Tick exposures and alpha-gal syndrome: A systematic review of the evidence

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creativework.keywords - en
Amblyomma americanum
Meat allergy
Anaphylaxis
Food Hypersensitivity
Mice
Tick bites
Urticaria
Ticks
α-Gal.
dc.contributor.author
Young, Ian
Prematunge, Chatura
Pussegoda, Kusala
Corrin, Tricia
Waddell, Lisa
dc.date.accessioned
2024-06-21T17:14:58Z
dc.date.available
2024-06-21T17:14:58Z
dc.date.issued
2021-01
dc.description.abstract - en
Alpha-gal syndrome (AGS) refers to a delayed allergic reaction to galactose-α-1,3-galactose (α-Gal) that occurs following the consumption of mammalian meat or exposure to other animal-based foods and products. Increasing evidence suggests that bites from certain tick species can lead to AGS through sensitization of a person's α-Gal specific IgE levels. This systematic review aimed to summarize the published evidence on this topic to understand post-tick exposure AGS epidemiology and health outcomes. A structured search for literature in eight bibliographic databases was conducted in January, 2020. Grey literature and verification searches were also performed. The exposure of interest was tick bites, and the outcome of interest was AGS. All primary research study designs were eligible for inclusion. References were screened for relevance, and data extraction and risk-of-bias assessment were conducted on relevant studies by two independent reviewers. Data were descriptively and narratively summarized. Of 1390 references screened, 102 relevant articles (103 unique studies) were identified (published from 2009 to 2020). Most studies (76.7 %) were case report or series. These 79 studies reported on 236 post-tick exposure AGS cases from 20 different countries, mostly the United States (33.5 %), Spain (19.5 %), Sweden (18.6 %), and France (12.7 %). The mean case age was 51.3 (SD = 16.7, range 5-85, n = 229), while 68.1 % were male (n = 226). The most commonly reported symptom was urticaria (71.2 %); 51.7 % of cases reported anaphylaxis. Twenty-one observational studies were reported, mostly (95.2 %) among clinical allergy patients. The proportion of AGS cases that recalled tick bites was highly variable across these studies. Three challenge studies evaluating tick exposures and α-Gal levels in α-Gal deficient mice were identified. The existing evidence suggests tick bites lead to α-Gal-specific IgE sensitization, which can cause AGS, but further research is needed to clarify if AGS is only attributable to certain tick species and whether other vectors may trigger AGS. Additional research is needed on risk factors for AGS development, evaluation of diagnostic immunoassays, and the epidemiology and distribution of AGS in different populations. Climate change will likely lead to future cases of AGS in new regions worldwide due to the predicted alteration of suitable tick habitats.
dc.identifier.citation
Young I, Prematunge C, Pussegoda K, Corrin T, Waddell L. Tick exposures and alpha-gal syndrome: A systematic review of the evidence. Ticks Tick Borne Dis. 2021 May;12(3):101674. doi: 10.1016/j.ttbdis.2021.101674. Epub 2021 Jan 27.
dc.identifier.doi
https://doi.org/10.1016/j.ttbdis.2021.101674
dc.identifier.issn
1877-959X
dc.identifier.pubmedID
33529984
dc.identifier.uri
https://science-ouverte.canada.ca/handle/123456789/2620
dc.language.iso
en
dc.publisher
Elsevier
dc.rights - en
Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
dc.rights - fr
Creative Commons Attribution - Pas d'utilisation commerciale - Pas de modification 4.0 International (CC BY-NC-ND 4.0)
dc.rights.uri - en
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.uri - fr
https://creativecommons.org/licenses/by-nc-nd/4.0/deed.fr
dc.subject - en
Health
dc.subject - fr
Santé
dc.subject.en - en
Health
dc.subject.fr - fr
Santé
dc.title - en
Tick exposures and alpha-gal syndrome: A systematic review of the evidence
dc.type - en
Article
dc.type - fr
Article
local.acceptedmanuscript.articlenum
101674
local.article.journalissue
3
local.article.journaltitle
Ticks and Tick-borne Diseases
local.article.journalvolume
12
local.peerreview - en
Yes
local.peerreview - fr
Oui
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