Baptist Health-University of Arkansas for Medical Sciences North Little Rock, OH
Award: ACG Presidential Poster Award
Nosheen Hafeez, MD1, FNU Murlidhar, MBBS, MD2, Zaira Shahid, MBBS, MD3, Mohamed Boshnaf, MD, MPH4, Osama Ijaz, MD5, Samuel Hunter. Dunn, MD1 1Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR; 2Mayo Clinic, Rochester, MN; 3King Edward Medical University, Tallahassee, FL; 4Prime Health SJMC, Lockport, IL; 5SSM Health St. Mary's Hospital - St. Louis, Richmond Heights, MO Introduction: Unlike typical IgE-mediated food allergies triggered by proteins, Alpha-Gal Syndrome (AGS) is a delayed hypersensitivity reaction to galactose-α-1,3-galactose (alpha-gal), a carbohydrate found in non-primate mammalian meat (e.g., beef, pork, lamb). This unique allergy arises due to a loss-of-function mutation in the α1,3-galactosyltransferase gene, rendering alpha-gal immunogenic in humans. Sensitization is often triggered by tick bites, leading to IgE-mediated responses several hours after meat consumption. Though potentially affecting hundreds of thousands in the U.S., AGS remains underdiagnosed and often misattributed due to its atypical presentation.
Case Description/
Methods: We present a case series of three patients of AGS wtih chronic non-specific gastrointestinal symptoms. A 27-year-old (y/o) male presented with chronic non-specific GI symptoms, including abdominal pain, alternating bowel habits, nausea, along with fatigue, headache, and dizziness. His extensive GI and infectious workup, including CT Enteroclysis (CTE), stool studies, Gastric emptying study, and EGD/colonoscopy, were unrevealing. An elevated ANA and persistent symptoms raised concern for an evolving autoimmune disease, ultimately revealing elevated beef, lamb, and pork-specific IgE and alpha-gal IgE (0.39 kU/L). Another 21 y/o with a strong family history of Crohn’s disease presented with nausea, episodic diarrhea, and food intolerance, particularly to red meat and dairy. Despite extensive workup, including a colonoscopy, EGD, celiac panel, and biopsies for IBD & eosinophilic esophagitis, the diagnosis remained unclear. Diagnosed with AGS after elevated beef, lamb, and pork-specific IgE and alpha-gal IgE (12.4 kU/L) were found. A 59-year-old woman presented with cyclic nausea and vomiting. Initial labs and HIDA scan were unremarkable. EGD showed atrophic gastric mucosa and a 5 mm polyp consistent with carcinoid. Repeat EGD later in the year showed no recurrence of carcinoid or atrophic changes. Labs revealed a positive antiparietal cell antibody (1:160) and alpha-gal IgE of 50.90 kU/L. Dietary modification led to significant improvement in these patients Discussion: AGS can present with non-specific GI symptoms after consumption of mammalian meat or related products. Clinicians should maintain a high index of suspicion and a low threshold for checking alpha-gal-specific IgE, especially in patients with tick exposure or intolerance to red meat. Early recognition and dietary modification can significantly improve symptoms.
Disclosures: Nosheen Hafeez indicated no relevant financial relationships. FNU Murlidhar indicated no relevant financial relationships. Zaira Shahid indicated no relevant financial relationships. Mohamed Boshnaf indicated no relevant financial relationships. Osama Ijaz indicated no relevant financial relationships. Samuel Dunn indicated no relevant financial relationships.
Nosheen Hafeez, MD1, FNU Murlidhar, MBBS, MD2, Zaira Shahid, MBBS, MD3, Mohamed Boshnaf, MD, MPH4, Osama Ijaz, MD5, Samuel Hunter. Dunn, MD1. P2714 - Alpha-Gal Syndrome: A Case Series Supporting the Need for Greater Clinical Recognition, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
