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Labor and Delivery of a Parturient with Alpha-Gal Syndrome
Abstract Number: RF7A10-144
Abstract Type: Case Report Case Series
Introduction: Alpha Gal syndrome, also known as mammalian meat allergy, is an allergy to galactose-alpha-1,3-galactose. This carbohydrate, often called alpha-gal, is a component of mammalian meat. Those sensitized to alpha-gal often manifest IgE-mediated responses after ingesting meat or medications containing animal by-products. Interestingly, the geographic distribution of Alpha Gal syndrome mimics that of the lone star tick. In fact the bite from this tick, as well as the monoclonal antibody cetuximab, has been implicated in triggering Alpha Gal syndrome.
Methods: This case describes a 38 year old primagravida with Alpha Gal syndrome, with associated allergies to gel-tabs and leather products developed following a tick bite. Her other medical history is notable for asthma, gestational diabetes requiring insulin, and placenta previa. At 39 weeks gestation, the patient was admitted for an elective cesarean section which was performed under spinal anesthesia with intrathecal bupivacaine, fentanyl, and morphine. Despite pre-treatment with nearly a 1 liter of crystalloid fluids, the patient developed significant hypotension following spinal placement, unlikely related to her Alpha Gal syndrome, and was successfully treated with boluses of ephedrine and a high dose infusion of phenylephrine. The patient tolerated the remainder of the surgery without further issue, and synthetic sutures were chosen by the obstetric team, rather than collagen derived Plain Gut and Chromic sutures, for wound closure. Heparin was avoided post-operatively, and replaced with intermittent lower extremity venous compression devices, along with aggressive early ambulation. She was discharged home on post-operative day three.
Conclusion: There is limited literature on obstetric patients with Alpha Gal syndrome, however, both vaginal and cesarean section as modes of delivery appear safe. While this patient tolerated her intra-partum, delivery, and post-partum course without issue, careful planning and avoidance of products containing animal by-products is necessary. Furthermore, immediate availability of IV epinephrine, H1 and H2 blockers, and steroids are necessary in the event a severe allergic reaction should develop.
1) Commins SP, Platts-Mills TA. Delayed anaphylaxis to red meat in patients with IgE specific for galactose alpha-1,3-galactose (alpha-gal). Curr Allergy Asthma Res. 2013;13(1):72-77
2) Chung CH, Mirakhur B, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. The New England journal of medicine. 2008;358:1109–17
3) Commins SP, James HR, et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-a-1,3-galactose. J Allergy Clin Immunol. 2011; 127:1286–93
4) Mullins RJ, James H, et al. The relationship between red meat allergy and sensitization to gelatin and galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2012;129(5):1334-1342