Galactose-α-1,3-galactose (alpha-gal) allergy: first pediatric case in a series of patients in Spain.

INTRODUCTION AND OBJECTIVES: Allergy to galactose-α-1,3-galactose (alpha-gal) is a peculiar form of food allergy generally manifesting as an anaphylactic reaction hours after mammalian meat consumption, due to the presence of specific IgE against this oligosaccharide. In addition, immediate anaphylaxis may develop after exposure to other sources of alpha-gal, such as monoclonal antibody cetuximab, vaccines, plasma expanders or anti-snake venoms. Sensitization to alpha-gal has also been implicated in the rapid degeneration of biological valve implants, and recognized as a cause of occupational disease in cattle raisers. The implication of tick bites in this type of sensitization has been accepted by all the research groups dedicated to this disease. PATIENTS AND METHOD: The present study describes the clinical and sensitization characteristics of 39 patients diagnosed with alpha-gal allergy in the hospitals of our province (Lugo, Monforte de Lemos and Burela, Spain). RESULTS: Most patients were middle-age males. Of note, is the fact that the series includes the first pediatric patient reported in Spain to date. The predominant clinical manifestations were urticaria or delayed anaphylaxis after consumption of mammalian meat. Seventy-four percent of the patients reported having suffered a previous tick bite, and the clinical presentation of anaphylaxis was significantly more prevalent in those with a persistent local reaction following the bite than in those with no such reaction (p = 0.032). CONCLUSIONS: A review is also made of the disorder which, due to its variable clinical expression, is referred to as alpha-gal syndrome. The study concludes that a diagnosis of alpha-gal allergy should be considered in patients with urticaria-anaphylaxis of uncertain origin or manifesting after the administration of vaccines or products of bovine/porcine origin.

Anafilaxia perioperatoria / Perioperative anaphylaxis

La anafilaxia perioperatoria es un cuadro clínico que puede amenazar la vida del paciente, producido por fármacos o sustancias usados durante la anestesia. Después de una anafilaxia debe realizarse un estudio alergológico para identificar el agente responsable y prevenir recurrencias. La incidencia global se estima de 1 entre 10.000-20.000 anestesias. Los agentes más frecuentemente implicados son los bloqueantes neuromusculares, látex y antibióticos. El diagnóstico inicial es clínico y en el tratamiento es esencial la adrenalina. En este artículo se describe la clínica, pruebas diagnósticas, así como protocolos de prevención y tratamiento del cuadro de anafilaxia perioperatoria. Será importante desarrollar protocolos de detección y manejo precoz de estas reacciones en circuitos de cirugía ambulatoria y establecer un adecuado seguimiento posterior (AU)

Perioperative anaphylaxis may be a life threatening clinical condition and is typically due to the results of drugs used for anesthesia. Once anaphylaxis occurs, allergy studies are essential to identify the responsible agent so to prevent recurrences. The overall incidence is estimated at 1 in 10,000-20,000 anesthetic procedures. The most commonly involved agents are neuromuscular blocking agents, latex and antibiotics. The initial diagnosis is presumptive; including clinical signs and adrenalin is the treatment of choice. The aim of this article is to review etiology, diagnosis, prevention and treatment of perioperative anaphylaxis. It will be important to produce action protocols to ensure the detection of these reactions of anaphylaxis in outpatient surgery and to establish the correct follow-up (AU)