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  1. Article ; Online: Allergen Sold Separately? All Early Allergen Introduction Foods Are Not Equivalent.

    Commins, Scott P

    The journal of allergy and clinical immunology. In practice

    2022  Volume 10, Issue 1, Page(s) 159–160

    MeSH term(s) Allergens ; Food Hypersensitivity ; Humans
    Chemical Substances Allergens
    Language English
    Publishing date 2022-01-09
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Comment
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2021.10.027
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  2. Article ; Online: Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients.

    Commins, Scott P

    Expert review of clinical immunology

    2020  Volume 16, Issue 7, Page(s) 667–677

    Abstract: Introduction: Alpha-gal Syndrome (AGS) is a unique allergy to non-primate mammalian meat (and derived-products) that is associated with tick bites and is due to a specific IgE antibody to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). AGS ... ...

    Abstract Introduction: Alpha-gal Syndrome (AGS) is a unique allergy to non-primate mammalian meat (and derived-products) that is associated with tick bites and is due to a specific IgE antibody to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). AGS has many novel features that broaden the paradigm of food allergy, including that reactions are delayed 3-6 hours after exposure and patients have frequently tolerated red meat for many years prior to the development of allergic reactions. Due to the ubiquitous inclusion of mammal-derived materials in foods, medications, personal products and stabilizing compounds, full avoidance is difficult to achieve.
    Areas covered: This review describes the author's experience with diagnosis, management, and design of appropriate avoidance for patients with AGS and provides clinicians with practical advice for care of these patients.
    Expert opinion: The number of patients with AGS is rising and may have exceeded awareness of the diagnosis amongst healthcare providers. In summarizing experience gained to thus far, we hope to create a resource for identifying and managing this unique allergic syndrome.
    MeSH term(s) Allergens/immunology ; Anaphylaxis ; Animals ; Food Hypersensitivity/diagnosis ; Food Hypersensitivity/therapy ; Galactose/immunology ; Humans ; Immunoglobulin E/metabolism ; Red Meat ; Tick-Borne Diseases/diagnosis ; Tick-Borne Diseases/therapy ; Ticks/immunology
    Chemical Substances Allergens ; Immunoglobulin E (37341-29-0) ; Galactose (X2RN3Q8DNE)
    Language English
    Publishing date 2020-07-08
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 2274260-8
    ISSN 1744-8409 ; 1744-666X
    ISSN (online) 1744-8409
    ISSN 1744-666X
    DOI 10.1080/1744666X.2020.1782745
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  3. Article ; Online: Tick bite-induced alpha-gal syndrome and immunologic responses in an alpha-gal deficient murine model.

    Sharma, Surendra Raj / Choudhary, Shailesh K / Vorobiov, Julia / Commins, Scott P / Karim, Shahid

    Frontiers in immunology

    2024  Volume 14, Page(s) 1336883

    Abstract: Introduction: Alpha-Gal Syndrome (AGS) is a delayed allergic reaction due to specific IgE antibodies targeting galactose-α-1,3-galactose (α-gal), a carbohydrate found in red meat. This condition has gained significant attention globally due to its ... ...

    Abstract Introduction: Alpha-Gal Syndrome (AGS) is a delayed allergic reaction due to specific IgE antibodies targeting galactose-α-1,3-galactose (α-gal), a carbohydrate found in red meat. This condition has gained significant attention globally due to its increasing prevalence, with more than 450,000 cases estimated just in the United States alone. Previous research has established a connection between AGS and tick bites, which sensitize individuals to α-gal antigens and elevate the levels of specific IgE. However, the precise mechanism by which tick bites influence the host's immune system and contribute to the development of AGS remains poorly understood. This study investigates various factors related to ticks and the host associated with the development of AGS following a tick bite, using mice with a targeted disruption of alpha-1,3-galactosyltransferase (AGKO) as a model organism.
    Methods: Lone-star tick (
    Results: Our results showed a significant increase in the total IgE, IgG1, and α-gal IgG1 antibodies titers in the lone-star tick-sensitized AGKO mice compared to the gulf-coast tick-sensitized mice. Pork challenge in
    Conclusion: This study supports the hypothesis that specific tick species may increase the risk of developing α-gal-specific IgE and hypersensitivity reactions or AGS, thereby providing opportunities for future research on the mechanistic role of tick and host-related factors in AGS development.
    MeSH term(s) Animals ; Mice ; Tick Bites ; Galactose ; Disease Models, Animal ; Immunoglobulin E ; Ticks ; Amblyomma ; Immunoglobulin G ; Food Hypersensitivity
    Chemical Substances Galactose (X2RN3Q8DNE) ; Immunoglobulin E (37341-29-0) ; Immunoglobulin G
    Language English
    Publishing date 2024-02-08
    Publishing country Switzerland
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 2606827-8
    ISSN 1664-3224 ; 1664-3224
    ISSN (online) 1664-3224
    ISSN 1664-3224
    DOI 10.3389/fimmu.2023.1336883
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  4. Article ; Online: Outpatient Emergencies: Anaphylaxis.

