Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:134

Article

Commins, Scott P.¹  James, Hayley R.¹  Stevens, Whitney¹  Pochan, Shawna L.¹  Land, Michael H.²  King, Carol¹  Mozzicato, Susan¹  Platts-Mills, Thomas A. E.¹ 

[1] Univ Virginia, Dept Med, Asthma & Allerg Dis Ctr, Charlottesville, VA 22908 USA

[2] Duke Univ, Duke Asthma Allergy & Airway Ctr, Durham, NC USA

关键词: Anaphylaxis;    alpha-gal;    basophil;    mammalian meat;    food allergy;   

DOI  :  10.1016/j.jaci.2014.01.024

来源: Elsevier

【 摘 要 】

Background: In 2009, we reported a novel form of delayed anaphylaxis to red meat related to serum IgE antibodies to the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal). Although patients were remarkably consistent in their description of a 3-to 6-hour delay between eating mammalian meat and the appearance of symptoms, this delay has not been demonstrated under observed studies. Objectives: We sought to formally document the time course of clinical symptoms after the ingestion of mammalian meat in subjects with IgE to alpha-gal and to monitor ex vivo for the appearance of markers of an allergic reaction. Methods: Open food challenges were performed with mammalian meat in 12 subjects with a history of severe urticarial reactions 3 to 6 hours after eating beef, pork, or lamb, as well as in 13 control subjects. Blood samples were taken hourly during each challenge. Results: Ten of 12 subjects with IgE to alpha-gal had clinical evidence of a reaction during the food challenge (vs none of the control subjects, P <. 001). The reactions occurred 3 to 7 hours after the initial ingestion of mammalian meat and ranged from urticaria to anaphylaxis. Tryptase levels were positive in 3 challenges. Basophil activation, as measured by increased expression of CD63, correlated with the appearance of clinical symptoms. Conclusion: The results presented provide clear evidence of an IgE-mediated food allergy that occurs several hours after ingestion of the inciting allergen. Moreover, here we report that in vivo basophil activation during a food challenge occurs in the same time frame as clinical symptoms and likely reflects the appearance of the antigen in the bloodstream.

【 授权许可】

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