Treatment for MCAS and Alpha-Gal Syndrome with Hypotension and Neurological Symptoms

Alpha-Gal Syndrome Management

Complete avoidance of all mammalian meat and related products is the cornerstone of managing alpha-gal syndrome, as recommended by Clinical Gastroenterology and Hepatology 1, 2
Particularly avoid high-fat dairy products like ice cream, cream, and cream cheese which contain higher amounts of alpha-gal, according to Clinical Gastroenterology and Hepatology 2
Safe alternatives include fish, seafood, turkey, chicken, and other fowl, as suggested by Clinical Gastroenterology and Hepatology 2
Avoid gelatin-containing products as they are derived from mammalian collagen, as noted by Clinical Gastroenterology and Hepatology 2
Avoid eating at restaurants due to high risk of cross-contamination, as warned by Clinical Gastroenterology and Hepatology 3
Be cautious with processed foods which may contain hidden animal-derived ingredients, as advised by Clinical Gastroenterology and Hepatology 2

Take measures to prevent tick bites as additional exposure can worsen both conditions, according to Clinical Gastroenterology and Hepatology 2, 4
Perform tick checks and shower after outdoor activities in wooded areas, as recommended by Clinical Gastroenterology and Hepatology 4
Create barriers at ankles by pulling up tight mesh socks over pant cuffs when hiking, as suggested by Clinical Gastroenterology and Hepatology 4
Treat clothes and boots with permethrin to reduce tick bites, as advised by Clinical Gastroenterology and Hepatology 4

Re-evaluate symptoms after at least one month of strict alpha-gal avoidance diet, as recommended by Clinical Gastroenterology and Hepatology 3
Consider repeating alpha-gal IgE levels 6-12 months after diagnosis if tick bites are avoided, according to Clinical Gastroenterology and Hepatology 2
As IgE levels decrease, patients may gradually reintroduce first dairy products, then small portions of mammalian meat under medical supervision, as suggested by Clinical Gastroenterology and Hepatology 2

Some medications and medical products contain alpha-gal, which can trigger reactions in sensitive individuals, as noted by Clinical Gastroenterology and Hepatology 4
Alpha-gal sensitization may be associated with increased risk of coronary artery disease, making management even more important, according to Clinical Gastroenterology and Hepatology 5

Refer to an allergist when the patient experiences systemic symptoms such as facial swelling, urticaria, or respiratory difficulty, as recommended by Clinical Gastroenterology and Hepatology 6
Consider referral to a gastroenterologist if GI symptoms persist despite adherence to an alpha-gal avoidance diet, as suggested by Clinical Gastroenterology and Hepatology 7

Some medications and medical products contain alpha-gal, which can potentially cause reactions in sensitized or allergic individuals, creating a critical safety concern when prescribing any medication to alpha-gal patients, according to Clinical Gastroenterology and Hepatology guidelines 8, 9

Gelatin capsules should be avoided because gelatin is derived from mammalian collagen and may trigger allergic reactions in alpha-gal patients 8
Liquid formulations can be considered as a safe alternative when available 8
Medications with plant-based or synthetic excipients only can be considered as safe alternatives 8

Patients with alpha-gal syndrome requiring acid reflux treatment should have their pharmaceutical manufacturer contact the manufacturer directly to verify the source of all excipients before prescribing, as recommended by Clinical Gastroenterology and Hepatology 8

Patients with alpha-gal syndrome who have experienced systemic symptoms should be referred to an allergist before starting any new medication, as they are at risk for anaphylaxis and need formal counseling on epinephrine autoinjector use, according to Clinical Gastroenterology and Hepatology guidelines 9
Patients trying new medications should have antihistamines and autoinjectable epinephrine available, as recommended by Clinical Gastroenterology and Hepatology guidelines 9

When trying a new medication after manufacturer verification, have antihistamines and autoinjectable epinephrine immediately available, and have someone else present who is aware of potential progressing symptoms, according to the American Gastroenterological Association, as medications can contain alpha-gal, creating a potentially dangerous situation for sensitized individuals 10
Take the medication during daytime hours when medical help is readily accessible, as recommended by the American Gastroenterological Association, to minimize risks associated with alpha-gal allergy 10

Patients with a history of systemic symptoms such as facial swelling, urticaria, respiratory difficulty, and hypotension require formal counseling on epinephrine autoinjector use as they are at risk for anaphylaxis, according to the American Gastroenterological Association 11
The lack of knowledge about Alpha-Gal Syndrome (AGS) among healthcare providers (42% of surveyed providers had never heard of it) highlights the need for increased awareness and education on this topic, as reported by the Clinical Gastroenterology and Hepatology society 11

The American Academy of Allergy, Asthma, and Immunology recommends that patients with alpha-gal allergy should be closely monitored for delayed reactions, as alpha-gal reactions characteristically occur 3-5 hours after exposure 11