    Commins, Scott P

    The Medical clinics of North America

    2017  Volume 101, Issue 3, Page(s) 521–536

    Abstract: Anaphylactic fatalities are rare; however, mild reactions can rapidly progress to cardiovascular and respiratory arrest. The clinical course of anaphylaxis can be unpredictable. Prompt and early use of epinephrine should be considered. Most anaphylaxis ... ...

    Abstract Anaphylactic fatalities are rare; however, mild reactions can rapidly progress to cardiovascular and respiratory arrest. The clinical course of anaphylaxis can be unpredictable. Prompt and early use of epinephrine should be considered. Most anaphylaxis episodes have an immunologic mechanism involving immunoglobulin E (IgE). Foods are the most common cause in children; medications and insect stings are more common in adults. When the cause is not completely avoidable or cannot be determined, a patient should be supplied with autoinjectable epinephrine and be instructed its use. They should keep the device with them at all times and taught the signs and symptoms of anaphylaxis.
    MeSH term(s) Adrenergic beta-Agonists/therapeutic use ; Airway Management/methods ; Anaphylaxis/diagnosis ; Anaphylaxis/drug therapy ; Anaphylaxis/physiopathology ; Cardiopulmonary Resuscitation ; Emergencies ; Epinephrine/therapeutic use ; Glucocorticoids/therapeutic use ; Hemodynamics ; Histamine Antagonists/therapeutic use ; Humans ; Immunoglobulin E/immunology ; Outpatients ; Severity of Illness Index
    Chemical Substances Adrenergic beta-Agonists ; Glucocorticoids ; Histamine Antagonists ; Immunoglobulin E (37341-29-0) ; Epinephrine (YKH834O4BH)
    Language English
    Publishing date 2017-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 215710-x
    ISSN 1557-9859 ; 0025-7125
    ISSN (online) 1557-9859
    ISSN 0025-7125
    DOI 10.1016/j.mcna.2016.12.003
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  5. Article ; Online: Suddenly Steakless: A Gastroenterologist's Guide to Managing Alpha-Gal Allergy.

    McGill, Sarah K / Richards, Robert D / Commins, Scott P

    The American journal of gastroenterology

    2022  Volume 117, Issue 6, Page(s) 822–826

    MeSH term(s) Food Hypersensitivity/diagnosis ; Food Hypersensitivity/therapy ; Gastroenterologists ; Humans
    Language English
    Publishing date 2022-04-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 390122-1
    ISSN 1572-0241 ; 0002-9270
    ISSN (online) 1572-0241
    ISSN 0002-9270
    DOI 10.14309/ajg.0000000000001765
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  6. Article ; Online: Complete remission of eosinophilic esophagitis with multi-aeroallergen subcutaneous immunotherapy: A case report.

