Is Alpha-Gal an Emerging Allergen in Drug Allergy?

Galactose-alpha-1,3-galactose (alpha-gal) is a ubiquitous singular oligosaccharide and a relevant emergent allergen, first reported in 2008, which caused severe and even fatal allergic reactions to drugs such as the monoclonal antibody cetuximab. This article reviews the literature on drugs containing alpha-gal and on drugs acting such as compounding-factors in alpha-gal allergy and the concomitant risk of anaphylaxis, from the last 15 years.

On the one hand, contact with mammal-derived excipients or additives, could be an emergent cause of an alpha-gal hypersensitivity reaction. Previously, monoclonal antibodies (abs) and intravenous gelatins have been the most frequent culprits responsible for immediate alpha-gal drug allergic reactions regardless of the initially described cetuximab. On the other hand, drug co-factors such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Angiotensin Converting Enzyme (ACE) Inhibitors and Proton Pump Inhibitors (PPIs), have been reported to trigger alpha-gal allergy and increase the risk of anaphylaxis.

This review provides the latest updates on Alpha-Gal Syndrome (AGS), focusing on drugs that contain alpha-gal, and emphasizing that certain medications can act as risky compounding-factors.

Data on prevalence, clinical presentation, current diagnosis and patient management are also reviewed, providing practical resources to support today´s best care including nutritional assessment. Future research should focus on improving effective treatment for managing AGS.