{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:19:17Z","timestamp":1787167157081,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Alpha\u2010gal syndrome (AGS) is an IgE\u2010mediated hypersensitivity to galactose\u2010\u03b1\u20101,3\u2010galactose, triggered by tick bites. It typically presents with delayed onset allergic or gastrointestinal symptoms after red meat consumption. This study aims to evaluate the prevalence of clinical symptoms and outcomes in AGS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed, Embase, and Cochrane Central was conducted to identify studies with at least five AGS patients that utilized alpha\u2010gal IgE for diagnosis and reported symptomatology. A random\u2010effects model calculated pooled prevalence and 95% confidence intervals (CIs) for clinical characteristics of AGS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 739 studies screened, 15 met the inclusion criteria, comprising 1162 AGS patients (57% female). Urticaria was identified as the most prevalent symptom (63.8%, CI: 34.5\u201388.3,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998.8%). At least one gastrointestinal symptom was reported in 69.2% of patients (CI: 49.3\u201385.9,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200997.5%), including abdominal pain (58.3%, CI: 36.0\u201378.9,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200996.0%), diarrhea (41.7%, CI: 22.3\u201362.5,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200993.4%), nausea (39.1%, CI: 29.2\u201349.6,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200979.1%), and vomiting (31.1%, CI: 21.9\u201341.2,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200970.4%). Tick bite history was recalled by 78.7% (CI: 46.4\u201398.1;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200999.1%), and 91.8% (CI: 84.6\u201396.8;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200970.3%) had symptom onset \u2265\u20091\u2009h post red meat intake. Symptomatic improvement was observed in 86.5% (CI: 73.9\u201395.4,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200980.9%) of patients, with complete resolution in 42.7% (CI: 26.4\u201359.8,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200973.8%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AGS typically presents with delayed onset allergic and GI symptoms after red meat intake, often with tick bite history. Majority of patients report symptomatic improvement on follow\u2010up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70245","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:56:46Z","timestamp":1768834606000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Understanding Alpha\u2010Gal Syndrome: A Systematic Review and Meta\u2010Analysis of Clinical Manifestations and Outcomes"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4576-1745","authenticated-orcid":false,"given":"Sameer","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Medicine Rutgers New Jersey Medical School  Newark New Jersey USA"},{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sawai Singh","family":"Rathore","sequence":"additional","affiliation":[{"name":"Dr Sampurnanand Medical College  Jodhpur Rajasthan India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritik Mahaveer","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Medicine Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8614-584X","authenticated-orcid":false,"given":"Amy","family":"Narakornpichit","sequence":"additional","affiliation":[{"name":"Department of Medicine Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-2482","authenticated-orcid":false,"given":"Rohan","family":"Karkra","sequence":"additional","affiliation":[{"name":"Department of Medicine Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al\u2010Khazraji","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhusudan","family":"Grover","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2008.10.052"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.11.7812"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa033025"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa074943"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326\u20105377.2009.tb02533.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7230a2"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ttbdis.2023.102161"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ttbdis.2021.101674"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.12804"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.09.017"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.06.044"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.03.031"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.13156"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.01.218"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2014.02.017"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7230a1"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBISRIR\u2010D\u201019\u201000099"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2018.12.005"},{"key":"e_1_2_10_20_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G. 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