    Iglesia, Edward G A / Commins, Scott P / Dellon, Evan S

    The journal of allergy and clinical immunology. In practice

    2021  Volume 9, Issue 6, Page(s) 2517–2519.e2

    MeSH term(s) Allergens ; Eosinophilic Esophagitis/diagnosis ; Eosinophilic Esophagitis/therapy ; Humans ; Immunotherapy ; Remission Induction
    Chemical Substances Allergens
    Language English
    Publishing date 2021-02-17
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2843237-X
    ISSN 2213-2201 ; 2213-2198
    ISSN (online) 2213-2201
    ISSN 2213-2198
    DOI 10.1016/j.jaip.2021.01.045
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  7. Article ; Online: Invited Commentary: Alpha-Gal Allergy: Tip of the Iceberg to a Pivotal Immune Response.

    Commins, Scott P

    Current allergy and asthma reports

    2016  Volume 16, Issue 9, Page(s) 61

    Abstract: The syndrome of delayed allergic reactions to the carbohydrate galactose-alpha-1,3-galactose ("alpha-gal") has become increasingly recognized in allergy and immunology clinics regionally throughout the southeastern USA. Due to the increasing awareness of ...

    Abstract The syndrome of delayed allergic reactions to the carbohydrate galactose-alpha-1,3-galactose ("alpha-gal") has become increasingly recognized in allergy and immunology clinics regionally throughout the southeastern USA. Due to the increasing awareness of this unique food allergy, cases have been identified in the northeastern and central USA as well as in Central and South America, Europe, Asia, Scandinavia, and Australia. Clinically, alpha-gal allergy is characterized by reactions to non-primate mammalian meat (e.g., beef, pork, lamb) that occur 3-6 h following exposure. The IgE response to alpha-gal is thought to develop after tick bites and can result in the loss of tolerance to foods that have been safely consumed for years. Although the initial description of alpha-gal allergy in 2009 was limited to red meat, this epitope is now identified in an expanded number of products, medications and foods-both labeled and unlabeled. Moreover, we are beginning to recognize that alpha-gal food allergy is the tip of the iceberg for this immune response.
    MeSH term(s) Allergens/immunology ; Food Hypersensitivity/immunology ; Humans ; Hypersensitivity, Delayed ; Immunoglobulin E/immunology ; alpha-Galactosidase/adverse effects
    Chemical Substances Allergens ; Immunoglobulin E (37341-29-0) ; GLA protein, human (EC 3.2.1.22) ; alpha-Galactosidase (EC 3.2.1.22)
    Language English
    Publishing date 2016-07-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057370-4
    ISSN 1534-6315 ; 1529-7322
    ISSN (online) 1534-6315
    ISSN 1529-7322
    DOI 10.1007/s11882-016-0641-6
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  8. Article ; Online: Tick bites, IgE to galactose-alpha-1,3-galactose and urticarial or anaphylactic reactions to mammalian meat: The alpha-gal syndrome.

    Wilson, Jeffrey M / Erickson, Loren / Levin, Michael / Ailsworth, Samuel M / Commins, Scott P / Platts-Mills, Thomas A E

    Allergy

    2024  

    Abstract: The recent recognition of a syndrome of tick-acquired mammalian meat allergy has transformed the previously held view that mammalian meat is an uncommon allergen. The syndrome, mediated by IgE antibodies against the oligosaccharide galactose-alpha-1,3- ... ...

    Abstract The recent recognition of a syndrome of tick-acquired mammalian meat allergy has transformed the previously held view that mammalian meat is an uncommon allergen. The syndrome, mediated by IgE antibodies against the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal), can also involve reactions to visceral organs, dairy, gelatin and other products, including medications sourced from non-primate mammals. Thus, fittingly, this allergic disorder is now called the alpha-gal syndrome (AGS). The syndrome is strikingly regional, reflecting the important role of tick bites in sensitization, and is more common in demographic groups at risk of tick exposure. Reactions in AGS are delayed, often by 2-6 h after ingestion of mammalian meat. In addition to classic allergic symptomatology such as urticaria and anaphylaxis, AGS is increasingly recognized as a cause of isolated gastrointestinal morbidity and alpha-gal sensitization has also been linked with cardiovascular disease. The unusual link with tick bites may be explained by the fact that allergic cells and mediators are mobilized to the site of tick bites and play a role in resistance against ticks and tick-borne infections. IgE directed to alpha-gal is likely an incidental consequence of what is otherwise an adaptive immune strategy for host defense against endo- and ectoparasites, including ticks.
    Language English
    Publishing date 2024-01-09
    Publishing country Denmark
    Document type Journal Article ; Review
    ZDB-ID 391933-x
    ISSN 1398-9995 ; 0105-4538
    ISSN (online) 1398-9995
    ISSN 0105-4538
    DOI 10.1111/all.16003
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  9. Article ; Online: Gastrointestinal-isolated Distress is Common in Alpha-gal Allergic Patients on Mammalian Meat Challenge.

