Accurate assessment of alpha-gal syndrome using cetuximab and bovine thyroglobulin-specific IgE.
SCOPE
IgE against galactose-α-1,3-galactose (α-Gal) causes alpha-gal syndrome. Bovine thyroglobulin (BTG) and cetuximab share this epitope. We aimed to determine the utility of specific IgE (sIgE) against cetuximab as compared to BTG for diagnosing alpha-gal syndrome.


METHODS AND RESULTS
Twelve patients with alpha-gal syndrome, 11 patients with immediate beef or pork allergy, 18 asymptomatic individuals with meat sensitization, and 10 non-atopic subjects were enrolled. We checked the levels of sIgE against BTG and cetuximab using the streptavidin CAP assay. Additionally, IgE reactivity to BTG and cetuximab was assessed by immunoblotting. All alpha-gal syndrome patients had a high concentration of sIgE against BTG, and cetuximab. In contrast to alpha-gal syndrome, patients with immediate allergic reactions to meat consumption and those with asymptomatic sensitization had significantly lower concentration of BTG and cetuximab sIgE, and a high prevalence of sIgE against bovine or porcine serum albumin. Although the concentration of sIgE against alpha-gal was lower in individuals with asymptomatic sensitization, IgE immunoblotting showed the presence of sIgE against α-Gal in this group.


CONCLUSION
Differentiation of alpha-gal syndrome from patients with immediate allergy to meat consumption or asymptomatic sensitization requires quantification of cetuximab- or BTG-induced sIgE via detection of IgE for α-gal.
['Sim|Da Woon|DW|0000-0002-9723-0720', 'Lee|Jong Sun|JS|', 'Park|Kyung Hee|KH|', 'Jeong|Kyoung Yong|KY|', 'Ye|Young-Min|YM|', 'Lee|Jae-Hyun|JH|', 'Park|Jung-Won|JW|']
D000293:Adolescent D000328:Adult D000368:Aged D000485:Allergens D000818:Animals D002417:Cattle D000068818:Cetuximab D002648:Child D002675:Child, Preschool D004187:Disaccharides D005260:Female D005512:Food Hypersensitivity D006801:Humans D015151:Immunoblotting D007073:Immunoglobulin E D008297:Male D008875:Middle Aged D000069466:Red Meat D012189:Retrospective Studies D013552:Swine D013954:Thyroglobulin D055815:Young Adult
Alpha-gal syndrome α-Gal Bovine thyroglobulin-specific IgE Cetuximab-specific IgE Component-resolved diagnosis