Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Thurston Arthritis Research Center.
Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina Food Allergy Initiative, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Curr Opin Pediatr. 2020 Dec;32(6):816-824. doi: 10.1097/MOP.0000000000000955.
Alpha-gal syndrome encompasses a constellation of symptoms associated with immune-mediated hypersensitivity responses to galactose-alpha-1,3-galactose (alpha-gal). The purpose of this review is to discuss our current understanding of the etiology, clinical symptoms, natural history, epidemiology, and management of alpha-gal syndrome.
Sensitization to alpha-gal is associated with bites from ectoparasites like the lone star tick Amblyomma americanum. Allergic reactions in alpha-gal syndrome are often delayed and inconsistent. The magnitude of the allergic response depends on co-factors like exercise and alcohol consumption and the amount of alpha-gal and fat present in the food. Assaying alpha-gal-specific IgE in the serum is the primary diagnostic test used to confirm the allergy. Long-term management of the condition involves avoidance of both mammalian food products and tick bites.
Alpha-gal syndrome disrupts the current paradigm for understanding food allergy. Exposure to an ectoparasite is critical for the development of specific IgE antibodies underlying sensitization, and allergic reactions depend on the activation of mast cells and basophils sensitized with IgE against a carbohydrate rather than a protein. Research in this field may lead to the development of improved diagnostic and therapeutic tools that can revolutionize the management of patients with alpha-gal syndrome.
α-半乳糖综合征包括一系列与免疫介导的过敏反应相关的症状，这些症状与半乳糖-α-1,3-半乳糖（α-半乳糖）有关。本文综述的目的是讨论我们目前对α-半乳糖综合征的病因、临床症状、自然史、流行病学和管理的理解。
对 α-半乳糖的致敏与孤星蜱 Amblyomma americanum 等外寄生虫的叮咬有关。α-半乳糖综合征中的过敏反应通常是延迟且不一致的。过敏反应的程度取决于运动和饮酒等共同因素以及食物中 α-半乳糖和脂肪的含量。检测血清中 α-半乳糖特异性 IgE 是用于确认过敏的主要诊断测试。该疾病的长期管理包括避免食用哺乳动物食品和避免被蜱虫叮咬。
α-半乳糖综合征打破了人们对食物过敏的理解模式。暴露于外寄生虫对于产生特异性 IgE 抗体至关重要，这些抗体是致敏的基础，过敏反应取决于 IgE 致敏的肥大细胞和嗜碱性粒细胞对碳水化合物而不是蛋白质的激活。该领域的研究可能会导致开发出改进的诊断和治疗工具，从而彻底改变 α-半乳糖综合征患者的管理。
