Q&A: Survey reveals misconceptions about alpha-gal syndrome among PCPs

Although primary care physicians have basic knowledge of alpha-gal syndrome, results of a small survey suggest that many characteristics of the condition are unknown or misunderstood, according to researchers.

Curtis L. Hedberg, MD, FACP, FACAAI, FAAAAI, an allergist with Hedberg Allergy & Asthma in Arkansas and Missouri, and colleagues reported that alpha-gal syndrome is an IgE-mediated hypersensitivity to galactose-a-1,3-galactose, which is found in meat from mammals.

“The Lone Star Tick may play a role in its development,” Hedberg and colleagues wrote.

The researchers administered an online survey to PCPs in Arkansas. Among the 39 respondents, most were either pediatricians or internists. The median year of medical school graduation was 2002.

Hedberg and colleagues’ results, presented during the American College of Allergy, Asthma and Immunology annual meeting, showed that 12.8% of respondents were unaware of alpha-gal syndrome until they received the survey and 2.6% denied the syndrome’s base characteristics. These participants were excluded from the rest of the analysis.

Of the remaining 33 physicians, 54.5% said they did not currently have a patient with alpha-gal syndrome. All of them knew that beef can cause alpha-gal syndrome; however, only 60.6% knew pork could also trigger it.

About one-third of respondents knew that symptoms of alpha-gal syndrome usually appear within 2 to 8 hours of red meat consumption. Only 6.1% knew that more than 20% of Arkansas residents had “laboratory evidence” of alpha-gal IgE sensitivity; 81.8% thought the prevalence was 10% or less. In addition, 87.9% correctly identified “elimination of all mammalian meat items as a clear recommendation” for patients with the condition.

“Alpha-gal syndrome is and was a serious issue,” Hedberg told Healio Primary Care.

He said he has helped facilitate awareness “of this novel allergic disease” by distributing information about alpha-gal syndrome to first responders, paramedics, emergency medical technicians and ED physicians. However, the survey suggests that greater awareness is needed.

In an interview with Healio Primary Care, Hedberg discussed the characteristics of the condition, future research opportunities to better understand it and more.

Healio Primary Care: How prevalent is alpha-gal syndrome?

Hedberg: The presence of alpha-gal syndrome is known to vary depending on the geographic location and as to the potential occupation or exposure to tick bites. Forest climates and mammalian populations are strong factors.

Healio Primary Care: What are the symptom characteristics of the syndrome?

Hedberg: The typical symptoms of alpha-gal syndrome occur in a 3- to 6-hour range after ingestion. Most patients experience anaphylaxis or recurrent and chronic urticaria after having tolerated red meats in the past.

Healio Primary Care: What prompted you to conduct the current study?

Hedberg: Alpha-gal syndrome has become an increasing disease entity and treatment in my practice. I have had patients who come to me who have either diagnosed themselves (most are usually correct) or somehow have been referred by their primary care provider with a suspected diagnosis but otherwise were thought to have had an “allergic reaction.”

I felt our questions would help survey the degree of knowledge and help identify areas where allergists may need to concentrate educational efforts toward our primary caregivers. In general, awareness of alpha-gal syndrome is increasing among PCPs yet there appears to be some discrepancy of the disease among physicians.

Healio Primary Care: Were you surprised by the findings? Why or why not?

Hedberg: I suspected there would be some who would respond by saying they had no awareness. I also thought there would be a larger number of PCPs would have given answers that indicated that they personally treated and managed alpha-gal syndrome.

Healio Primary Care: What are the next steps for your research?

Hedberg: I would be most interested now to do a comparison that sends the same survey to nurse practitioners and physician assistants in the state of Arkansas. I also plan to use the survey results to publish an article in the state’s medical journal and address the areas where knowledge gaps exist.

Healio Primary Care: What are the most important things that PCPs need to know about alpha-gal allergy?

Hedberg: PCPs need to know and understand that alpha-gal syndrome is a novel form of hypersensitivity that is delayed and therefore may present differently than a typical food allergy. For allergic reactions or anaphylactic reactions that do not have a clear determination of the etiology, alpha gal red meat/mammalian oligosaccaride allergy should be considered.

Reference:

Hedberg CL, et al. Abstract P110. Presented at: ACAAI Annual Scientific Meeting; Nov. 4-8, 2021; New Orleans (hybrid meeting).