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Allergy to meats

Author
Scott P Commins, MD, PhD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Anna M Feldweg, MD

INTRODUCTION

Meat allergy is uncommon in the developed world, despite relatively high levels of meat consumption [1]. Childhood meat allergy is usually associated with atopic dermatitis and outgrown during the first years of life. Meat allergy can also develop in adulthood.

The epidemiology, clinical manifestations, diagnosis, and natural history of allergy to meats will be discussed in this topic review. General issues related to food allergies are presented separately. (See "Clinical manifestations of food allergy: An overview" and "Food allergy in children: Prevalence, natural history, and monitoring for resolution" and "History and physical examination in the patient with possible food allergy" and "Diagnostic evaluation of food allergy".)

EPIDEMIOLOGY AND CAUSATIVE MEATS

Meat allergy is relatively uncommon, although the overall incidence and prevalence of allergies to meat in the general population are not known. Among patients with food allergies, meat allergy has been reported in about 3 to 15 percent of pediatric cases [2,3] and 3 percent of adult cases [4]. The low prevalence of meat allergy may be in part attributable to the fact that most meats are eaten in cooked forms, and cooking usually (not always) reduces the immunogenicity of allergens. (See 'Allergens' below.)

The type of meats that cause allergy appear to be related to their prominence in the diet and geographical variations are evident [5,6].

Beef is the most commonly reported allergy, with a prevalence of beef allergy ranging from 1.5 to 6.5 percent among children with atopic dermatitis or food allergies/intolerances [1,7,8]. However, the prevalence of beef allergy can be as high as 20 percent in children allergic to cow's milk [1]. (See 'Patterns of cross-reactivity' below.)

                      

