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Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-[alpha]-1,3-galactose

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To the Editor:

Gelatin-containing sweets can elicit anaphylaxis in mammalian meat allergic patients. A warning regarding gelatin-containing foods and medical products should be included in recommendations for patients with IgE recognizing Galactose--1,3-Galactose.

Galactose--1,3-galactose (-Gal) is known to be the responsible allergen for delayed onset anaphylaxis 3 to 6 h after ingestion of mammalian food products. 1 Recently Mullins et al 2 detected -Gal in meat-derived gelatin. With correlation of gelatin skin testing and anti--Gal IgE measurements a strong relation to red meat anaphylaxis was shown. It was hypothesized that -Gal is one of the targets of reactivity to gelatin. 2

Recently, we were able to examine the clinical relevance of meat-derived gelatin in food in 1 of our 21 patients with diagnosed red meat anaphylaxis. This 58-year-old hunter had presented with a 10-year history of episodes of anaphylaxis (flush, urticaria, hypotension, diarrhea) during night time after consuming meat and entrails from beef, pork, and game. The most severe reactions started <3 hours after eating entrails. Anaphylaxis after consumption of meat was regularly associated with symptoms that started 3 to 8 hours after eating and brought on by exercise. Remarkably, the patient reported multiple tick bites with persisting local reaction. 3 Prick-to-prick skin testing of pork meat, pork kidney, and beef kidney was reactive ( Table I ). Laboratory measures showed an elevated total IgE of 595 kUA/L and a specific IgE to pork of 4 kUA/L, to beef of 4.3 kUA/L, and to -Gal of 29.2 kUA/L (ImmunoCAP; Phadia GmbH, Freiburg, Germany). Baseline levels of tryptase were elevated on 3 occasions (12.6-16.1 g/L; normal range, <11.4 g/L), but no cutaneous mastocytosis was detected, and bone marrow biopsy showed no histologic signs for systemic mastocytosis. 4 During 1 episode of anaphylaxis tryptase was further elevated to 82.7 g/L. To assess the...