Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal. In instances where the triggering allergen is not known, establishing the etiology of anaphylaxis is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody (Ab) response to a mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal), that has been associated with two distinct forms of anaphylaxis: i) immediate onset anaphylaxis during first exposure to intravenous cetuximab, and ii) delayed onset anaphylaxis 3-6 hours after ingestion of mammalian food products (e.g., beef and pork). The overarching hypothesis for this proposal is that defining both the cause and the mechanism of the IgE Ab response to alpha-gal as well as identifying the antigen responsible for the delayed food reactions will provide insight into the factors that govern allergic responses and control anaphylaxis. The significance of investigating these reactions comes not only from the obvious importance of understanding a novel life threatening form of food allergy, but also because of the possibility of defining a totally new mechanism for reactions related to an important food substance. Our plan of research focuses on the epidemiology of IgE Ab to alpha-gal, the antigen that appears in the bloodstream 3-5 hours after eating beef, pork or lamb, and the role of tick bites in initiating the IgE response. Our current work has shown that IgE to the carbohydrate alpha-gal is present in a cohort of patients who report delayed anaphylaxis and allergic reactions after eating mammalian meat. We believe that IgE to alpha-gal represents a novel cause of food allergy.
The specific aims outlined in this proposal are designed to investigate the epidemiology of this carbohydrate-directed IgE (Specific Aim #1), elucidate the mechanism for delayed reactions (Specific Aim #1), establish the cause of the IgE response (Specific Aim #2), and investigate the mechanism of specific IgE production against a glycan (Specific Aim #2). Overall, these studies are uniquely positioned to provide insight into a recently recognized allergic response as well as identify the molecules present during an allergic reaction and possibly establish a model for ecto-parasitic tick bites initiating an IgE response.

Public Health Relevance

Anaphylaxis, or shock, is a severe allergic reaction that can progress quickly and may be fatal if appropriate medical action is not taken. We have identified a group of patients who develop delayed anaphylaxis 3-6 hours after eating beef, pork or lamb and the allergy appears to begin after tick bites, even in people who have tolerated these meats their entire lives. Because of the delay, their symptoms would normally be regarded as 'spontaneous'or 'of unknown cause'but understanding why the delay occurs and why patients - particularly in the Southeast - are suddenly becoming allergic to red meat may provide real insight into the factors that control anaphylaxis and food allergy.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
High Priority, Short Term Project Award (R56)
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Hypersensitivity, Autoimmune, and Immune-mediated Diseases Study Section (HAI)
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Davidson, Wendy F
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University of Virginia
Internal Medicine/Medicine
Schools of Medicine
United States
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Commins, Scott P (2017) Outpatient Emergencies: Anaphylaxis. Med Clin North Am 101:521-536
Stone Jr, Cosby A; Hemler, Jonathan A; Commins, Scott P et al. (2017) Anaphylaxis after zoster vaccine: Implicating alpha-gal allergy as a possible mechanism. J Allergy Clin Immunol 139:1710-1713.e2
Steinke, John W; Pochan, Shawna L; James, Hayley R et al. (2016) Altered metabolic profile in patients with IgE to galactose-alpha-1,3-galactose following in vivo food challenge. J Allergy Clin Immunol 138:1465-1467.e8
Commins, Scott P; Jerath, Maya R; Cox, Kelly et al. (2016) Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int 65:16-20
Platts-Mills, Thomas A E; Schuyler, Alexander J; Erwin, Elizabeth A et al. (2016) IgE in the diagnosis and treatment of allergic disease. J Allergy Clin Immunol 137:1662-1670
Steinke, John W; Platts-Mills, Thomas A E; Commins, Scott P (2015) The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol 135:589-96; quiz 597
Platts-Mills, Thomas A E; Schuyler, Alexander J; Hoyt, Alice E W et al. (2015) Delayed Anaphylaxis Involving IgE to Galactose-alpha-1,3-galactose. Curr Allergy Asthma Rep 15:12
Commins, Scott P (2015) Mechanisms of Oral Tolerance. Pediatr Clin North Am 62:1523-9