• Alpha-gal syndrome
• case report
• delayed hypersensitivity reaction
• dental products
• excipients
• pharmaceuticals

• Allergy
• Anaphylaxis
• Floseal
• Gelatin
• Partial nephrectomy

• anticoagulants
• postextraction bleeding
• rivaroxaban
• socket healing
• tissue adhesives
• tooth extraction

• alpha-gal syndrome
• anesthesia
• gelatin allergy
• hemostasis
• mammalian products
• neurosurgery

• alpha‐gal syndrome (AGS)
• cetuximab
• delayed‐type allergy
• mammalian meat allergy
• red meat allergy
• tick bites
• ticks

• Biological scaffolds
• Cellular activities enhancement
• Extracellular matrix mimicry
• Scaffold characteristics
• Stem-cell-based therapy
• Wound healing

• anticoagulants
• postoperative hemorrhage
• rivaroxaban
• tissue adhesives
• tooth extraction

• 115/20 START- Programm of the Faculty of Medicine of the Rheinisch- Westfälische Technische Hochschule (RWTH) Aachen Uni-versity

• Animals
• Humans
• Swine
• Thrombelastography/methods
• Thrombin
• Hemostasis/physiology
• Fibrinogen
• Hemostatics
• Liver
• Biopsy

• chemical modification
• chitosan
• hemostasis
• hydrogel
• self-healing

• Humans
• Hemostatics/pharmacology
• Hemostatics/therapeutic use
• Hemostatics/chemistry
• Chitosan/pharmacology
• Chitosan/therapeutic use
• Chitosan/chemistry
• Hydrogels/pharmacology
• Hydrogels/therapeutic use
• Hydrogels/chemistry
• Hemostasis
• Hemorrhage/drug therapy

Gelatin-based hemostatic agents are widely used in neurosurgery. This is a case of postoperative aphagia strongly suspected to be caused by an allergic reaction to a gelatin-based hemostatic agent after anterior cervical decompression and fusion for central cervical cord injury. A 55-year-old man underwent cervical anterior decompression and fusion at the C3/4 and 4/5 levels for central cervical cord injury. Immediately after the surgery, he could not swallow saliva at all, but his voice was not hoarse. Postoperative cervical computed tomography and magnetic resonance imaging showed significant edema from the post-hypopharynx wall to the front of the vertebral body. The retropharyngeal space was remarkably enlarged to 15.8 mm with cervical spine X-rays. Without neurological symptom improvement, his condition was diagnosed as marked edema of the area where Surgiflo (porcine-derived gelatin-based hemostatic agent; Johnson & Johnson Wound Management, Somerville, NJ, USA) had been applied during the operation. It was strongly suspected to be caused by an allergic response to the porcine-derived gelatin. When methylprednisolone 1000 mg was administered for 3 days from the 5th postoperative day, swallowing became almost normal within a few hours after the initial administration, and his neurological symptoms improved. The patient left the hospital on the 12th day after the operation. Before using porcine-derived gelatin products during surgery, special consideration should be given to patients with an allergy history before surgery.

• causes of anaphylaxis
• idiopathic anaphylaxis
• molecular diagnostics

• Male
• Humans
• Adult
• Anaphylaxis/epidemiology
• Anaphylaxis/etiology
• Poland/epidemiology
• Food Hypersensitivity/epidemiology
• Allergens
• Registries

• allergy
• anaphylaxis
• artificial intelligence
• drugs
• intraoperative

Alpha-gal syndrome is an unconventional food allergy, characterized by IgE-mediated hypersensitivity responses to the glycan galactose-alpha-1,3-galactose (alpha-gal) and not to a food-protein. In this review, we discuss how alpha-gal syndrome reframes our current conception of the mechanisms of pathogenesis of food allergy. The development of alpha-gal IgE is associated with tick bites though the possibility of other parasites promoting sensitization to alpha-gal remains. We review the immune cell populations involved in the sensitization and effector phases of alpha-gal syndrome and describe the current understanding of why allergic responses to ingested alpha-gal can be delayed by several hours. We review the foundation of management in alpha-gal syndrome, namely avoidance, but also discuss the use of antihistamines, mast cell stabilizers, and the emerging role of complementary and alternative therapies, biological products, and oral immunotherapy in the management of this condition. Alpha-gal syndrome influences the safety and tolerability of medications and medical devices containing or derived from mammalian products and impacts quality of life well beyond food choices.

• 3-galactose
• galactose-alpha-1
• mammalian meat
• red meat allergy
• tick

In addition to the therapeutic agent, drugs contain excipients such as stabilizers, preservatives, solubilizers, or dyes, some of which are identical to additives in foods. Anaphylaxis to these excipients is probably an underestimated problem. After the first descriptions of anaphylactic reactions to drug excipients appeared more than 30 years ago, the number of corresponding reports has increased significantly over the years. However, a diagnostic gap exists in the clarification of drug allergic reactions when the index product is not known and/or is not available for testing. In the present work, individual excipients are presented as examples for which publications on anaphylaxis are available. Furthermore, the options of allergological testing both in vivo and in vitro are discussed. The pathogenesis of such reactions is still unresolved in many cases, and current concepts are briefly presented in the conclusion. With increasing knowledge about anaphylaxis to drug excipients, it is assumed that these can then be recognized more often and diagnostically clarified.

