Is bovine gelatin anaphylaxis always associated with α-Gal syndrome? Two case reports and a literature review

Abstract

Gelatin is extracted from beef, pork, and fish tissues. An increasing number of cases of gelatin-induced anaphylaxis are associated with α-Gal syndrome (AGS). Only a few cases of anaphylaxis to bovine gelatin (BG) without AGS (BG-woAG) have been described. We report two new cases of anaphylaxis to BG-woAG, highlight the characteristics of this entity, and propose a procedure in cases of suspected anaphylaxis to BG. We selected articles on gelatin allergy between 1987 and 2024. Results: we report two new cases of severe anaphylaxis BG-woAG. Diagnosis was established using skin tests (ST), IgE, and basophil activation tests (BAT). We confirm the existence of allergies to BG-woAG. The main characteristic of these allergies seems to be the presence of BG IgE which differentiates them from AGS-related allergies. These initial data need to be confirmed by larger case series. We propose a diagnostic algorithm for better patient management. To confirm the diagnosis, ST and IgE to BG and α-Gal should be performed. The role of BAT to Gelofusine^® in the diagnostic strategy remains to be defined.

Keywords

Anaphylaxis / basophil activation test / galactose-alpha-1,3-galactose (alpha-Gal) / bovine gelatin / fish gelatin / IgE

References

[1] Ebo DG, Faber M, Sabato V, Leysen J, Gadisseur A, Bridts CH, et al. Sensitization to the mammalian oligosaccharide galactose-alpha-1,3-galactose (alpha-gal): experience in a Flemish case series. Acta Clin Belg. 2013; 68: 206-9.

[2] Mullins RJ, James H, Platts-Mills TAE, Commins S. Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose. J Allergy Clin Immunol. 2012; 129: 1334-42.e1.

[3] Mehlich J, Fischer J, Hilger C, Swiontek K, Morisset M, Codreanu-Morel F, et al. The basophil activation test differentiates between patients with alpha-gal syndrome and asymptomatic alpha-gal sensitization. J Allergy Clin Immunol. 2019; 143: 182-9.

[4] Nucera E, Colagiovanni A, Mezzacappa S, Buonomo A, Aruanno A, Rizzi A, et al. Anaphylaxis by antihistamine containing bovine gelatin: the utility of the basophil activation test in the diagnostic work-up. Postepy Dermatol Alergol. 2017; 34: 279-80.

[5] Tacquard C, Serrier J, Viville S, Chiriac A, Franchina S, Gouel-Cheron A, et al. Epidemiology of perioperative anaphylaxis in France in 2017-2018: the 11th GERAP survey. Br J Anaesth. 2024; 132: 1230-7.

[6] Fujimoto W, Fukuda M, Yokooji T, Yamamoto T, Tanaka A, Matsuo H. Anaphylaxis provoked by ingestion of hydrolyzed fish collagen probably induced by epicutaneous sensitization. Allergol Int. 2016; 65: 474-6.

[7] Molina-Molina GJ, Carrasco-González MD, Viñas-Giménez L, Sanz-Martínez M, Galván-Blasco P, Luengo O, et al. Fatal Anaphylactic Shock Induced by Intravenous Gelatin Colloid: A Postmortem Allergological Work-up. J Investig Allergol Clin Immunol. 2020; 30: 143-5.

[8] Retterer MKC, Workman LJ, Bacon JR, Platts-Mills TAE. Specific IgE to gelatin as a cause of anaphylaxis to zoster vaccine. J Allergy Clin Immunol. 2018; 141: 1956-7.

[9] Rauschenberg R, Beissert S, Bauer A, Spornraft-Ragaller P. Intraoperative anaphylactic reaction IV° to gelatin. J Dtsch Dermatol Ges. 2014; 12: 617-8.

[10] Bradfisch F, Pietsch M, Forchhammer S, Strobl S, Stege HM, Pietsch R, et al. Case series of anaphylactic reactions after rabies vaccinations with gelatine sensitization. Allergo J Int. 2019; 28: 103-6.

[11] Fischer J, Hebsaker J, Caponetto P, Platts-Mills TAE, Biedermann T. Galactose-alpha-1,3-galactose sensitization is a prerequisite for pork-kidney allergy and cofactor-related mammalian meat anaphylaxis. J Allergy Clin Immunol. 2014; 134: 755-9.e1.

[12] Sakaguchi M, Nakayama T, Inouye S. Food allergy to gelatin in children with systemic immediate-type reactions, including anaphylaxis, to vaccines. J Allergy Clin Immunol. 1996; 98: 1058-61.

[13] Bogdanovic J, Halsey NA, Wood RA, Hamilton RG. Bovine and porcine gelatin sensitivity in children sensitized to milk and meat. J Allergy Clin Immunol. 2009; 124: 1108-10.