    McGill, Sarah K / Levin, Michael E / Shaheen, Nicholas J / Cotton, Cary C / Platts-Mills, Thomas A / Commins, Scott P

    Journal of clinical gastroenterology

    2024  Volume 58, Issue 1, Page(s) 80–84

    Abstract: Background and aims: 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.: Methods!# ...

    Abstract Background and aims: 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.
    Methods: 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).
    Results: 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).
    Conclusions: 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.
    MeSH term(s) Adult ; Child ; Animals ; Humans ; Prospective Studies ; Immunoglobulin E ; Food Hypersensitivity/diagnosis ; Meat/adverse effects ; Dyspepsia ; Mammals
    Chemical Substances Immunoglobulin E (37341-29-0)
    Language English
    Publishing date 2024-01-01
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 448460-5
    ISSN 1539-2031 ; 0192-0790
    ISSN (online) 1539-2031
    ISSN 0192-0790
    DOI 10.1097/MCG.0000000000001827
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  10. Article ; Online: Geographic Distribution of Suspected Alpha-gal Syndrome Cases - United States, January 2017-December 2022.

    Thompson, Julie M / Carpenter, Ann / Kersh, Gilbert J / Wachs, Tyler / Commins, Scott P / Salzer, Johanna S

    MMWR. Morbidity and mortality weekly report

    2023  Volume 72, Issue 30, Page(s) 815–820

    Abstract: Alpha-gal syndrome (AGS) is an emerging, tick bite-associated allergic condition characterized by a potentially life-threatening immunoglobulin E (IgE)-mediated hypersensitivity to galactose-alpha-1,3-galactose (alpha-gal), an oligosaccharide found in ... ...

    Abstract Alpha-gal syndrome (AGS) is an emerging, tick bite-associated allergic condition characterized by a potentially life-threatening immunoglobulin E (IgE)-mediated hypersensitivity to galactose-alpha-1,3-galactose (alpha-gal), an oligosaccharide found in most nonprimate mammalian meat and products derived from these mammals. Specific symptoms and severity of AGS vary among persons, and no treatment or cure is currently available. During 2010-2018, more than 34,000 suspected cases of AGS were identified in the United States, but current knowledge of where cases occur is limited. This study examined alpha-gal-specific IgE (sIgE) antibody testing results submitted to the commercial laboratory responsible for nearly all testing in the United States before 2022 to assess the geographic distribution and magnitude of this emerging condition. During January 1, 2017-December 31, 2022, a total of 357,119 tests were submitted from residences in the United States, corresponding to 295,400 persons. Overall, 90,018 (30.5%) persons received a positive test result in the study period, and the number of persons with positive test results increased from 13,371 in 2017 to 18,885 in 2021. Among 233,521 persons for whom geographic data were available, suspected cases predominantly occurred in counties within the southern, midwestern, and mid-Atlantic U.S. Census Bureau regions. These data highlight the evolving emergence of AGS and can be used to help state and local health agencies initiate surveillance and target public health outreach and health care provider education to high-risk localities.
    MeSH term(s) Animals ; Humans ; United States/epidemiology ; Galactose ; Food Hypersensitivity ; Tick Bites/epidemiology ; Immunoglobulin E ; Mammals
    Chemical Substances Galactose (X2RN3Q8DNE) ; Immunoglobulin E (37341-29-0)
    Language English
    Publishing date 2023-07-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 412775-4
    ISSN 1545-861X ; 0149-2195
    ISSN (online) 1545-861X
    ISSN 0149-2195
    DOI 10.15585/mmwr.mm7230a2
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