Understanding Alpha-Gal Syndrome: Key Symptoms and Findings

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E Lesmana et al. Clin Gastroenterol Hepatol 2025; 23: 69-78. Open Access! Clinical Presentation and Outcomes of Alpha-Gal Syndrome

This was a retrospective chart review of patients who underwent serological testing for suspected Alpha-Gal Syndrome (AGS) between 2014 and 2023 at Mayo Clinic. Of 1260 patients who underwent testing,124 tested positive for AGS. –matched with 380 seronegative control subjects. 40 patients had long-term followup data available

Key findings:

  • AGS patients reported a higher frequency of tick bites (odds ratio [OR], 26.0)
  • AGS patients reported a higher prevalence of urticaria (56% vs 37%; P = .0008)
  •  A total of 47% experienced at least 1 GI symptom, such as diarrhea, nausea, vomiting, abdominal pain, abdominal cramps, bloating, heartburn, and constipation, in descending order of frequency
  • 11% of AGS patients presented solely with GI symptoms
  • After institution of red meat restriction, 22 of 40 were asymptomatic at followup, 14 of 40 were improved, and 4 of 40 reported no improvement. 7 of the asymptomatic group were able to resume a diet without restrictions.

Discussion point:

  • “Symptom onset in AGS typically occurs more than 4 hours after allergen exposure, with studies emphasizing a tight association with delayed reactions within the 3- to 6-hour range.”

My take: This study provides some more granular data on Alpha-gal and highlights the importance of asking about tick bites and urticaria in patients with possible AGS.

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