Allergic reactions associated with medically relevant arthropods

Figures & data

Figure 1. Images of collected robber fly specimen in case 1.

Figure 2. Skin reactions to different deer tick bites in case 2. Photos courtesy of participants in case 2.

Figure 3. Images of collected adult female and male deer ticks in case 2. Photos courtesy of participants in case 2.

Figure 4. Images of lone star ticks feeding on white-tailed deer in close contact with cases 4 and 5. Photos courtesy of participants in cases 4 and 5.

Table 1. Addressing questions received by affected individuals regarding COVID-19 and immune response to the glycan alpha-gal.

Question	Response
Are individuals with the AGS protected from COVID-19 or the SARS-CoV-2 infection triggers a cytokine storm in them?	Research showed a significant negative correlation between anti-alpha-gal antibody titers and COVID-19 symptoms [33]. Humans can develop allergic and protective responses against tick infestations, which involves IgE antibodies and basophils with alpha-gal sensitization.
A person who has COVID-19 is vomiting after only a few specific lactose products but is repeatedly vomiting an hour or two after any attempt to eat any type of beef product. No problem with chicken, fish, seafood, and interestingly lamb is okay. This has occurred multiple times. Any possibility the SARS-CoV-2 could trigger an anti-alpha-gal-related problem?	Food allergies may have different origins. It is essential for the diagnosis of AGS to establish the link with recurrent exposure to tick bites and anti-alpha-gal IgE antibody titers. Allergic reactions associated with AGS typically occur between 2 to 6 h from mammalian meat consumption. Metabolic changes have been associated with AGS and its clinical outcome and may also reflect the differences in the intestinal microbiota and absorption of nutrients [37]. Regarding COVID-19, although a direct correlation between anti-α-Gal response and virus load has not been established, there are evidence that the coronavirus may affect the antibody response to α-Gal [33]. However, results have shown a negative [33] or no [38] correlation with SARS-CoV-2 infection, suggesting that allergic reactions in COVID-19 patients may be related to other factors [39].
In response to vaccination against SARS-CoV-2, is allergy to alpha-gal a risk factor?	Regarding the vaccine and associated allergic reactions [40], risks associated with the immune response to alpha-gal have not been reported. If you are vaccinated, you are likely to develop a protective response against SARS-CoV-2, and the immune response against alpha-gal may also contribute to your protective immune response by other mechanisms [41].

A total of 55 messages received between 3 October 2020 and 28 April 2021 were summarised in the Table.

Urra JM, Ferreras-Colino E, Contreras M, et al. The antibody response to the glycan α-gal correlates with COVID-19 disease symptoms. J Med Virol. 2021;93(4):2065–2075. doi: 10.1002/jmv.26575.

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Steinke JW, Pochan SL, James HR, et al. Altered metabolic profile in patients with IgE to galactose-alpha-1,3-galactose following in vivo food challenge. J Allergy Clin Immunol. 2016;138(5):1465–1467.e8. doi: 10.1016/j.jaci.2016.05.021.

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Breiman A, Ruvoën-Clouet N, Deleers M, et al. Low levels of natural anti-α-N-acetylgalactosamine (Tn) antibodies are associated with COVID-19. Front Microbiol. 2021;12:641460. doi: 10.3389/fmicb.2021.641460.

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Ridolo E, Pucciarini F, Barone A, et al. Dermatological manifestations during COVID-19 infection: a case series and discussion on the problem of differential diagnosis. Acta Biomed. 2021;92:e2021103.

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Kounis NG, Koniari I, de Gregorio C, et al. Allergic reactions to current available covid-19 vaccinations: pathophysiology, causality, and therapeutic considerations. Vaccines. 2021;9:221. doi: 10.3390/vaccines9030221.

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de la Fuente J, Gortázar C, Cabezas-Cruz A. Immunity to glycan α-gal and possibilities for the control of COVID-19. Immunotherapy. 2021;13(3):185–188. doi: 10.2217/imt-2020-0247.

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Data availability statement

The data obtained for the study are included in the article. Further inquiries can be directed to the corresponding author.