'Doc, will I ever eat steak again?': diagnosis and management of alpha-gal syndrome.
'Doc, will I ever eat steak again?': diagnosis and management of alpha-gal syndrome.
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DOI：
10.1097/mop.0000000000000955
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发表时间：
2020-12
影响因子：
3.6
通讯作者：
Iweala OI
中科院分区：
文献类型：
--
作者：
Patel C;Iweala OI
α-半乳糖综合征包括与对半乳糖-α-1，3-半乳糖（α-半乳糖）的免疫介导的超敏反应相关的一系列症状。这篇综述的目的是讨论我们目前对α-半乳糖综合征的病因、临床症状、自然病史、流行病学和治疗的认识。对α-半乳糖的致敏作用与体外寄生虫如孤星星蜱Amblyomma americanum的叮咬有关。α-半乳糖综合征的过敏反应通常是延迟和不一致的。过敏反应的程度取决于辅助因素，如运动和饮酒以及食物中存在的α-半乳糖和脂肪的量。测定血清中的α-gal特异性IgE是用于确认过敏的主要诊断试验。长期管理的条件包括避免哺乳动物食品和蜱叮咬。α-半乳糖综合征扰乱了目前理解食物过敏的范式。暴露于体外寄生虫对于特异性IgE抗体的产生至关重要，过敏反应取决于肥大细胞和嗜碱性粒细胞的活化，这些细胞被针对碳水化合物而非蛋白质的IgE致敏。这一领域的研究可能会导致改进的诊断和治疗工具的开发，从而彻底改变α-半乳糖综合征患者的管理。
Alpha-gal syndrome encompasses a constellation of symptoms associated with immune-mediated hypersensitivity responses to galactose-alpha-1,3-galactose (alpha-gal). The purpose of this review is to discuss our current understanding of the etiology, clinical symptoms, natural history, epidemiology, and management of alpha-gal syndrome. Sensitization to alpha-gal is associated with bites from ectoparasites like the lone star tick Amblyomma americanum. Allergic reactions in alpha-gal syndrome are often delayed and inconsistent. The magnitude of the allergic response depends on co-factors like exercise and alcohol consumption and the amount of alpha-gal and fat present in the food. Assaying alpha-gal specific IgE in the serum is the primary diagnostic test used to confirm the allergy. Long-term management of the condition involves avoidance of both mammalian food products and tick bites. Alpha-gal syndrome disrupts the current paradigm for understanding food allergy. Exposure to an ectoparasite is critical for the development of specific IgE antibodies underlying sensitization, and allergic reactions depend on the activation of mast cells and basophils sensitized with IgE against a carbohydrate rather than a protein. Research in this field may lead to the development of improved diagnostic and therapeutic tools that can revolutionize the management of patients with alpha-gal syndrome.