PMID- 36574585 OWN - NLM STAT- MEDLINE DCOM- 20230406 LR - 20230701 IS - 1534-4436 (Electronic) IS - 1081-1206 (Print) IS - 1081-1206 (Linking) VI - 130 IP - 4 DP - 2023 Apr TI - Tick bite as a risk factor for alpha-gal-specific immunoglobulin E antibodies and development of alpha-gal syndrome. PG - 472-478 LID - S1081-1206(22)01963-9 [pii] LID - 10.1016/j.anai.2022.11.021 [doi] AB - BACKGROUND: The disaccharide galactose-alpha-1,3-galactose (alpha-gal) is expressed in mammals other than humans, apes, and old-world monkeys. In humans, elevated immunoglobulin E (IgE) antibodies specific for alpha-gal can result in allergic hypersensitivity known as alpha-gal syndrome (AGS). Case reports and series suggest that tick bites can induce alpha-gal-specific IgE (sIgE) antibodies. OBJECTIVE: To evaluate tick exposure as a risk factor for AGS and elevated alpha-gal sIgE level. METHODS: We conducted a case-control study comparing patients with AGS from a North Carolina allergy clinic with controls who were patients at a nearby internal medicine clinic. Cases and controls were administered a questionnaire to obtain information about demographics, home environment, outdoor activities, and recollection of tick bite. Serum samples taken at the time of enrollment were tested for total IgE, alpha-gal sIgE, and antibodies to other tick-borne pathogens. RESULTS: The patients with AGS were more likely to recall finding a tick on themselves (odds ratio [OR], 11.20; 95% confidence interval [CI], 4.97-25.15), live near wooded forest (OR, 2.27; 95% CI, 0.92-5.55), and spend 17 or more hours per week outdoors in wooded areas (OR, 5.58; 95% CI, 2.56-12.19). The patients with AGS were also more likely to report 4 or more tick bites (OR, 33.05; 95% CI, 9.92-155.12) and reactions at the site of tick bites (OR, 7.93; 95% CI, 3.74-16.80). Furthermore, elevated alpha-gal sIgE level was observed in 33% of the controls and was associated with tick exposure in the controls (OR, 4.25; 95% CI, 2.21-8.18). CONCLUSION: The results define tick bite as a risk factor for AGS and elevated alpha-gal sIgE level. CI - Published by Elsevier Inc. FAU - Kersh, Gilbert J AU - Kersh GJ AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: gkersh@cdc.gov. FAU - Salzer, Johanna AU - Salzer J AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. FAU - Jones, Emma S AU - Jones ES AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado. FAU - Binder, Alison M AU - Binder AM AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. FAU - Armstrong, Paige A AU - Armstrong PA AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. FAU - Choudhary, Shailesh K AU - Choudhary SK AD - Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. FAU - Commins, Grace K AU - Commins GK AD - Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. FAU - Amelio, Claire L AU - Amelio CL AD - Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. FAU - Kato, Cecilia Y AU - Kato CY AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. FAU - Singleton, Joseph AU - Singleton J AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. FAU - Biggerstaff, Brad J AU - Biggerstaff BJ AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado. FAU - Beard, Charles B AU - Beard CB AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado. FAU - Petersen, Lyle R AU - Petersen LR AD - Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado. FAU - Commins, Scott P AU - Commins SP AD - Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. LA - eng GR - CC999999/ImCDC/Intramural CDC HHS/United States GR - R01 AI135049/AI/NIAID NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. DEP - 20221126 PL - United States TA - Ann Allergy Asthma Immunol JT - Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology JID - 9503580 RN - 0 (Allergens) RN - X2RN3Q8DNE (Galactose) RN - 37341-29-0 (Immunoglobulin E) RN - red meat allergy SB - IM CIN - Ann Allergy Asthma Immunol. 2023 Apr;130(4):405-406. PMID: 37005047 MH - Animals MH - Humans MH - Allergens MH - Case-Control Studies MH - *Food Hypersensitivity MH - Galactose MH - Immunoglobulin E MH - Risk Factors MH - *Tick Bites MH - *Ticks PMC - PMC10148555 MID - NIHMS1895185 COIS- Disclosures: Dr Commins is on the speaker's bureau of Genentech and receives royalties from UptoDate. All other authors have no conflicts of interest to report. EDAT- 2022/12/28 06:00 MHDA- 2023/04/04 06:42 PMCR- 2023/04/29 CRDT- 2022/12/27 15:08 PHST- 2022/09/26 00:00 [received] PHST- 2022/11/22 00:00 [revised] PHST- 2022/11/23 00:00 [accepted] PHST- 2023/04/04 06:42 [medline] PHST- 2022/12/28 06:00 [pubmed] PHST- 2022/12/27 15:08 [entrez] PHST- 2023/04/29 00:00 [pmc-release] AID - S1081-1206(22)01963-9 [pii] AID - 10.1016/j.anai.2022.11.021 [doi] PST - ppublish SO - Ann Allergy Asthma Immunol. 2023 Apr;130(4):472-478. doi: 10.1016/j.anai.2022.11.021. Epub 2022 Nov 26.