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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: A detailed patient history is key to diagnosing alpha-gal syndrome, as the antibody test can yield false positives. Symptoms include abdominal pain, vomiting and diarrhea 4 to 8 hours after eating mammalian meat. Summer may be winding down, but tick season is still in full swing \u2014 and that means the possibility of developing alpha-gal syndrome remains high in certain areas of the country. The food allergy \u2014 caused by an immunoglobulin E (IgE)-mediated reaction hours after eating beef, pork or other mammalian meat or mammalian-derived products and triggered by the bite of a lone star tick \u2014 should be considered among patients with unexplained gastrointestinal symptoms like abdominal pain, vomiting and diarrhea.
In 2023, the AGA published a clinical practice update on the diagnosis and management of alpha-gal syndrome. Now, more than 3 years later, researchers are still trying to raise awareness about the unusual food allergy. \u201cIt\u2019s really the weirdest medical condition I\u2019ve ever heard of, and it is new,\u201d Sarah K. McGill, MD, MSc, professor of gastroenterology and hepatology at University of North Carolina at Chapel Hill and coauthor of the update, told Healio. \u201cWhen I was doing my medical training, it had not been discovered, so it\u2019s something we\u2019re all trying to wrap our heads around. \u201cAnd it can be life-threatening,\u201d she continued, \u201cso we all need to take notice and get up to speed on how to diagnose and manage it.\u201d The CDC estimates that 6% to 31% of people aged older than 16 years in endemic areas may have alpha-gal IgE antibodies, but not all seropositive individuals develop alpha-gal syndrome. The diagnosis can be tricky, according to McGill. \u201cThat requires getting a good history, including, \u2018What did you eat before you got sick?\u2019\u201d she said. \u201cIt is a challenging diagnosis, because the time delay leads most patients to not link their symptoms with mammalian products. Plus, the blood test has the potential to have a lot of false positives, so following up with the patient clinically is very important, even after a positive blood test.\u201d Healio spoke with McGill about diagnosing alpha-gal syndrome, preventive measures patients can take and the biggest misconception about the condition. Healio: What do gastroenterologists recognize now \u2014 3 years after the AGA clinical practice update \u2014 that they might have missed in 2023? McGill: The year the clinical practice update came out, the CDC surveyed primary care providers, and about half of them had never heard of alpha-gal syndrome. Unlike primary care providers, gastroenterologists don\u2019t typically manage food allergies, so you can probably take that awareness number and cut it in half. At this point, I\u2019m just hopeful that GIs in endemic areas know about alpha-gal syndrome, what causes it and how to diagnose it. We\u2019re probably not there yet. Healio: Are clinicians testing for alpha-gal often enough? When should unexplained GI symptoms in an endemic area trigger testing? McGill: The most convincing clinical scenario is a person in an endemic area who\u2019s having intermittent abdominal pain, vomiting, diarrhea or some variation of that within 4 to 8 hours after eating mammalian meat, like pork or beef. That patient should certainly be screened with the alpha-gal IgE blood test, and if that\u2019s positive, followed up a few weeks after assuming an alpha-gal avoidant diet to ensure that the symptoms have resolved or improved. When we talk about alpha-gal endemic areas, that\u2019s a pretty broad part of the Eastern U.S., including the Northeast up to Martha\u2019s Vineyard \u2014 that\u2019s the one that\u2019s getting all the attention. The Midwest is highly endemic, the mid-Atlantic states and the Southeast. Alpha-gal syndrome lays at this intersection of exploding autoimmune illness, because of depletions in the gut microbiome, and climate change, as the Lone Star tick is now endemic in regions that were too cold for it a few decades ago. Healio: Have diagnostic practices evolved? When should clinicians remain suspicious, despite a negative test result? McGill: We know that the IgE test to diagnose food allergies has problems with false positives. That hasn\u2019t changed much. With GIs and alpha-gal syndrome, since it is a really new diagnosis and we\u2019re just learning how to diagnose it and manage it, we definitely need to keep in mind that every positive test does not mean that someone has alpha-gal syndrome. Every test should be performed with some information from the patient that [alpha-gal syndrome] is what you\u2019re looking for. Would testing for an allergy to mammalian meat even make sense in their case? Do they eat mammalian meat? Have they had problems a few hours after eating mammalian meat? Do they go into the outdoors? This diagnosis is not made by the test alone. We need to see how they do with a mammalian meat-free or alpha-gal avoidant diet. The test is very similar to other tests that we do; for example, the Clostridioides difficile test. C. diff also requires a particular clinical scenario for it to be valid, because that has problems with false positives and false negatives. Celiac testing also requires a two-step diagnosis. However, if the alpha-gal IgE blood test is negative, clinicians should largely move on to other diagnoses and management. The rare exception, I would say, is in patients where the clinical scenario is highly supportive \u2014 recurrent abdominal distress a few hours after eating mammalian meat \u2014 and then symptom resolution with avoidance. Healio: Have dietary recommendations caught up with the science? What should gastroenterologists know about dairy, gelatin, lard, medications and other mammalian-derived products? McGill: Clinically, tolerance of alpha-gal among<\/p>\n","protected":false},"author":1,"featured_media":3692,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3691","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3691","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3691"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3691\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3692"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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