Association between lone star tick bites and increased alpha-gal sensitization: evidence from a prospective cohort of ou
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SHORT REPORT
Association between lone star tick bites and increased alpha‑gal sensitization: evidence from a prospective cohort of outdoor workers Cedar L. Mitchell1* , Feng‑Chang Lin2, Meagan Vaughn1, Charles S. Apperson3, Steven R. Meshnick1 and Scott P. Commins4
Abstract Background: Alpha-gal is an oligosaccharide implicated in delayed anaphylaxis following red meat consumption. Exposure to tick bites has been correlated with development of an allergic response to alpha-gal. However, evidence prospectively linking exposure to a single tick species and an immune response to alpha-gal is lacking. Methods: We used serum samples from a prior study cohort of outdoor workers in North Carolina, USA, with high exposure to the lone star tick, Amblyomma americanum, to prospectively evaluate the relationship between tick bites and anti-alpha-gal IgE antibodies. Results: Individuals who reported exposure to one or more tick bites were significantly more likely to have a positive change in anti-alpha-gal IgE compared to individuals with no reported tick bites. This relationship was not dependent on time. A trend toward increasing number of tick bites and increased anti-alpha-gal IgE levels was observed but not statistically significant. Conclusion: To our knowledge, this is the first study to prospectively link documented exposure to A. americanum bites and increased sensitization to alpha-gal in a cohort of outdoor workers. Our results support the role of A. americanum as likely agents for eliciting an allergic response to red meat, and highlight the importance of preventing tick bites. Keywords: Alpha-gal, Amblyomma americanum, Red meat allergy Background Alpha-gal syndrome (AGS) is an immunoglobulin E (IgE)-mediated allergy to the oligosaccharide galactosealpha-1,3-galactose (alpha-gal), present in non-primate mammals [1]. AGS is characterized by a delayed onset allergic reaction following ingestion of mammalian meat (e.g. beef, pork, lamb) or its derivatives, and a positive serum IgE result to alpha-gal (≥ 0.1 kU/l) [1, 2] Since 2009, AGS has been widely reported in North America, Australia, Europe and Asia, with bites from various tick *Correspondence: [email protected] 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Full list of author information is available at the end of the article
species often suggested as a proximate cause of AGS [3–6]. While these previous reports have proposed a relationship between tick bites and AGS, the nature of the study designs (case reports [1, 3], cross-sectional studies [4, 5] or retrospective epidemiological studies [6]) preclude recording of the exposure prior to the outcome and are vulnerable to recall bias and exposure misclassification. Thus, evidence from prospective studies is needed to confirm the role of tick bites in the development of AGS. In the USA, most cases of AGS have been reported from the Southeast, where the lone star tick, Amblyomma ame
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