allergy (n = 241), nonmeat food allergy (n = 222), and miscellaneous disorders (n = 290). ImmunoCAP results were positive to α-Gal in 20 of 24 patients with meat allergy and in 20 of 22 patients with positive gelatin skin test results. The results of gelatin skin testing and anti–α-Gal IgE measurements were strongly correlated (r = 0.46, P < .01). α-Gal was detected in bovine gelatin colloids at concentrations of approximately 0.44 to 0.52 μg/g gelatin by means of inhibition RIA.

Conclusion

Most patients allergic to red meat were sensitized to gelatin, and a subset was clinically allergic to both. The detection of α-Gal in gelatin and correlation between the results of α-Gal and gelatin testing raise the possibility that α-Gal IgE might be the target of reactivity to gelatin. The pathogenic relationship between tick bites and sensitization to red meat, α-Gal, and gelatin (with or without clinical reactivity) remains uncertain.

Section snippets

Study population

The study was undertaken in a mixed adult/pediatric specialty allergy/immunology practice in the Australian Capital Territory in southeastern Australia. The practice services the local inland metropolitan population and surrounding regional (including coastal) areas. Referrals were received from general medical practitioners, accident and emergency departments, and pediatricians. Patients were assessed by the first author (R.J.M.). Clinical and demographic data were entered prospectively into a

Patients' characteristics

Between 1995 and 2011, 1159 adults aged 18 to 101 years (423 male subjects) assessed by the first author (R.J.M.) were given a diagnosis of FA triggered by seafood (n = 284), peanut (n = 189), tree nuts (n = 188), systemic allergic reactions to fruits/vegetables (n = 134), wheat (n = 77), egg (n = 57), red meat (n = 40), sesame seed (n = 22), cow's milk (n = 21), or soybean (n = 8). Of 40 patients with red meat allergy identified, 18 (46%) were male and aged 18 to 78 years (median, 48 years),

Discussion

We have identified a significant relationship between adult-onset red meat allergy and sensitization and clinical reactivity to gelatin, which is supported by the results of intraoperative exposure (MG23 and MG24 and GC1 and GC2), accidental exposure (MG12), observed challenge (ID1-ID4), or claims of reactivity to oral gelatin. Consistent with previous studies, SPT responses to commercial meat extracts were relatively small and sometimes negative,19, 29 and IDT and in vitro test results were

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    Supported in part by National Institutes of Health grants RO1 AI-20565, K08 AI085190, and R21 AI087985.

    Disclosure of potential conflict of interest: T. A. E. Platts-Mills is a consultant for IBT/Viracor and has received honoraria and research support from Phadia/Thermo-Fisher. S. Commins is on the Cornerstone Therapeutics speakers' bureau and has received research support from the National Institutes of Health. The rest of the authors declare that they have no relevant conflicts of interest.

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