The rise of Alpha-gal allergies

The mechanism of food allergies is well defined and extensively studied. It’s no wonder that when the first patients were diagnosed with alpha-gal allergies, in 2007, it took scientists by surprise.

Allergy to alpha-gal is manifested via individuals reacting adversely to mammalian meat products, e.g. red meat.

Alpha-gal allergies, also known as alpha-gal syndrome or mammalian meat allergies, do not follow the traditional trends of classic food allergies. First, they are not an IgE-mediated reaction to protein, but rather to a carbohydrate linked to protein. The carbohydrate or sugar found in mammals that triggers this reaction is called galactose-alpha-1,3-galactose, or alpha-gal for short. It is found in most mammals, but not in humans, great apes, or old-world monkeys.

Second, reactions are often not acute, with symptoms typically presenting from two to 10 (and sometimes up to 24) hours after a patient has eaten the offending food. It is frequently referred to as ‘midnight anaphylaxis’, because symptoms often occur in the early hours of the morning after a meaty supper the night before.

It is widely accepted that tick bites play a significant role in the development of this syndrome. After consuming mammalian blood, ticks inject alpha-gal into humans when they bite them next. Because humans do not produce alpha-gal naturally the carbohydrate is seen as foreign, and the immune system produces IgE antibodies against it. Every time thereafter that mammalian meat is consumed, the individual has a reaction. (Though it is important to note that not everyone who is bitten by a tick will develop the syndrome.)

Alpha-gal is found not only in the meat of mammals, but also in their fat, skin, dander, milk, saliva, oils, and even excrement. Ingredients derived from mammal products are used widely, and are not confined to the food industry. They often hide in over-the-counter and prescription medicines, lotions, soaps, self-care products, crayons, glue and paint. In food products (other than meat), alpha-gal is associated with ingredients such as gelatine, tallow, lard and some flavourings and additives.

Reference doses for alpha-gal have not yet been determined, but it’s thought that a relatively small amount can cause a significant reaction. This makes cross-contamination in the kitchen and production environment a noteworthy risk, with some individuals even reacting when inhaling airborne alpha-gal from cooking meat.

Symptoms range from mild (e.g. abdominal pain, heartburn, itchy skin, etc.) to severe reactions, such as cardiac arrest and anaphylaxis.

Up to 10% of people in some regions and select populations may be affected by alpha-gal allergies, and it’s believed that its prevalence may be under-reported in South Africa. In 2017, in the rural Eastern Cape, a research group from the Red Cross Hospital diagnosed 85 people with alpha-gal allergies in a period of six weeks.

What is the role of the food industry? We are monitored through several different regulations, one of which is the Regulation Relating to the Labelling and Advertising of Foodstuffs (R. 146). This regulation oversees a number of different elements with regard to food allergies, such as the labelling of common allergens, Information in the case of uncommon allergens, and the listing of ingredients. Alpha-gal is not regulated as a common allergen, but it may be considered an uncommon one.

The regulation states the following regarding uncommon allergens: “The presence of uncommon allergens in or on the foodstuff or its packaging material has to be disclosed by manufacturers upon request by a consumer, inspector or the Department based on the information contained in the Supplier Ingredient Information File … which shall be kept on record.” The industry can protect themselves and allergic consumers by ensuring that mammalian meat and associated products are always listed in the ingredients panel.

And if the allergic consumer should contact the producer, they must be able to disclose this information.

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