A comprehensive toolkit to identify blood donors and recipients with a history of alpha-Gal allergy or suspected sensitization during pre-transfusion assessments

Authors

• Z Osterwind
• MJ Miller
• V De Giorgi

Abstract

The oligosaccharide galactose-alpha-1,3-galactose (alpha-gal) is universally produced by mammals, excluding certain primates and humans. Saliva of the Lone Star tick (Amblyomma americanum) contains alpha-gal that can trigger the development of an IgE-mediated food allergy to mammalian meat and derived products known as alpha-gal syndrome (AGS). The blood type B antigen is structurally similar to alpha-gal potentially allowing cross-reactivity between alpha-gal IgE and B red blood cells. It is speculated that alpha-gal sensitized type A and O recipients of type B blood product transfusions (platelets, plasma, cryoprecipitate) may experience allergic transfusion reactions (ATRs) to type B red blood cells. The objective of this study was to evaluate the quality of evidence on the role of AGS in ATRs and organize the information into a comprehensive toolkit. A narrative review of peer-reviewed articles and gray literature on the topic was performed in PubMed and Google without publication language or date restrictions using “alpha-gal syndrome” and “blood transfusion reaction” or “allergy.” The preliminary results were used for a citation search. Overall, the search yielded 216 results, with 45 results reviewed. Two medical chart reviews and one commentary letter specifically discussing AGS and ATRs were found. This literature search yielded few results regarding the hypothesized mechanism of allergic reaction, though alpha-gal sensitization is known to be increasing in prevalence in the United States. This toolkit and other clinical studies investigating the alpha-gal sensitization phenomenon may assist blood bankers managing transfusion reactions in regions such as Washington, D.C. with Lone Star tick presence.

Scientific Focus Area: Immunology

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