Alergologia Polska - Polish Journal of Allergology

Full text

3/2026 vol. 13
Case report

The case of a patient with alpha-gal syndrome with atypical symptoms and variable asthma control

Konrad Gawin 1
,
Wiktoria Zawiślak 1
,
Jakub Wąsik 1, 2
,
Marcin Kurowski 1

  1. Department of Immunology and Allergy, Medical University of Lodz, Poland

  2. International Doctoral School, Medical University of Lodz, Poland

Alergologia Polska – Polish Journal of Allergology 2026; 13, 3: 262-268

DOI: https://doi.org/10.5114/pja.2026.164679
Data publikacji online: 2026/10/06
Article file
PJA The case.pdf
  1. Propst SBH, Thompson DK. Alpha-gal syndrome and the gastrointestinal reaction: a narrative review. Front Allergy 2025; 6: 1535103.
  2. Macher BA, Galili U. The Galα1,3Galβ1,4GlcNAc-R (α-Gal) epitope: a carbohydrate of unique evolution and clinical relevance. Biochim Biophys Acta 2008; 1780: 75-88.
  3. Mitchell CL, Lin FC, Vaughn M, et al. Association between lone star tick bites and increased alpha-gal sensitization: evidence from a prospective cohort of outdoor workers. Parasites Vectors 2020; 13: 470.
  4. Platts-Mills TAE, Gangwar RS, Workman L, Wilson JM. The immunology of alpha‐Gal syndrome: history, tick bites, IgE, and delayed anaphylaxis to mammalian meat. Immunol Rev 2025; 332: e70035.
  5. Brzozowska M, Mokrzycka N, Porębski G. Alpha-gal syndrome: the first report in Poland. Cent Eur J Immunol 2021; 46: 398-400.
  6. Lis K, Ukleja-Sokołowska N, Karwowska K, et al. Clinical use of the ImmunoCAP inhibition test in the diagnosis of meat allergy caused by a tick bite in an adult male with no previous atopic history. Life 2023; 13: 699.
  7. Branicka O, Rozłucka L, Gawlik R, Glück J. Alpha-Gal syndrome-a series of cases with different clinical pictures. Int J Mol Sci 2025; 26: 8601.
  8. Martínez-Arcediano A, de La Viuda Camino E, Ruiz de Galarreta Beristain M, et al. Is alpha-Gal an emerging allergen in drug allergy? Curr Treat Options Allergy 2024; 11: 185-93.
  9. Hilger C, Fischer J, Wölbing F, Biedermann T. Role and mechanism of galactose-alpha-1,3-galactose in the elicitation of delayed anaphylactic reactions to red meat. Curr Allergy Asthma Rep 2019; 19: 3.
  10. Popa CM, Cherciu Harbiyeli IF, Ciurea AM, et al. A preliminary study examining the correlation between EGFRI treatment, clinic dermatoscopy features, and serum levels of anti-alpha-galactosyl IgE in colorectal cancer patients. Gastroenterol Insights 2024; 15: 505-18.
  11. Peralta T, Roizen G, Crisóstomo N, AguileraInsunza R. What is new in alpha-Gal syndrome? Curr Treat Options Allergy 2023; 10: 428-41.
  12. Ching SJ, Susi A, Ailsworth SM, et al. Incidence of alpha-Gal IgE sensitization in 3000 military personnel, assessing sex, race, installation, and occupational impacts. J Clin Med 2024; 13: 7162.
  13. Johnson RW, Roden-Reynolds P, Snow AA, Rich SM. The spread of lone star ticks (Amblyomma americanum) and persistence of blacklegged ticks (Ixodes scapularis) on a Coastal Island in Massachusetts, USA. Insects 2024; 15: 709.
  14. Ailsworth SM, Susi A, Workman LJ, et al. Alpha-Gal IgE prevalence patterns in the United States: an investigation of 3,000 military recruits. J Allergy Clin Immunol Pract 2024; 12: 175-84.e5.
  15. Rutkowski K, Sowa P, Mroczko B, et al. Sensitisation and allergic reactions to alpha-1,3-galactose in Podlasie, Poland, an area endemic for tick-borne infections. Infect Dis 2022; 54: 572-9.
  16. Román-Carrasco P, Hemmer W, Cabezas-Cruz A, et al. The α-Gal syndrome and potential mechanisms. Front Allergy 2021; 2: 783279.
  17. Park Y, Kim D, Boorgula GD, et al. Alpha-Gal and cross-reactive carbohydrate determinants in the N-Glycans of salivary glands in the lone star tick, Amblyomma americanum, Amblyomma americanum. Vaccines 2020; 8: 18.
  18. Cabezas-Cruz A, Hodžić A, Román-Carrasco P, et al. Environmental and molecular drivers of the α-Gal syndrome. Front Immunol 2019; 10: 1210.
  19. Rispens T, Derksen NIL, Commins SP, et al. IgE production to α-Gal is accompanied by elevated levels of specific IgG1 antibodies and low amounts of IgE to blood group B. PLoS One 2013; 8: e55566.