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 07 00:00:00 GMT+00:00 2014.
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References
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  1. Werfel SJ, Cooke SK, Sampson HA. Clinical reactivity to beef in children allergic to cow's milk. J Allergy Clin Immunol 1997; 99:293.
  2. Crespo JF, Pascual C, Burks AW, et al. Frequency of food allergy in a pediatric population from Spain. Pediatr Allergy Immunol 1995; 6:39.
  3. Steinke M, Fiocchi A, Kirchlechner V, et al. Perceived food allergy in children in 10 European nations. A randomised telephone survey. Int Arch Allergy Immunol 2007; 143:290.
  4. Etesamifar M, Wuethrich B. IgE-mediated food allergies including oral allergy syndrome in 383 patients. Allergologie 1998; 21:451.
  5. Hadley C. Food allergies on the rise? Determining the prevalence of food allergies, and how quickly it is increasing, is the first step in tackling the problem. EMBO Rep 2006; 7:1080.
  6. Mills EN, Mackie AR, Burney P, et al. The prevalence, cost and basis of food allergy across Europe. Allergy 2007; 62:717.
  7. Fiocchi A, Restani P, Riva E, et al. Meat allergy: I--Specific IgE to BSA and OSA in atopic, beef sensitive children. J Am Coll Nutr 1995; 14:239.
  8. Rancé F, Kanny G, Dutau G, Moneret-Vautrin DA. Food hypersensitivity in children: clinical aspects and distribution of allergens. Pediatr Allergy Immunol 1999; 10:33.
  9. Sabbah A, Lauret MG, Chène J, et al. [The pork-cat syndrome or crossed allergy between pork meat and cat epithelia (2)]. Allerg Immunol (Paris) 1994; 26:173.
  10. Palacios Benito R, Alvárez-Lovel MC, Martínez-Cócera C, et al. Allergy to meat. Allergy 2002; 57:858.
  11. Cahen YD, Fritsch R, Wüthrich B. Food allergy with monovalent sensitivity to poultry meat. Clin Exp Allergy 1998; 28:1026.
  12. Bourne HC, Restani P, Moutzouris M, Katelaris CH. An unusual pattern of meat allergy. Allergy 2005; 60:706.
  13. Moore LM, Rathkopf MM, Sanner CJ, et al. Seal and whale meat: two newly recognized food allergies. Ann Allergy Asthma Immunol 2007; 98:92.
  14. Commins SP, Satinover SM, Hosen J, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol 2009; 123:426.
  15. Nuñez R, Carballada F, Gonzalez-Quintela A, et al. Delayed mammalian meat-induced anaphylaxis due to galactose-α-1,3-galactose in 5 European patients. J Allergy Clin Immunol 2011; 128:1122.
  16. Van Nunen SA, O'Connor KS, Clarke LR, et al. An association between tick bite reactions and red meat allergy in humans. Med J Aust 2009; 190:510.
  17. Grönlund H, Adédoyin J, Commins SP, et al. The carbohydrate galactose-alpha-1,3-galactose is a major IgE-binding epitope on cat IgA. J Allergy Clin Immunol 2009; 123:1189.
  18. Hamsten C, Starkhammar M, Tran TA, et al. Identification of galactose-α-1,3-galactose in the gastrointestinal tract of the tick Ixodes ricinus; possible relationship with red meat allergy. Allergy 2013; 68:549.
  19. Rispens T, Derksen NI, Commins SP, et al. IgE production to α-gal is accompanied by elevated levels of specific IgG1 antibodies and low amounts of IgE to blood group B. PLoS One 2013; 8:e55566.
  20. Hamsten C, Tran TA, Starkhammar M, et al. Red meat allergy in Sweden: association with tick sensitization and B-negative blood groups. J Allergy Clin Immunol 2013; 132:1431.
  21. Mullins RJ, James H, Platts-Mills TA, Commins S. Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose. J Allergy Clin Immunol 2012; 129:1334.
  22. Breuer K, Heratizadeh A, Wulf A, et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy 2004; 34:817.
  23. Choi GS, Kim JH, Shin YS, et al. Food allergy to meat and milk in adults. Allergy 2010; 65:1065.
  24. Restani P, Ballabio C, Tripodi S, Fiocchi A. Meat allergy. Curr Opin Allergy Clin Immunol 2009; 9:265.
  25. Ayuso R, Lehrer SB, Tanaka L, et al. IgE antibody response to vertebrate meat proteins including tropomyosin. Ann Allergy Asthma Immunol 1999; 83:399.
  26. Ayuso R, Lehrer SB, Lopez M, et al. Identification of bovine IgG as a major cross-reactive vertebrate meat allergen. Allergy 2000; 55:348.
  27. Asero R, Mistrello G, Falagiani P. Oral allergy syndrome from pork. Allergy 1997; 52:684.
  28. Allergen Nomenclature Sub-Committee of the International Union of Immunological Societies. Allergen Nomenclature. http://www.allergen.org/Allergen.aspx (Accessed on August 17, 2010).
  29. Kanny G, de Hauteclocque C, Moneret-Vautrin DA. Food anaphylaxis to bovine serum albumin. J Allergy Clin Immunol 1998; 101:137.
  30. Beretta B, Conti A, Fiocchi A, et al. Antigenic determinants of bovine serum albumin. Int Arch Allergy Immunol 2001; 126:188.
  31. Restani P, Beretta B, Fiocchi A, et al. Cross-reactivity between mammalian proteins. Ann Allergy Asthma Immunol 2002; 89:11.
  32. Llátser R, Polo F, De La Hoz F, Guillaumet B. Alimentary allergy to pork. Crossreactivity among pork kidney and pork and lamb gut. Clin Exp Allergy 1998; 28:1021.
  33. Restani P, Fiocchi A, Beretta B, et al. Meat allergy: III--Proteins involved and cross-reactivity between different animal species. J Am Coll Nutr 1997; 16:383.
  34. Wahl R, Kleinhans D. IgE-mediated allergic reactions to fruit gums and investigation of cross-reactivity between gelatine and modified gelatine-containing products. Clin Exp Allergy 1989; 19:77.
  35. Commins S, personal communication.
  36. Morisset M, Richard C, Astier C, et al. Anaphylaxis to pork kidney is related to IgE antibodies specific for galactose-alpha-1,3-galactose. Allergy 2012; 67:699.
