ACTAS
De mo-Sifiliog áficas
115
(2024)
116---117
LETTER
TO
THE
EDITOR
The
alpha-Gal
Synd ome
is
Unde diagnosed
El
sínd ome
de
al a-Gal
es á
in adiagnos icado
To
he
Edi o ,
Recen ly,
Fe nández
de
la
Fuen e
e
al.1published
an
in e es ing
case
associa ed
wi h
eac ions
o
De macen o
ma gina us
ick
bi e.
Fo y-eigh
hou s
a e
ick
bi e
he
case
p esen ed
an
indu a ed
lesion
a ound
he
bi e
and
a
bad
bounded
e y hema ous
edema ous
plaque
accompanied
by
a
e y
pain ul
bila e al
palpable
ce ical
adenopa hy,
ele-
a ed
le els
o
some
hepa ic
enzymes
and
se e al
peaks
o
low-g ade
e e
(37.8 ◦C).
The
pa ien s
es ed
nega i e
o
ick-bo ne
pa hogens
Ricke sia
cono ii
and
Bo elia
bu gdo e i.1Acco dingly,
he
pa ien
was
diagnosed
wi h
he
spo ed
e e
g oup
disease
ick-bo ne
lymphadenopa-
hy
(TIBOLA).1
The
alpha-Gal
synd ome
(AGS)
is
associa ed
wi h
IgE
an ibodies
and
alle gic
eac ions
o
ick
bi es,
mammalian
mea
consump ion
and
pha maceu icals
con aining
glycan
galac ose-alpha-1,3-galac ose
(␣-Gal)
modifica ion
in
p o-
eins
and
lipids.2 --- 5 Mul iple
ick
species
wi h
di e en
␣-Gal
con en
a e
associa ed
wi h
he
AGS
wo ldwide.6
Hominids
e ol ed
wi h
mul iple
e en s
o
ca as ophic
selec ion
including
loosing
he
syn hesis
o
␣-Gal
and
hus
de eloping
he
capaci y
o
p oduce
IgM/IgG
an ibodies
and
ac i a e
immune
mechanisms
in
esponse
o
his
molecule
wi h
p o ec i e
capaci y
agains
pa hogens
con aining
o
no
his
glycan
modifica ion.2,3,7 Acco dingly,
immuniza ion
wi h
␣-Gal
and
p obio ics
wi h
␣-Gal
con en
can
bus
p o ec i e
immune
esponses
agains
pa hogen
in ec ion
(e.g.,
Re .
8).
Acco ding
o
Cen e s
o
Disease
Con ol
and
P e en ion
(CDC;
h ps://www.cdc.go / icks/alpha-gal/index.h ml),
AGS
eac ions
can
include
hi es
o
i chy
ash,
nausea
o
omi ing,
hea bu n
o
indiges ion,
dia hea,
cough,
sho ness
o
b ea h,
o
di ficul y
b ea hing,
d op
in
blood
p essu e,
swelling
o
he
lips,
h oa ,
ongue,
o
eye
lids,
dizziness
o
ain ness,
and
se e e
s omach
pain.
The
mos
common
symp oms
include
u ica ia
and
angioedema,
espi a o y
dis ess,
ca dio ascula /hea
disease,
gas oin-
es inal
symp oms,
dia hea,
abdominal
pain,
eflux,
and
emesis.5These
symp oms
can
be
di e en
om
pe son- o-
pe son
and
commonly
appea
2 --- 6
h
a e
ea ing
mea
o
dai y
p oduc s,
o
a e
exposu e
o
p oduc s
con aining
␣-Gal
such
as
gela in-coa ed
medica ions.5In
some
cases,
mo ali y
is
associa ed
wi h
AGS
while
some
people
may
no
ha e
alle gic
eac ions
a e
e e y
exposu e
o
ick
bi es
o
␣-Gal.5In
Spain,
some
cases
ha e
p esen ed
anaphylaxis
o
ick
bi es
associa ed
wi h
an i-␣-Gal
IgE
an ibody
le els
and
ick
p o eins.9
Despi e
ecen
ad ances
in
he
diagnosis
and
ea -
men
o
AGS,4,6 ick
p o eins
and
immune
mechanisms
igge ing
he
AGS
ha e
no
been
ully
cha ac e ized,10
and
only
p elimina y
e idence
on
ick
alphagalac ome
ha e
been
ecen ly
published.6Fu he mo e,
he
a ie y
in
AGS
symp oma ology
and
case- o-case
di e ences
oge he
wi h
limi ed
knowledge
in
heal h
ca e
p ac i ione s
and
gene al
popula ion
makes
i
di ficul
o
diagnose
and
ea
AGS.
Conside ing
hese
ac s
and
e en
i
he
iden ified
ick
species
ha e
no
been
p e iously
associa ed
wi h
AGS,
i
is
ecommended
o
cases
wi h
eac ions
o
ick
bi e
like
he
one
desc ibed
by
Fe nández
de
la
Fuen e
e
al.1 o
de ail
pa ien
his o y
and
es
se um
an i-␣-
Gal
IgE
an ibody
le els.4Alle gy
skin
es ing
may
be
also
conside ed.4
No e
Fo
in o ma ion
on
AGS
in
Spanish:
Mazuecos,
L.,
de
la
Fuen e,
J.,
Villa ,
M.,
2023.
Las
ga apa as
y
la
ale gia
a
la
ca ne
oja.
No as
de
di ulgación
del
IREC
No.
3.
Ins i-
u o
de
in es igación
en
Recu sos
Cinegé icos,
Ciudad
Real,
Espa˜
na.
