Anaphylaxis to the Carbohydrate Side Chain Alpha-gal - 03/04/15

Doi : 10.1016/j.iac.2015.01.009

Thomas A.E. Platts-Mills, MD, PhD, FRS ^⁎ , Alexander J. Schuyler, BS, BA, Anubha Tripathi, MD, Scott P. Commins, MD, PhD
Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA, USA

^∗Corresponding author. Allergy Division, University of Virginia Health System, PO Box 801355, Charlottesville, VA 22908-1355.

Résumé

In 2007, the monoclonal antibody cetuximab caused severe hypersensitivity reactions during the first infusion in a region of the southeastern United States. Investigation of pretreatment sera established that they contained immunoglobulin (Ig) E against the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal), which is present on the Fab of cetuximab. Alpha-gal is a blood group substance of nonprimate mammals. These IgE antibodies are also associated with delayed anaphylaxis to red meat (ie, to meat or organs of animals that carry this oligosaccharide). Evidence shows that the primary cause of these IgE antibodies is bites from the tick Amblyomma americanum or its larvae.

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Keywords : Delayed anaphylaxis, Alpha-gal, Ticks, Red-meat allergy, Cetuximab