  37. Gonzalez-Quintela A, Dam Laursen AS, Vidal C, et al. IgE antibodies to alpha-gal in the general adult population: relationship with tick bites, atopy, and cat ownership. Clin Exp Allergy 2014; 44:1061.
  38. Sekiya K, Fukutomi Y, Nakazawa T, et al. Delayed anaphylactic reaction to mammalian meat. J Investig Allergol Clin Immunol 2012; 22:446.
  39. Lee JH, Kim JH, Kim TH, Kim SC. Delayed mammalian meat-induced anaphylaxis confirmed by skin test to cetuximab. J Dermatol 2013; 40:577.
  40. Ebo DG, Faber M, Sabato V, 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.
  41. Fischer J, Hebsaker J, Caponetto P, et al. 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.
  42. Commins SP, James HR, Kelly LA, et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol 2011; 127:1286.
  43. Commins SP, Platts-Mills TA. Tick bites and red meat allergy. Curr Opin Allergy Clin Immunol 2013; 13:354.
  44. Fiocchi A, Bouygue GR, Sarratud T, et al. Clinical tolerance of processed foods. Ann Allergy Asthma Immunol 2004; 93:S38.
  45. Fiocchi A, Restani P, Riva E, et al. Meat allergy: II--Effects of food processing and enzymatic digestion on the allergenicity of bovine and ovine meats. J Am Coll Nutr 1995; 14:245.
  46. Spergel JM. Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients. Curr Opin Allergy Clin Immunol 2007; 7:274.
  47. Spergel JM, Andrews T, Brown-Whitehorn TF, et al. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 2005; 95:336.
  48. Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol 2005; 115:149.
  49. Levy Y, Danon YL. Food protein-induced enterocolitis syndrome--not only due to cow's milk and soy. Pediatr Allergy Immunol 2003; 14:325.
  50. Zacharisen MC. Severe allergy to chicken meat. WMJ 2006; 105:50.
  51. Liccardi G, Szépfalusi Z, Noschese P, et al. Allergy to chicken meat without sensitization to egg proteins: a case report. J Allergy Clin Immunol 1997; 100:577.
  52. de Maat-Bleeker F, van Dijk AG, Berrens L. Allergy to egg yolk possibly induced by sensitization to bird serum antigens. Ann Allergy 1985; 54:245.
  53. Mandallaz MM, de Weck AL, Dahinden CA. Bird-egg syndrome. Cross-reactivity between bird antigens and egg-yolk livetins in IgE-mediated hypersensitivity. Int Arch Allergy Appl Immunol 1988; 87:143.
  54. de Blay F, Hoyet C, Candolfi E, et al. Identification of alpha livetin as a cross reacting allergen in a bird-egg syndrome. Allergy Proc 1994; 15:77.
  55. Szépfalusi Z, Ebner C, Pandjaitan R, et al. Egg yolk alpha-livetin (chicken serum albumin) is a cross-reactive allergen in the bird-egg syndrome. J Allergy Clin Immunol 1994; 93:932.
  56. Quirce S, Marañón F, Umpiérrez A, et al. Chicken serum albumin (Gal d 5*) is a partially heat-labile inhalant and food allergen implicated in the bird-egg syndrome. Allergy 2001; 56:754.
  57. Drouet M, Boutet S, Lauret MG, et al. [The pork-cat syndrome or crossed allergy between pork meat and cat epithelia (1)]. Allerg Immunol (Paris) 1994; 26:166.
  58. Hilger C, Kohnen M, Grigioni F, et al. Allergic cross-reactions between cat and pig serum albumin. Study at the protein and DNA levels. Allergy 1997; 52:179.
  59. Posthumus J, James HR, Lane CJ, et al. Initial description of pork-cat syndrome in the United States. J Allergy Clin Immunol 2013; 131:923.
  60. Drouet M, Sabbah A, Le Sellin J, et al. [Fatal anaphylaxis after eating wild boar meat in a patient with pork-cat syndrome]. Allerg Immunol (Paris) 2001; 33:163.
  61. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med 2008; 358:1109.
  62. Theler B, Brockow K, Ballmer-Weber BK. Clinical presentation and diagnosis of meat allergy in Switzerland and Southern Germany. Swiss Med Wkly 2009; 139:264.
  63. Orhan F, Sekerel BE. Beef allergy: a review of 12 cases. Allergy 2003; 58:127.
  64. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985; 107:669.
  65. Fiocchi A, Bouygue GR, Restani P, et al. Accuracy of skin prick tests in IgE-mediated adverse reactions to bovine proteins. Ann Allergy Asthma Immunol 2002; 89:26.
  66. Available from ViracorIBT Laboratories. Search test menu on "Alpha-Gal IgE" www.viracoribt.com (Accessed on March 01, 2013).
  67. University of Virginia Medical Laboratories performs testing for IgE to alpha gal. Information is available at: http://www.healthsystem.virginia.edu/alive/medlabs/LabTestSearch/LabTests.cfm?searchType=detail&LabTest_ID=19520 (Accessed on March 01, 2013).
  68. Cat serum albumin is available commercially from Phadia ImmunoCAP (allergen code e220). http://www.phadia.com/en/Allergen-information/ImmunoCAP-Allergens/ (Accessed on March 04, 2013).
  69. Raison-Peyron N, Messaad D, Bousquet J, Demoly P. Anaphylaxis to beef in penicillin-allergic patient. Allergy 2001; 56:796.
  70. Kanny G, Puygrenier J, Beaudoin E, Moneret-Vautrin DA. [Alimentary anaphylactic shock: implication of penicillin residues]. Allerg Immunol (Paris) 1994; 26:181.
  71. Martelli A, De Chiara A, Corvo M, et al. Beef allergy in children with cow's milk allergy; cow's milk allergy in children with beef allergy. Ann Allergy Asthma Immunol 2002; 89:38.
  72. Eigenmann PA. Anaphylaxis to cow's milk and beef meat proteins. Ann Allergy Asthma Immunol 2002; 89:61.
  73. Fuentes Aparicio V, Sánchez Marcén I, Pérez Montero A, et al. Allergy to mammal's meat in adult life: immunologic and follow-up study. J Investig Allergol Clin Immunol 2005; 15:228.