{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T15:23:27Z","timestamp":1792337007686,"version":"4.4.0"},"reference-count":184,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    The \u03b1-Gal syndrome (AGS) is an emerging form of food allergy characterized by delayed hypersensitivity reactions to mammalian meat products and mediated by IgE antibodies specific to the carbohydrate galactose-\u03b1-1,3-galactose (\u03b1-Gal). Although \u03b1-Gal\u2013specific IgG, IgM and IgA antibodies are generally present in humans as a consequence of continuous exposure to commensal microbiota and dietary sources, IgE sensitization to \u03b1-Gal occurs only in a subset of individuals. Epidemiological and experimental evidence has firmly linked this sensitization to tick bites. Multiple ticks across continents have been implicated in \u03b1-Gal sensitization, and \u03b1-Gal has been detected in tick midgut, hemolymph, and salivary glands; yet the precise origin of \u03b1-Gal within ticks and the immunological mechanisms that drive \u03b1-Gal-specific IgE production remain incompletely understood. In particular, it remains unclear how cutaneous exposure to ticks promotes IgE class switching against \u03b1-Gal, whereas lifelong gastrointestinal exposure to the same epitope does not elicit allergic sensitization. Despite a growing number of reviews addressing the clinical and epidemiological aspects of AGS, significant gaps persist in our understanding of the molecular and immunological pathways underlying disease development. This review aims to address these gaps by focusing specifically on the molecular and immunological pathways involved in \u03b1-Gal sensitization following tick bites, with particular emphasis on the innate and adaptive immune responses that drive the production of \u03b1-Gal-specific IgE. By integrating data from human studies, animal models and\n                    <jats:italic>in vitro<\/jats:italic>\n                    systems, a more cohesive understanding of the immune dynamics contributing to Th2-biased immune responses and sensitization begins to emerge. Ultimately, a detailed understanding of how the cutaneous environment, tick saliva components, and host factors synergize to induce a Th2-biased IgE sensitization is key to identifying diagnostic biomarkers and prevention approaches.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1838920","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:47:21Z","timestamp":1779252441000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["From vector to allergen: exploring the immunology of tick-triggered \u03b1-Gal syndrome"],"prefix":"10.3389","volume":"17","author":[{"given":"Julie","family":"Petry","sequence":"first","affiliation":[{"name":"Department of Infection and Immunity, Luxembourg Institute of Health","place":["Esch-sur-Alzette, Luxembourg"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyra","family":"Swiontek","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity, Luxembourg Institute of Health","place":["Esch-sur-Alzette, Luxembourg"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Hilger","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity, Luxembourg Institute of Health","place":["Esch-sur-Alzette, Luxembourg"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7230a1","article-title":"Health care provider knowledge regarding alpha-gal syndrome \u2014 United States, March\u2013May 2022","volume":"72","author":"Carpenter","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7230a2","article-title":"Geographic distribution of suspected alpha-gal syndrome cases \u2014 United States, January 2017\u2013December 2022","volume":"72","author":"Thompson","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ttbdis.2021.101674","article-title":"Tick exposures and alpha-gal syndrome: A systematic review of the evidence","volume":"12","author":"Young","year":"2021","journal-title":"Ticks Tick-borne Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/all.14802","article-title":"Carbohydrate epitopes currently recognized as targets for IgE antibodies","volume":"76","author":"Platts-Mills","year":"2021","journal-title":"Allergy"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/all.16003","article-title":"Tick bites, IgE to galactose-alpha-1,3-galactose and urticarial or anaphylactic reactions to mammalian meat: The alpha-gal syndrome","volume":"79","author":"Wilson","year":"2024","journal-title":"Allergy"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2025.09.039","article-title":"Implications of a fatal anaphylactic reaction occurring 4 hours after eating beef in a young man with IgE antibodies to galactose-\u03b1-1,3-galactose","volume":"13","author":"Platts-Mills","year":"2025","journal-title":"J Allergy Clin Immunology: In Pract"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/imr.70035","article-title":"The immunology of alpha-gal syndrome: History, tick