Absolutely! It could be related to alpha-gal (galactose-alpha-1, 3-galactose) allergy (AGA), a condition found in thousands of Americans¹.  AGA (also known as red meat or mammalian allergy) is a novel form of IgE-mediated anaphylaxis that typically occurs 3-6 hrs (not immediately) after ingestion of mammalian meat (beef, pork, lamb, bison, goat, vension); turkey, chicken, and fish do not contain alpha-gal^1,2 . Another unique feature of AGA is that it seems to develop in adult life³.

What’s even more fascinating about AGA is its presumed causal relationship with prior bites of Amblyomma americanum (the lone star tick)^4,5, found in many southern, midwestern and eastern states in the US (Figure).    The proposed mechanism of sensitization is that tick saliva contains alpha-gal (possibly from feeding on deer or other mammals), which causes production of IgE to this oligosaccharide⁵.  When mammalian meat (in our patient, a hamburger) is ingested by the sensitized individual, an anaphylactic  reaction may ensue.  The delay in reaction is thought to be due to the time it takes for alpha-gal to be absorbed from the gut⁴. 

The story doesn’t end here! Some medications contain alpha-gal due to inert ingredients such as gelatin or magnesium stearate of bovine sources. At least one report of anaphylaxis in a patient with AGA has been blamed on medications with bovine-derived magnesium stearate⁶.  Measles-mumps-rubella and zoster vaccines may also contain alpha-gal, with zoster vaccine implicated in a case of anaphylaxis. ⁷

 Currently,  the FDA does not require manufacturers to disseminate this information, so when  in doubt, individual drug manufacturers should be contacted. 

Figure: Lone start tick and its distribution in USA (Courtesy of CDC).

Updated Nov 11, 2019.

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References

1. Van Nunen S. Galactose-alpha-1, 3-galactose, mammalian meat and anaphylaxis:a world-wide phenomenon? Curr Treat Options Allergy 2014;1:262-77. https://link.springer.com/article/10.1007%2Fs40521-014-0022-0
2. Kar I, Gong M, Muglia C, et al. Alpha-gal (mammalian meat) allergy: implications for pharmacists. Pharmacy Times, May 27, 2015. https://www.pharmacytimes.com/publications/issue/2015/may2015/alpha-gal-mammalian-meat-allergy-implications-for-pharmacists
3. Commins SP, Platts-Mills TAE. Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant. J Allergy Clin Immunol 2009;124:652-57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774206/
4. Commins SP, Platts-Mills TA. Delayed anaphylaxis to red meat in patients with IgE specific for galactose alpha-1, 3-galactose (alpha-gal). Curr Allergy Asthma Res 2013;13:72-77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545071/
5. Steinke JW, Platts-Mills TAE, Commins SP. The alpha gal story: lessons learned from connecting the dots. J Allergy Clin Immunol 2015;135:589-97. This is a must read for anyone interested in the subject! https://www.ncbi.nlm.nih.gov/pubmed/25747720
6. Muglia C, Kar I, Gong M, et al. Anaphylaxis to medications containing meat byproducts in an alpha-gal sensitized individual. J Allergy Clin Immunol Pract 2015; 3: 796-97.
7. Stone CA, Hemler JA, Commins SP, et al. Anaphylaxis after zoster vaccine:implicating alpha-gal allergy as a possible mechanism. J All Clin Immunol 2016;139 (5). DOI:10.1016/j.jaci.2016.10.037

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