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Alpha-gal syndrome (AGS) 2022 case definition
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September 19, 2022
[PDF-136.40 KB]
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Description:CSTE Position Statement(s)
21-ID-07
Alpha-gal Syndrome (AGS) is a hypersensitivity reaction to galactose-α-1,3-galactose (alpha-gal), found in non-primate mammalian meat and certain derivative products.1-5 Unlike typical food allergies, symptoms are often delayed by two hours or more after exposure and can arise suddenly following years of safe meat consumption.6–8 Evidence suggests that the bite of some tick species induces immunoglobulin E (IgE) antibodies to alpha-gal, sensitizing patients to subsequent alpha-gal exposures.1,9–12 Symptoms typically include abdominal cramping, urticaria, and anaphylaxis.8 Diagnosis relies on a history of symptoms following exposure to mammalian products, and an elevated serum IgE specific to alpha-gal.6 AGS has been reported worldwide13; in the United States, it is most closely associated with lone star tick (Amblyomma americanum) bites.10 Research has suggested that other tick species, including Ixodes spp., may also be associated with AGS development.14,15 Reports of AGS in the scientific literature have been increasing over the last decade, but the true burden of cases is unknown. Additionally, much of the country may be at risk given the expanding geographic range of lone star and other ticks.16 Responding to the increased diagnosis of cases and public interest, multiple states have expressed a desire to quantify the burden of AGS. The standardization of case definition and reporting criteria is necessary in order to characterize disease burden, compare interstate disease incidence, and monitor trends in patient demographics, morbidity, mortality, and geographic distribution of risk. This will inform public health recommendations and guidance. Preventing tick bites is the main strategy for AGS intervention1–3; disease surveillance could, therefore, inform activities to strengthen occupational health protocols of suspected risk groups and public health messaging regarding tick bite prevention behaviors, with the goal of reducing tick borne disease risk.11,17
NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.
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