Neben dem therapeutischen Agens enthalten Arzneimittel Hilfsstoffe als beispielsweise Stabilisatoren, Konservierungsstoffe, Löslichkeitsvermittler oder Farbstoffe, die teilweise identisch mit Zusatzstoffen in Nahrungsmitteln sind. Anaphylaxien auf diese Hilfsstoffe sind ein vermutlich unterschätztes Problem. Nachdem erste Beschreibungen anaphylaktischer Reaktionen auf Arzneimittelhilfsstoffe bereits vor über 30 Jahren auftauchten, hat die Zahl entsprechender Berichte in den letzten Jahren deutlich zugenommen. Eine diagnostische Lücke besteht allerdings in der Abklärung arzneimittelallergischer Reaktionen, wenn das Indexpräparat nicht bekannt ist und/oder nicht als Originalpräparat für Testungen zur Verfügung steht. In der vorliegenden Arbeit werden einzelne Hilfsstoffe exemplarisch vorgestellt, für die Publikationen zu Anaphylaxien vorliegen. Des Weiteren werden die Optionen allergologischer Testungen sowohl in vivo als auch in vitro besprochen. Die Pathogenese derartiger Reaktionen ist vielfach noch unklar, hier werden abschließend aktuelle Konzepte kurz vorgestellt. Mit zunehmendem Wissen über Anaphylaxien auf Arzneimittelhilfsstoffe ist davon auszugehen, dass diese auch vermehrt wahrgenommen und diagnostisch aufgeklärt werden können.

Zitierweise: Pfützner W. Anaphylaxis to drug excipients. Allergo J Int 2022;31:137-40

https://doi.org/10.1007/s40629-022-00214-9

• Craniotomy
• Dural closure
• Glioblastoma
• High-grade glioma
• Meningo-cerebral adhesions

• Acute Kidney Injury/veterinary
• Animals
• Catheters
• Dog Diseases/etiology
• Dog Diseases/therapy
• Dogs
• Female
• Iatrogenic Disease/veterinary
• Peritoneal Dialysis/veterinary
• Spleen

• Anaphylaxis
• Anesthesia
• Hypersensitivity reaction
• Intraoperative
• Perioperative

• Anaphylaxis/diagnosis
• Anaphylaxis/epidemiology
• Anaphylaxis/etiology
• Anti-Bacterial Agents
• Drug Hypersensitivity/diagnosis
• Drug Hypersensitivity/epidemiology
• Drug Hypersensitivity/therapy
• Humans
• Neuromuscular Blocking Agents/adverse effects

Alpha-gal syndrome is an immunoglobulin E (IgE)-dependent allergy to galactose-α-1,3-galactose, resulting in a delayed anaphylactic reaction to red meat. The syndrome is causally linked to bites from ticks and associated with cross-reactivity to some drugs, e.g. cetuximab. Although cases of alpha-gal allergy have already been reported in a few European countries, to our best knowledge, no cases have been reported so far in Central-Eastern Europe. In the current report, we describe a case of alpha-gal syndrome diagnosed in Poland, to highlight the fact that it may occur in new geographic areas. Within three months, the described patient underwent five anaphylactic reactions with typical clinical manifestations. They developed a few hours after ingestion of red meat (pork, beef or mutton) and were preceded by tick bites. The level of specific IgE antibodies to alpha-gal reached 72.6 kAU/l, whereas the levels of specific IgE antibodies to other food allergens were within the reference range. As the onset of symptoms in this syndrome is usually delayed, numerous cases may be identified as idiopathic anaphylaxis, while early diagnosis is indispensable to avoid potentially life-threatening complications.

• allergy
• alpha-gal syndrome
• anaphylaxis

• alpha‐gal syndrome
• delayed anaphylaxis to red meat
• red meat allergy
• re‐call urticaria
• tick bite

• Floseal
• Gelfoam
• Surgiflo
• anaphylaxis
• gelatin

Topical hemostatic agents are commonly used in a wide variety of surgical procedures to assist in hemostasis. However, the use of these agents is not without risk as many contain biologically active agents derived from human and animal products that have the potential to cause adverse reactions. This case report covers a 44-year-old man with a history of alpha-gal syndrome who was scheduled for an open reduction and internal fixation of a left distal radius fracture. Alpha-gal syndrome is characterized by an IgE-mediated type 1 hypersensitivity reaction to a mammalian oligosaccharide epitope. Patients with this condition have a history of a past tick bite and subsequent development of an allergic reaction to mammalian protein products, most notably red meat. The patient had concerns about products used during surgery and potential reactions based on his allergy. The intent of this case report is to promote physician awareness of the widespread use of mammalian products in surgical hemostatic agents and potential immunogenic reactions. By increasing awareness of the alpha-gal syndrome, the goal is that medical device companies will actively disclose product components that could potentiate these adverse reactions and continue to develop alternative agents.

• allergy
• alpha gal
• anaphylaxis
• gelatin
• hemostatic powder spray
• tick-borne disease
• topical thrombin

• aallergy, alpha gal, anaphylaxis, drug allergy, food allergy, glycolipids, ticks