What is the treatment for alpha-gal allergy?

Treatment of Alpha-Gal Syndrome

The cornerstone of alpha-gal syndrome (AGS) management is complete avoidance of mammalian products, implementation of tick prevention strategies, and having emergency medications available for accidental exposures. 1

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis with:

• Serum testing for alpha-gal IgE antibodies (positive result >0.1 IU/mL)
• Clinical correlation with symptoms (delayed reactions 3-6 hours after mammalian product consumption)
• Improvement of symptoms after adherence to an alpha-gal avoidance diet 2, 1

Primary Management Approach

1. Dietary Avoidance

• Complete avoidance of all mammalian meat products (beef, pork, lamb, venison, etc.)
• Avoid mammalian-derived products including:
  • Gelatin-containing foods and medications
  • Some medications with mammalian excipients
  • Dairy products (if reactive)

2. Safe Food Alternatives

• Fish and seafood
• Poultry (chicken, turkey)
• Plant-based foods 1

3. Tick Prevention Strategies

• Perform regular tick checks after outdoor activities
• Shower promptly after potential tick exposure
• Treat clothing with permethrin
• Use EPA-approved insect repellents
• Avoid tick-infested areas when possible 1

4. Emergency Medication

• Prescribe epinephrine auto-injector for patients with history of systemic reactions
• Recommend antihistamines for milder reactions 1, 3

Monitoring and Follow-up

• Monitor symptom improvement after dietary elimination
• Repeat alpha-gal IgE levels 6-12 months after diagnosis if tick bites are avoided
• Some patients may experience a waning of sensitivity over time if further tick bites are prevented 1, 3

Potential Reintroduction Protocol

For patients with decreasing alpha-gal IgE levels and no recent tick bites:

1. Begin with small amounts of low-fat dairy products
2. Monitor for reactions for 4-6 hours
3. If dairy is tolerated, consider lean mammalian meat in small portions
4. Always have emergency medications available during reintroduction
5. Work with an allergist for patients with history of significant systemic reactions 1

Special Considerations

• Avoid co-factors that can increase reaction severity:
  • NSAIDs
  • Exercise around the time of potential exposure
  • Alcohol consumption 1
• Be aware that reaction severity can vary significantly between and within individuals 3
• Reactions to dairy typically occur more quickly (1-4 hours) and are milder than meat reactions 1

Common Pitfalls

• Misdiagnosis as irritable bowel syndrome or other functional GI disorders when GI symptoms predominate 2
• Failure to recognize the delayed nature of reactions (3-6 hours after ingestion) 3
• Overlooking hidden sources of mammalian products in medications, supplements, and processed foods
• Not implementing tick prevention strategies, which can lead to worsening of the allergy 1

While some alternative approaches like auricular acupuncture 4 and desensitization protocols 5 have been reported in small studies, these are not yet supported by major guidelines and should not replace the standard management approach of avoidance.