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Allergy. 2017 Oct;72(10):1540-1547. doi: 10.1111/all.13156. Epub 2017 May 10.

Prevalence of type I sensitization to alpha-gal in forest service employees and hunters.

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Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Department of Clinical Epidemiology and Applied Biostatistics, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Baden-Württemberg State Health Office, District Government Stuttgart, Stuttgart, Germany.
Department of Dermatology and Allergy Biederstein, Technische Universität, Munich, Germany.



The production of IgE molecules specific to the carbohydrate galactose-α-1,3-galactose (alpha-gal) is known to induce delayed anaphylaxis against mammalian meat. Tick bites constitute the primary sensitization source, as ticks transfer alpha-gal in their saliva to a host during a bite. The reported prevalence of alpha-gal-specific IgE (alpha-gal-sIgE) positivity varies between different populations from diverse geographic regions.


To investigate the prevalence of alpha-gal-sIgE positivity in a population of forest service employees who are highly exposed to ticks in comparison with a residential population and a historic sample.


A cross-sectional study evaluating 300 forest service employees and hunters from southwest Germany was performed. Alpha-gal-sIgE levels were assessed by ImmunoCAP assay. The prevalence of alpha-gal-sIgE-positive individuals was compared with a matched cohort composed of a residential population and blood samples from forest service employees collected 15 years ago.


In the study population, the prevalence of alpha-gal-sIgE-positive (≥0.10 kUA /L) individuals was 35.0%, whereas the prevalence of individuals with alpha-gal-sIgE levels ≥0.35 kUA /L was 19.3%. Alpha-gal-sIgE positivity was associated with total IgE levels and recent tick bites. Mammalian meat-induced delayed anaphylaxis was found in 8.6% of the participants with alpha-gal-sIgE levels ≥0.35 kUA /L. For forest service employees and hunters, the odds ratio for alpha-gal-sIgE positivity was 2.48 compared to the residential population. The prevalence of alpha-gal-sIgE positivity in the current and historic cohort was comparable.


Forest service employees and hunters compose a population with a high prevalence of alpha-gal-sIgE positivity and carry a considerable risk of red meat allergy.


alpha-gal syndrome; anaphylaxis; galactose-α-1, 3-galactose; occupational medicine, tick bite

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