bites, IgE, and delayed anaphylaxis to mammalian meat","volume":"332","author":"Platts-Mills","year":"2025","journal-title":"Immunol Rev"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2014.10.053","article-title":"Gut microbiota elicits a protective immune response against malaria transmission","volume":"159","author":"Yilmaz","year":"2014","journal-title":"Cell"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1021\/acscentsci.7b00311","article-title":"Virus-like particle display of the \u03b1-Gal carbohydrate for vaccination against Leishmania infection","volume":"3","author":"Moura","year":"2017","journal-title":"ACS Cent Sci"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.146.7.2394","article-title":"Complement-mediated lysis of Trypanosoma cruzi trypomastigotes by human anti-alpha-galactosyl antibodies","volume":"146","author":"Almeida","year":"1991","journal-title":"J Immunol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens14080789","article-title":"The role of Anisakis sp. in \u03b1-Gal sensitization: Implications for parasitic-induced meat allergy","volume":"14","author":"Rodero","year":"2025","journal-title":"Pathogens"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1084\/jem.42.6.863","article-title":"Serological studies on the blood of the primates: III. Distribution of serological factors related to human isoagglutinogens in the blood of lower monkeys","volume":"42","author":"Landsteiner","year":"1925","journal-title":"J Exp Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.jbchem.a128881","article-title":"Chemistry of lipid of the posthemolytic residue or stroma of erythrocytes: XVI. Occurrence of ceramide pentasaccharide in the membrane of erythocytes and reticulocytes of rabbit","volume":"64","author":"Eto","year":"1968","journal-title":"J Biochem"},{"key":"B14","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.bbagen.2007.11.003","article-title":"The Gal\u03b11,3Gal\u03b21,4GlcNAc-R (\u03b1-Gal) epitope: A carbohydrate of unique evolution and clinical relevance","volume":"1780","author":"Macher","year":"2008","journal-title":"Biochim Biophys Acta (BBA) - Gen Subj"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/s0021-9258(17)42779-7","article-title":"Occurrence of alpha-D-galactosyl residues in the thyroglobulins from several species. Localization in the saccharide chains of the complex carbohydrate units","volume":"259","author":"Spiro","year":"1984","journal-title":"J Biol Chem"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/s0006-291x(84)80113-8","article-title":"The identification of terminal \u03b1(1\u21923)-linked galactose in N-acetyllactosamine type of glycopeptides by means of 500-MHz 1H-NMR spectroscopy","volume":"122","author":"Dorland","year":"1984","journal-title":"Biochem Biophys Res Commun"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/0304-4165(86)90142-x","article-title":"Structures of the asparagine-linked sugar chains of laminin","volume":"883","author":"Arumugham","year":"1986","journal-title":"Biochim Biophys Acta (BBA)-General Subj"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/s0021-9258(17)35665-x","article-title":"Macromolecular organization of basement membranes. Characterization and comparison of glomerular basement membrane and lens capsule components by immunochemical and lectin affinity procedures","volume":"261","author":"Mohan","year":"1986","journal-title":"J Biol Chem"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1084\/jem.160.5.1519","article-title":"A unique natural human IgG antibody with anti-alpha-galactosyl specificity","volume":"160","author":"Galili","year":"1984","journal-title":"J Exp Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1021\/bi00468a024","article-title":"Distribution of Gal.alpha.1.fwdarw.3Gal.beta.1.fwdarw.4GlcNAc residues on secreted mammalian glycoproteins (thyroglobulin, fibrinogen, and immunoglobulin G) as measured by a sensitive solid-phase radioimmunoassay","volume":"29","author":"Thall","year":"1990","journal-title":"Biochemistry"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/s0041-1345(00)01074-5","article-title":"The major surface-labeled \u03b1-galactosylated glycoprotein of pig endothelial cells is the \u03b21 integrin subunit","volume":"32","author":"Richard","year":"2000","journal-title":"Transplant Proc"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1128\/iai.56.7.1730-1737.1988","article-title":"Interaction between human natural anti-alpha-galactosyl immunoglobulin G and bacteria of the human flora","volume":"56","author":"Galili","year":"1988","journal-title":"Infect Immun"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-065x.1994.tb00877.x","article-title":"Gal alpha (1,3)Gal, the major xenoantigen(s) recognised in pigs by human natural antibodies","volume":"141","author":"Sandrin","year":"1994","journal-title":"Immunol Rev"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.12.1947","article-title":"The