α-Gal on Crotalidae-polyvalent Fab antivenom (CroFab): Investigating the relevance to immediate hypersensitivity reactions

In 2012, a meta-analysis of 11 unique studies reported an incidence rate of immediate hypersensitivity reactions to FabAV at 8%, but the range varied by study (0%-22%).4 A more recent nationwide registry of 373 patients found an incidence rate of 2.7%.2 In 2016, a group in Germany reported that the...

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Veröffentlicht in:The journal of allergy and clinical immunology in practice (Cambridge, MA) MA), 2021-02, Vol.9 (2), p.1015-1017.e1
Hauptverfasser: Straesser, Matthew, Keshavarz, Behnam, Borish, Larry, Khokhar, Dilawar, Holian, Angela, Charlton, Nathan P., Platts-Mills, Thomas A.E., Wilson, Jeffrey M.
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Sprache:eng
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Zusammenfassung:In 2012, a meta-analysis of 11 unique studies reported an incidence rate of immediate hypersensitivity reactions to FabAV at 8%, but the range varied by study (0%-22%).4 A more recent nationwide registry of 373 patients found an incidence rate of 2.7%.2 In 2016, a group in Germany reported that the oligosaccharide galactose-α-1, 3-galactose (α-Gal), the relevant allergen in the syndrome of delayed anaphylaxis to mammalian meat,5 was present in multiple mammal-derived antivenom products.6 The authors postulated that α-Gal could be a possible target in IgE-mediated reactions to antivenom; however, there were no clinical cases reported, nor was Crotalidae-polyvalent immune Fab/FabAV among the products studied in that report. Of note, α-Gal sensitization is caused by tick bites and in the United States IgE to α-Gal has a regional distribution that is most pronounced in southeastern States.8 Interestingly, a retrospective study of the Arizona Poison and Drug Information Center database, which services an area where neither ticks nor α-Gal cases are common, demonstrated a 1.4% rate of acute allergic reactions to FabAV.3 Because this reaction frequency is below the rate reported in other studies, it implies that there may be regional variability in reaction frequency. [...]we hypothesized that α-Gal is present on FabAV and that IgE to α-Gal could be relevant to immediate hypersensitivity reactions to FabAV, particularly in snake bite cases managed at our hospital and other hospitals in the Southeast. [...]basophil activation tests were conducted using peripheral blood from subjects with and without α-Gal syndrome (for methods, see this article's Online Repository). In keeping with the indications for administering FabAV, many patients presented to the emergency department with systemic manifestations (eg, flushing, nausea, and vomiting) related to the toxic envenomation. [...]some patients may have received prophylactic intravenous diphenhydramine and/or methylprednisolone treatment before FabAV administration as part of standard management.
ISSN:2213-2198
2213-2201
DOI:10.1016/j.jaip.2020.10.026