Feature Article

Managing mammalian meat allergy and tick anaphylaxis

SHERYL VAN NUNEN, ANDREW RATCHFORD

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© Ric_Jo/Istockphoto.com
© Ric_Jo/Istockphoto.com

Abstract

Tick-induced allergies, including mammalian meat allergy after tick bite and tick anaphylaxis, are increasingly prevalent, particularly on Australia’s eastern seaboard. Tick bite prevention and appropriate management are crucial to both primary and secondary prevention of these allergies. Sensitisation to alpha-gal in mammalian meat can have many consequences, mostly affecting use of certain medical therapies.

Key Points

  • Tick-induced allergies are emerging worldwide, and tick anaphylaxis has caused fatalities in Australia.
  • Mammalian meat allergy after tick bite (MMA) classically presents as severe anaphylaxis that is delayed (typically three to 6 hours after ingesting mammalian meat, i.e. ‘middle of the night’) and evolves rapidly in an individual with a past history of tick bite.
  • The MMA spectrum comprises anaphylaxis, other systemic allergic reactions (urticaria and angioedema), gut-predominant symptoms, ‘asymptomatic’ alpha-gal sensitisation and, rarely, food-dependent carbohydrate- induced enterocolitis syndrome.
  • Evidence-based tick bite prevention and management strategies are crucial to primary and secondary prevention of MMA and tick anaphylaxis.
  • Consequences of developing alpha-gal specific IgE are myriad, affecting the use of medical therapies such as certain vaccines, heparin and cetuximab, and probably increasing atheroma risk.