alpha-gal story: Lessons learned from connecting the dots","volume":"135","author":"Steinke","year":"2015","journal-title":"J Allergy Clin Immunol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.11.7812","article-title":"High incidence of cetuximab-related infusion reactions in Tennessee and North Carolina and the association with atopic history","volume":"25","author":"O'Neil","year":"2007","journal-title":"J Clin Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa074943","article-title":"Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose","volume":"358","author":"Chung","year":"2008","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ab.2007.01.023","article-title":"Structural characterization of N-linked oligosaccharides on monoclonal antibody cetuximab by the combination of orthogonal matrix-assisted laser desorption\/ionization hybrid quadrupole\u2013quadrupole time-of-flight tandem mass spectrometry and sequential enzymatic digestion","volume":"364","author":"Qian","year":"2007","journal-title":"Anal Biochem"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2008.10.052","article-title":"Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose","volume":"123","author":"Commins","year":"2009","journal-title":"J Allergy Clin Immunol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.122937","article-title":"Atopy, asthma, and antibodies to Ascaris among rural and urban children in Kenya","volume":"140","author":"Perzanowski","year":"2002","journal-title":"J Pediatr"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2006.11.637","article-title":"Cat IgA, representative of new carbohydrate cross-reactive allergens","volume":"119","author":"Ad\u00e9doyin","year":"2007","journal-title":"J Allergy Clin Immunol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.03.011","article-title":"The carbohydrate galactose-alpha-1,3-galactose is a major IgE-binding epitope on cat IgA","volume":"123","author":"Gr\u00f6nlund","year":"2009","journal-title":"J Allergy Clin Immunol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201111-2017oc","article-title":"Galactose-\u03b1-1,3-galactose-specific IgE is associated with anaphylaxis but not asthma","volume":"185","author":"Commins","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.02.038","article-title":"Relationship between red meat allergy and sensitization to gelatin and galactose-\u03b1-1,3-galactose","volume":"129","author":"Mullins","year":"2012","journal-title":"J Allergy Clin Immunol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2014.04.014","article-title":"Anaphylaxis to succinylated gelatin in a patient with a meat allergy: galactose-\u03b1(1, 3)-galactose (\u03b1-gal) as antigenic determinant","volume":"26","author":"Uyttebroek","year":"2014","journal-title":"J Clin Anesth"},{"key":"B35","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1111\/all.12302","article-title":"Laminin \u03b3-1 and collagen \u03b1-1 (VI) chain are galactose-\u03b1-1,3-galactose-bound allergens in beef","volume":"69","author":"Takahashi","year":"2014","journal-title":"Allergy"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1111\/all.12835","article-title":"Two galactose-\u03b1-1,3-galactose carrying peptidases from pork kidney mediate anaphylactogenic responses in delayed meat allergy","volume":"71","author":"Hilger","year":"2016","journal-title":"Allergy"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1111\/all.13873","article-title":"Only \u03b1\u2010Gal bound to lipids, but not to proteins, is transported across enterocytes as an IgE\u2010reactive molecule that can induce effector cell activation","volume":"74","author":"Rom\u00e1n\u2010Carrasco","year":"2019","journal-title":"Allergy"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.02.006","article-title":"Glycolipid-mediated basophil activation in alpha-gal allergy","volume":"146","author":"Iweala","year":"2020","journal-title":"J Allergy Clin Immunol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/j.jaci.2022.02.030","article-title":"\u03b1-Gal present on both glycolipids and glycoproteins contributes to immune response in meat-allergic patients","volume":"150","author":"Chakrapani","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1084\/jem.165.3.693","article-title":"The human natural anti-Gal IgG. III. The subtlety of immune tolerance in man as demonstrated by crossreactivity between natural anti-Gal and anti-B antibodies","volume":"165","author":"Galili","year":"1987","journal-title":"J Exp Med"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.142.8.2828","article-title":"Immunogenic Gal alpha 1----3Gal carbohydrate epitopes are present on pathogenic American Trypanosoma and Leishmania","volume":"142","author":"Avila","year":"1989","journal-title":"J Immunol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1038\/emm.2016.164","article-title":"Effect of blood type on