Background: Tick bite-induced galactose-α-1,3-galactose (α-Gal) IgE and subsequent ingestion of red meat may cause delayed severe allergic reactions including urticaria, gastrointestinal symptoms or anaphylaxis. We tested the hypothesis that increased levels of IgE to α-Gal due to tick bites and the subsequent ingestion of red meat or meat products may possibly be an un(der)recognized cause of chronic spontaneous urticaria (CSU). Methods: Levels of IgE to α-Gal and total IgE were measured (ImmunoCAP, Phadia AB/Thermo Fisher Scientific) in 83 patients (61 female and 22 male, median age 43 years, range 18-82) from the Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany. All had been clinically diagnosed with moderate-to-severe CSU of a median duration of 2.9 years (range 0.1-50). Results: Eighty of the 83 patients (96%) had undetectable (<0.1 kUA/l) serum levels of IgE against α-Gal. The levels in the remaining 3 were all low (0.25, 0.4 and 3.1 kUA/l). In no patient, including those with measurable serum levels of IgE against α-Gal, was eating red meat associated with the development of symptoms of urticaria. Conclusion: Our results indicate that an allergic response to α-Gal is highly unlikely to be a hitherto unrecognized common cause of CSU.

1.
Commins SP, James HR, Stevens W, Pochan SL, Land MH, King C, Mozzicato S, Platts-Mills TA: Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-α-1,3-galactose. J Allergy Clin Immunol 2014;134:108-115.
2.
Hamsten C, Tran TA, Starkhammar M, Brauner A, Commins SP, Platts-Mills TA, van Hage M: Red meat allergy in Sweden: association with tick sensitization and B-negative blood groups. J Allergy Clin Immunol 2013;132:1431-1434.
3.
Maurer M, Weller K, Bindslev-Jensen C, Gimenez-Arnau A, Bousquet PJ, Bousquet J, Canonica GW, Church MK, Godse KV, Grattan CE, Greaves MW, Hide M, Kalogeromitros D, Kaplan AP, Saini SS, Zhu XJ, Zuberbier T: Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy 2011;66:317-330.
4.
Chang TW, Chen C, Lin CJ, Metz M, Church MK, Maurer M: The potential pharmacologic mechanisms of omalizumab in patients with chronic spontaneous urticaria. J Allergy Clin Immunol 2015;135:337-342.
5.
Fischer J, Hebsaker J, Caponetto P, Platts-Mills TA, Biedermann T: Galactose-α-1,3-galactose sensitization is a prerequisite for pork-kidney allergy and cofactor-related mammalian meat anaphylaxis. J Allergy Clin Immunol 2014;134:755-759.
6.
Van Nunen SA, O'Connor KS, Clarke LR, Boyle RX, Fernando SL: An association between tick bite reactions and red meat allergy in humans. Med J Aust 2009;190:510-511.
7.
Hamsten C, Starkhammar M, Tran TA, Johansson M, Bengtsson U, Ahlen G, Sallberg M, Gronlund H, van Hage M: Identification of galactose-α-1,3-galactose in the gastrointestinal tract of the tick Ixodes ricinus: possible relationship with red meat allergy. Allergy 2013;68:549-552.
8.
Ghahramani GK, Temprano J: Tick bite-related meat allergy as a cause of chronic urticaria, angioedema, and anaphylaxis in endemic areas. Int J Dermatol 2015;54:e64-e65.
9.
Commins SP, Kelly LA, Ronmark E, James HR, Pochan SL, Peters EJ, Lundback B, Nganga LW, Cooper PJ, Hoskins JM, Eapen SS, Matos LA, McBride DC, Heymann PW, Woodfolk JA, Perzanowski MS, Platts-Mills TA: Galactose-α-1,3-galactose-specific IgE is associated with anaphylaxis but not asthma. Am J Respir Crit Care Med 2012;185:723-730.
10.
Gonzalez-Quintela A, Dam Laursen AS, Vidal C, Skaaby T, Gude F, Linneberg A: IgE antibodies to α-Gal in the general adult population: relationship with tick bites, atopy, and cat ownership. Clin Exp Allergy 2014;44:1061-1068.
11.
Gronlund H, Adedoyin J, Commins SP, Platts-Mills TA, van Hage M: The carbohydrate galactose-α-1,3-galactose is a major IgE-binding epitope on cat IgA. J Allergy Clin Immunol 2009;123:1189-1191.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.