4
pp.
h ps://www.i ec.es/di ulgacion-cien ifica/
no a-di ulga i a-ga apa as-y-ale gia-ca ne- oja/.
Funding
Ou
esea ch
on
AGS
is
suppo ed
by
Minis e io
de
Ciencia
e
Inno ación/Agencia
Es a al
de
In es igación
MCIN/AEI/10.13039/501100011033,
Spain
and
EU-FEDER
(g an
BIOGAL
PID2020-116761GB-I00).
Conflic
o
in e es
The
au ho
decla es
ha
he
esea ch
was
conduc ed
in
he
absence
o
any
comme cial
o
financial
ela ionships
ha
could
be
cons ued
as
a
po en ial
conflic
o
in e es .
h ps://doi.o g/10.1016/j.ad.2023.07.018
0001-7310/©
2023
AEDV.
Published
by
Else ie
Espa˜
na,
S.L.U.
This
is
an
open
access
a icle
unde
he
CC
BY-NC-ND
license
(h p://
c ea i ecommons.o g/licenses/by-nc-nd/4.0/).
ACTAS
De mo-Sifiliog áficas
115
(2024)
116---117
Re e ences
1.
Fe nández
de
la
Fuen e
L,
He e o
Ruiz
S,
Eche e ía
B.
Complica ion
o
a
ick
bi e
[Ga apa a
complicada].
Ac as
De -
mosifiliog .
2023;19:S0001-7310(23)00503-3.
h ps://doi.o g/
10.1016/j.ad.2022.07.045.
2.
Van
Nunen
SA,
O’Conno
KS,
Cla ke
LR,
Boyle
RX,
Fe -
nando
SL.
An
associa ion
be ween
ick
bi e
eac ions
and
ed
mea
alle gy
in
humans.
Med
J
Aus .
2009;190:510---1,
h p://dx.doi.o g/10.5694/j.1326-5377.2009. b02533.x.
3.
Galili
U.
E olu ion
in
p ima es
by
‘‘Ca as ophic-selec ion’’
in e play
be ween
en eloped
i us
epidemics,
mu a ed
genes
o
enzymes
syn hesizing
ca bohyd a e
an igens,
and
na -
u al
an i-ca bohyd a e
an ibodies.
Am
J
Phys
An h opol.
2019;168:352---63,
h p://dx.doi.o g/10.1002/ajpa.23745.
4.
Vaz-Rod igues
R,
Mazuecos
L,
de
la
Fuen e
J.
Cu en
and
u u e
s a egies
o
he
diagnosis
and
ea men
o
he
alpha-Gal
synd ome
(AGS).
J
As hma
Alle gy.
2022;15:957---70,
h p://dx.doi.o g/10.2147/JAA.S265660.
5.
Macdougall
JD,
Thomas
KO,
Iweala
OI.
The
mea
o
he
ma e :
unde s anding
and
managing
alpha-Gal
synd ome.
Immuno a ge s
The .
2022;11:37---54,
h p://dx.doi.o g/
10.2147/ITT.S276872.
6.
Villa
M,
Pacheco
I,
Ma eos-He nández
L,
Cabezas-C uz
A,
Tabo
AE,
Rod íguez-Valle
M.
Cha ac e iza ion
o
ick
sali a y
gland
and
sali a
alphagalac ome
e eals
candida e
alpha-
gal
synd ome
disease
bioma ke s.
Expe
Re
P o eomics.
2021;18:1099---116,
h p://dx.doi.o g/10.1080/14789450.
2021.2018305.
7.
de
la
Fuen e
J,
Con e as
M.
Vaccinomics:
a
u u e
a enue
o
accine
de elopmen
agains
eme ging
pa hogens.
Expe
Re
Vaccines.
2021;20:1561---9,
h p://dx.doi.o g/
10.1080/14760584.2021.1987222.
8.
Pacheco
I,
Díaz-Sánchez
S,
Con e as
M,
Villa
M,
Cabezas-C uz
A,
Go áza
C,
e
al.
P obio ic
bac e ia
wi h
high
alpha-Gal
con en
p o ec
zeb afish
agains
mycobac e iosis.
Pha maceu-
icals.
2021;14:635,
h p://dx.doi.o g/10.3390/ph14070635.
9.
Ma eos-He nández
L,
Villa
M,
Mo al
A,
Ga cía
Rod íguez
C,
Al aya
A ias
T,
de
la
Osa
V,
e
al.
Tick---hos
conflic :
immunoglobulin
E
an ibodies
o
ick
p o eins
in
pa ien s
wi h
anaphylaxis
o
ick
bi e.
Onco a ge .
2017;8:20630---44,
h p://dx.doi.o g/10.18632/onco a ge .15243.
10.
Sha ma
SR,
Ka im
S.
Tick
sali a
and
he
alpha-Gal
syn-
d ome:
finding
a
needle
in
a
hays ack.
F on
Cell
In ec
Mic obiol.
2021;11:680264,
h p://dx.doi.o g/10.3389/ cimb.
2021.680264.
J.
de
la
Fuen ea,b
aSaBio,
Ins i u o
de
In es igación
en
Recu sos
Cinegé icos
(IREC-CSIC-UCLM-JCCM),
Ronda
de
Toledo
12,
13005
Ciudad
Real,
Spain
bDepa men
o
Ve e ina y
Pa hobiology,
Cen e
o
Ve e ina y
Heal h
Sciences,
Oklahoma
S a e
Uni e si y,
S illwa e ,
OK
74078,
USA
E-mail
add ess:
jose
[email p o ec ed]
117