  20. Brestoff JR, Tesfazghi M, Zaydman M, et al. The B antigen protects against the development of red meat allergy. J Allergy Clin Immunol Pract 2018; 6: 1790-1.e3.
  21. Apostolovic D, Rodrigues R, Thomas P, et al. Immunoprofile of α-Gal- and B-antigen-specific responses differentiates red meat-allergic patients from healthy individuals. Allergy 2018; 73: 1525-31.
  22. Kiewiet MBG, Apostolovic D, Starkhammar M, et al. Clinical and serological characterization of the α-gal syndrome – importance of atopy for symptom severity in a European Cohort. J Allergy Clin Immunol Pract 2020; 8: 2027-34.e2.
  23. Kiewiet MBG, Grundström J, Apostolovic D, et al. Elucidating the α-Gal syndrome at the molecular allergen level. Allergy 2021; 76: 1576-8.
  24. Carter MC, Ruiz-Esteves KN, Workman L, et al. Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis. Allergy 2018; 73: 1131-4.
  25. Binder AM, Cherry-Brown D, Biggerstaff BJ, et al. Clinical and laboratory features of patients diagnosed with alpha-gal syndrome – 2010–2019. Allergy 2023; 78: 477-87.
  26. Muratore A, Barnes EL, Long MD, et al. Alpha guy? No, alpha Gal – important to remember in patients with IBD in endemic areas. Dig Dis Sci 2025; 70: 111-4.
  27. Martín-Lázaro J, Núñez-Orjales R, González-Guzmán LA, et al. Galactose-α-1,3-galactose (alpha-gal) allergy: first pediatric case in a series of patients in Spain. Allergol Immunopathol 2020; 48: 251-8.
  28. Bellutti Enders F, Elkuch M, Wörner A, et al. Alpha-gal syndrome initially misdiagnosed as chronic spontaneous urticaria in a pediatric patient: a case report and review of the literature. J Med Case Rep 2023; 17: 6.
  29. Wilson JM, Schuyler AJ, Workman L, et al. Investigation into the α-Gal syndrome: characteristics of 261 children and adults reporting red meat allergy. J Allergy Clin Immunol Pract 2019; 7: 2348-58.e4.
  30. Perusko M, Grundström J, Eldh M, et al. Allergenic potency of various foods of mammalian origin in patients with α‐Gal syndrome. Allergy 2025; 80: 181-92.
  31. Platts-Mills TAE, Li RC, Keshavarz B, et al. Diagnosis and management of patients with the α-Gal syndrome. J Allergy Clin Immunol Pract 2020; 8: 15-23.e1.
  32. Nalçacı M. Mysterious allergy caused by tick bite: alpha-Gal syndrome. Turkiye Parazitol Derg 2024; 48: 195-207.
  33. Michel S, Scherer K, Heijnen IAFM, Bircher AJ. Skin prick test and basophil reactivity to cetuximab in patients with IgE to alpha-gal and allergy to red meat. Allergy 2014; 69: 403-5.
  34. Germán-Sánchez A, Alonso-Llamazares A, García-González F, et al. Diagnostic validity of specific immunoglobulin E levels to alpha-gal in alpha-gal syndrome: a cross-sectional analysis. Allergy Asthma Clin Immunol 2023; 19: 102.
  35. Kollmann D, Nagl B, Ebner C, et al. The quantity and quality of α-gal-specific antibodies differ in individuals with and without delayed red meat allergy. Allergy 2017; 72: 266-73.
  36. Kopač P, Koren A, Bidovec-Stojkovič U, et al. Basophil activation test predicts cetuximab anaphylaxis severity in alpha-Gal IgE-positive patients. Diagnostics 2024; 14: 1403.
  37. Darsow U, Gelincik A, Jappe U, et al. Algorithms in allergy: an algorithm for alpha-Gal syndrome diagnosis and treatment, 2024 update. Allergy 2024; 79: 3169-72.
  38. Rymarczyk B, Jura-Szołtys E, Gluck J, Gawlik R. Does a healthy diet always mean a safe diet? Food allergy as an obstacle to a healthy lifestyle. Pol J Allergol 2025; 12: 91-7.
  39. Kim MS, Straesser MD, Keshavarz B, et al. IgE to galactose-α-1,3-galactose wanes over time in patients who avoid tick bites. J Allergy Clin Immunol Pract 2020; 8: 364-7.e2.
  40. Vaz-Rodrigues R, Mazuecos L, de la Fuente J. Current and future strategies for the diagnosis and treatment of the alpha-Gal syndrome (AGS). J Asthma Allergy 2022; 15: 957-70.
  41. Commins SP. Diagnosis and management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol 2020; 16: 667-77.
  42. Ünal D, Eyice-Karabacak D, Kutlu A, et al. Oral immunotherapy in alpha-gal red meat allergy: could specific IgE be a potential biomarker in monitoring management? Allergy 2023; 78: 3241-51.
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