Demystifying alpha-gal syndrome: identification and risk management in the perioperative setting

Purpose of review alpha-Gal syndrome is among a vexing perioperative consideration for anesthesiologists. Commonly referred to as 'red meat allergy', alpha-Gal syndrome is precipitated by a lone star tick bite resulting in the formation of immunoglobulin E (IgE) antibodies against the tick salivary glycoproteins and noncatarrhine mammalian tissue. Recent findings Up to 20% of the population in the southeastern United States may test positive for IgE antibodies to alpha-Gal. Increasingly, recognition of alpha-Gal syndrome as an immune response to red meat consumption and certain drugs, many of which may be administered within the perioperative period, has led to greater awareness of the insidious nature of its presentation - from mild urticaria and gastrointestinal symptoms to severe anaphylaxis. Summary With the increasing prevalence and identification of alpha-Gal syndrome, a safe and tailored perioperative process is needed to integrate a pathway that involves multidisciplinary communication, robust information sharing platform, and a structured peri-procedure management.