McGill Sarah K, Levin Michael E, Shaheen Nicholas J, Cotton Cary C, Platts-Mills Thomas A, Commins Scott P
Division of Gastroenterology and Hepatology.
Department of Pediatric Allergology, University of Cape Town, Cape Town, South Africa.
J Clin Gastroenterol. 2024 Jan 1;58(1):80-84. doi: 10.1097/MCG.0000000000001827.
Alpha-gal allergy causes a delayed reaction to mammalian meats and has been reported worldwide. Patients with the allergy may present with isolated gastrointestinal (GI) symptoms, but this phenotype is poorly understood.
We pooled and analyzed symptoms and demographics of patients from two prospective cohorts of patients with a diagnosis of alpha-gal allergy who reacted after eating mammalian meat under observation. We compared the characteristics of patients who demonstrated GI-isolated symptoms on a challenge with those who exhibited symptoms outside the GI tract (skin, respiratory, and circulatory).
Among the 91 children and adult alpha-gal allergic patients who exhibited symptoms after oral challenge with mammalian meat, 72.5% experienced GI distress with one or more GI symptoms, which was the most frequent class of symptoms, compared with skin changes in 57.1% and respiratory distress in 5.5%. The most common GI symptoms were abdominal pain (71%) and vomiting (22.0%). GI-isolated symptoms occurred in 37 patients (40.7%) who reacted, and those patients reacted more quickly than patients who exhibited systemic symptoms (median onset of symptoms in GI-isolated group 90 min vs 120 min) and were more likely to be children than adults (relative risk=1.94, 95% CI: 1.04-3.63).
Isolated-GI distress occurred in 4 in every 10 alpha-gal allergic individuals who developed symptoms on oral food challenge with mammalian meat. Alpha-gal allergic patients, particularly children, may exhibit GI distress alone, and adult and pediatric gastroenterologists should be aware of the diagnosis and management of the allergy.
α-半乳糖过敏会引发对哺乳动物肉类的延迟反应，且已在全球范围内有相关报道。患有这种过敏症的患者可能仅出现胃肠道（GI）症状，但这种表型目前了解较少。
我们汇总并分析了两个前瞻性队列中被诊断为α-半乳糖过敏且在食用哺乳动物肉类后出现反应的患者的症状和人口统计学数据。我们比较了在激发试验中表现出孤立胃肠道症状的患者与在胃肠道以外部位（皮肤、呼吸和循环系统）出现症状的患者的特征。
在91名经口服哺乳动物肉类激发试验后出现症状的儿童和成人α-半乳糖过敏患者中，72.5%经历了一种或多种胃肠道不适症状，这是最常见的症状类型，相比之下，57.1%的患者出现皮肤变化，5.5%的患者出现呼吸窘迫。最常见的胃肠道症状是腹痛（71%）和呕吐（22.0%）。37名有反应的患者（40.7%）出现了孤立的胃肠道症状，这些患者的反应比出现全身症状的患者更快（孤立胃肠道症状组症状出现的中位时间为90分钟，而全身症状组为120分钟），且儿童比成人更易出现（相对风险=1.94，95%置信区间：1.04 - 3.63）。
在每10名经口服哺乳动物肉类激发试验出现症状的α-半乳糖过敏个体中，有4人会出现孤立的胃肠道不适。α-半乳糖过敏患者，尤其是儿童，可能仅表现出胃肠道不适，成人和儿科胃肠病学家应了解这种过敏症的诊断和管理。
