Asia Pac Allergy.  2015 Jan;5(1):3-16. 10.5415/apallergy.2015.5.1.3.

Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance

• van Nunen

• KMID: 2397062
• DOI: http://doi.org/10.5415/apallergy.2015.5.1.3

Abstract

Serious tick-induced allergies comprise mammalian meat allergy following tick bites and tick anaphylaxis. Mammalian meat allergy is an emergent allergy, increasingly prevalent in tick-endemic areas of Australia and the United States, occurring worldwide where ticks are endemic. Sensitisation to galactose-α-1,3-galactose (α-Gal) has been shown to be the mechanism of allergic reaction in mammalian meat allergy following tick bite. Whilst other carbohydrate allergens have been identified, this allergen is unique amongst carbohydrate food allergens in provoking anaphylaxis. Treatment of mammalian meat anaphylaxis involves avoidance of mammalian meat and mammalian derived products in those who also react to gelatine and mammalian milks. Before initiating treatment with certain therapeutic agents (e.g., cetuximab, gelatine-containing substances), a careful assessment of the risk of anaphylaxis, including serological analysis for α-Gal specific-IgE, should be undertaken in any individual who works, lives, volunteers or recreates in a tick endemic area. Prevention of tick bites may ameliorate mammalian meat allergy. Tick anaphylaxis is rare in countries other than Australia. Tick anaphylaxis is secondarily preventable by prevention and appropriate management of tick bites. Analysis of tick removal techniques in tick anaphylaxis sufferers offers insights into primary prevention of both tick and mammalian meat anaphylaxis. Recognition of the association between mammalian meat allergy and tick bites has established a novel cause and effect relationship between an environmental exposure and subsequent development of a food allergy, directing us towards examining environmental exposures as provoking factors pivotal to the development of other food allergies and refocusing our attention upon causation of allergy in general.

Keyword

Mammalian meat; Ticks; Anaphylaxis; Alpha-gal; Cetuximab

MeSH Terms

Allergens
Anaphylaxis*
Australia
Cetuximab
Environmental Exposure
Food Hypersensitivity
Gelatin
Hypersensitivity*
Meat*
Milk
Primary Prevention
Tick Bites
Ticks*
United States
Volunteers
Allergens
Cetuximab
Gelatin

Figure

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  Fig. 1 Confluent large local reactions to 2 tick bites (Ixodes holocyclus). Adapted with permission of Stephen L. Doggett, Senior Hospital Scientist, Pathology West, ICPMR (level 3), Westmead Hospital, Locked Bag 9001, Westmead NSW 2145, Australia.

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  Fig. 2 Distribution of Ixodes holocyclus (Australian paralysis tick). Map adapted from Roberts FHS (1970) Australian Ticks. Yeerongpilly, QLD, Australia by TAGS Inc., Bill Conroy & Norbert Fischer.

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  Fig. 3 Numbers of patients with anaphylaxis to insects presenting to a single allergy consultant practice in Sydney, Australia 2011-2013. Adapted with permission of Stephen L. Doggett, Senior Hospital Scientist, Pathology West, ICPMR (level 3), Westmead Hospital, Locked Bag 9001, Westmead NSW 2145, Australia. Illustrations of bee and wasps courtesy of WikiCommons.

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