Allergenicity of carbohydrates and their role in anaphylactic events. improve mechanical strength of the implant. However, alternative is usually often necessary due to calcification and subsequently decreased durability. Decellularized valves, shown to have no detectable expression of alpha-gal6, have been reported to be less immunogenic and more durable.7, 8 Bloch et al. found a considerable Rabbit Polyclonal to CRMP-2 (phospho-Ser522) anti-alpha-gal antibody response to glutaraldehyde-treated porcine and bovine valves, but no response to decellularized valves, suggesting that glutaraldehyde treatment is not sufficient to eliminate immune response to the alpha-gal epitope completely.7 Therefore, it is possible that decellularized valves should be considered for use in patients with IgE to alpha-gal. These case studies, given the difference in clinical courses including lack of reactivity of Case 3, are not sufficient to identify risk factors or predict end result for such perioperative anaphylaxis episodes. In addition, although we chose to discuss heparin in this report since it is usually a polysaccharide derived from porcine and bovine sources, we currently have no evidence that heparin reactions are related to IgE to alpha-gal. These studies do Dalbavancin HCl highlight that patients with IgE to alpha-gal should be evaluated and carefully observed for indicators of perioperative and postoperative anaphylaxis and that the possible risk should be considered. ? Table I Total IgE and Specific IgE to alpha-gal and Various Mammalian Meats1 thead th align=”center” valign=”middle” rowspan=”1″ colspan=”1″ /th th align=”center” valign=”middle” rowspan=”1″ colspan=”1″ Case 1 /th th align=”center” valign=”middle” rowspan=”1″ colspan=”1″ Case 2 /th th align=”center” valign=”middle” rowspan=”1″ colspan=”1″ Case 3 /th th colspan=”4″ align=”center” valign=”middle” rowspan=”1″ hr / /th /thead Total IgE (IU/mL)4031601364 hr / AllergenSpecific IgE (ku/L) hr / Alpha-gal6575.378.4Beef104.9623.0Pork4.434.6823.6Lamb5.092.025.96Heparin2Not doneNot done 0.35 Open in a separate window 1Assays are carried out with the specific ImmunoCAP using an ImmunoCAP 250 machine from ThermoFisher Scientific. 2The assay was prepared for this study using biotinylated heparin (EMD Millipore, Darmstadt, Germany) on an ImmunoCAP with streptavidin around the solid phase. Clinical Implications We statement three cases of porcine/ bovine valve replacement in patients with IgE antibodies to alpha-gal; two patients experienced perioperative reactions. At present, there is no way to predict the severity of reactions following valve replacement in patients with mammalian meat allergy. Footnotes **Case 1 was offered at the 2012 Annual Getting together with of the American College of Asthma, Allergy & Immunology.9 Publisher’s Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version Dalbavancin HCl of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the producing proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. REFERENCES 1. Gatti G, Casu B, Hamer GK, Perlin AS. Studies on the Conformation of Heparin by lH and 13C NMR Spectroscopy. Macromolecules. 1979;12(5):1001C1007. [Google Scholar] 2. Kishimoto TK, Viswanathan K, Ganguly T, Elankumaran S, Smith S, Pelzer K, et al. Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System. N Engl J Med. 2008;358(23):2457C67. [PMC free article] [PubMed] [Google Scholar] 3. Commins SP, Platts-Mills TA. Allergenicity of carbohydrates and their role in anaphylactic events. Curr Allergy Asthma Rep. 2010;10(1):29C33. [PMC free article] [PubMed] [Google Scholar] 4. Galili U. The alpha-gal epitope and the anti-gal antibody in xenotransplantation and in cancer immunotherapy. Immunol Cell Biol. 2005;83:674C686. [PubMed] [Google Dalbavancin HCl Scholar] 5. Konakci KZ, Bohle B, Blumer R, Hoetznecker W, Roth G, Moser B, et al. Alpha-gal on bioprostheses: xenograft immune response in cardiac surgery. Eur J Clin Invest. 2005;35(1):17C23. [PubMed] [Google Scholar] 6. Simon P, Kasimir MT, Rieder P, Seebacher G, Wolner E, Weigel G. Presence and Elimination.