Updated guidance provided for GI clinicians on alpha-gal syndrome

A subset of patients with alpha-gal allergy have gastrointestinal symptoms without skin changes or anaphylaxis, according to a clinical practice update published in the April issue of Clinical Gastroenterology and Hepatology.

Sarah K. McGill, M.D., from the University of North Carolina at Chapel Hill, and colleagues provide information relating to the presentation and management of alpha-gal syndrome in order to increase awareness among gastroenterologists.

The authors note that a subset of alpha-gal allergic patients show gastrointestinal symptoms, such as abdominal pain, diarrhea, nausea, or vomiting, without skin changes or anaphylaxis. Among patients with gastrointestinal distress and increased serum alpha-gal immunoglobulin E (IgE) antibodies whose symptoms are relieved adequately on an alpha-gal avoidance diet, which eliminates pork, beef, and mammalian-derived products, alpha-gal syndrome can be diagnosed. Counseling for an alpha-gal avoidance diet is suggested for patients with suspected alpha-gal allergy because it is the primary management. Measures to avoid tick bites should also be included in counseling, because additional bites can cause a further increase in alpha-gal IgE titers and worsen the allergy. Referral to allergists is recommended for patients who also have reactions such as facial swelling, urticaria, and respiratory difficulty.

"It is important for gastroenterologists to be aware of this condition and to be capable of diagnosing and treating it in a timely manner," the authors write.

Two authors disclosed financial ties to the medical technology industry.

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