anti-\u03b1-Gal immunity and the incidence of infectious diseases","volume":"49","author":"Cabezas-Cruz","year":"2017","journal-title":"Exp Mol Med"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.03000","article-title":"Distribution of bacterial \u03b11,3-galactosyltransferase genes in the human gut microbiome","volume":"10","author":"Montassier","year":"2020","journal-title":"Front Immunol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006039","article-title":"An \u03b1-Gal-containing neoglycoprotein-based vaccine partially protects against murine cutaneous leishmaniasis caused by Leishmania major","volume":"11","author":"Iniguez","year":"2017","journal-title":"PloS NeglTrop Dis"},{"key":"B45","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3390\/vaccines8020195","article-title":"Vaccination with alpha-Gal protects against mycobacterial infection in the zebrafish model of tuberculosis","volume":"8","author":"Pacheco","year":"2020","journal-title":"Vaccines (Basel)"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2020.12.017","article-title":"Loss of \u03b1-gal during primate evolution enhanced antibody-effector function and resistance to bacterial sepsis","volume":"29","author":"Singh","year":"2021","journal-title":"Cell Host Microbe"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.958952","article-title":"A novel monoclonal IgG1 antibody specific for Galactose-alpha-1,3-galactose questions alpha-Gal epitope expression by bacteria","volume":"13","author":"Kreft","year":"2022","journal-title":"Front Immunol"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2009.tb02533.x","article-title":"An association between tick bite reactions and red meat allergy in humans","volume":"190","author":"Van Nunen","year":"2009","journal-title":"Med J Aust"},{"key":"B49","doi-asserted-by":"publisher","first-page":"A132","DOI":"10.1111\/j.1445-5994.2007.01551.x","article-title":"The association between Ixodes holocyclus tick bite reactions and red meat allergy","volume":"37","author":"van Nunen","year":"2007","journal-title":"Internal Med J"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.02.019","article-title":"The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-\u03b1-1,3-galactose","volume":"127","author":"Commins","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.06.014","article-title":"Mammalian meat\u2013induced anaphylaxis: Clinical relevance of anti\u2013galactose-\u03b1-1,3-galactose IgE confirmed by means of skin tests to cetuximab","volume":"124","author":"Jacquenet","year":"2009","journal-title":"J Allergy Clin Immunol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1016\/j.jaci.2011.07.020","article-title":"Delayed mammalian meat-induced anaphylaxis due to galactose-\u03b1-1,3-galactose in 5 European patients","volume":"128","author":"Nu\u00f1ez","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/j.jaci.2014.05.051","article-title":"Galactose-alpha-1,3-galactose sensitization is a prerequisite for pork-kidney allergy and cofactor-related mammalian meat anaphylaxis","volume":"134","author":"Fischer","year":"2014","journal-title":"J Allergy Clin Immunol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.07.050","article-title":"Red meat allergy in Sweden: association with tick sensitization and B-negative blood groups","volume":"132","author":"Hamsten","year":"2013","journal-title":"J Allergy Clin Immunol"},{"key":"B55","article-title":"Delayed anaphylactic reaction to mammalian meat","volume":"22","author":"Sekiya","year":"2012","journal-title":"J Investig Allergol Clin Immunol"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.12140","article-title":"Delayed mammalian meat-induced anaphylaxis confirmed by skin test to cetuximab","volume":"40","author":"Lee","year":"2013","journal-title":"J Dermatol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"AB212","DOI":"10.1016\/j.jaci.2013.12.760","article-title":"The first 4 central American cases of delayed meat allergy with galactose-alpha-1,3-galactose positivity clustered among field biologists in Panama","volume":"133","author":"Wickner","year":"2014","journal-title":"J Allergy Clin Immunol"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.3201\/eid3104.241265","article-title":"Alpha-Gal Syndrome after Ixodes scapularis Tick Bite and Statewide Surveillance, Maine, USA, 2014-2023","volume":"31","author":"Saunders","year":"2025","journal-title":"Emerg Infect Dis"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.5415\/apallergy.2018.8.e31","article-title":"A novel Australian tick Ixodes (Endopalpiger) australiensis inducing mammalian meat allergy after tick bite","volume":"8","author":"Kwak","year":"2018","journal-title":"Asia Pac Allergy"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1111\/all.12804","article-title":"Haemaphysalis longicornis tick bites are a possible cause of red meat allergy in Japan","volume":"71","author":"Chinuki","year":"2016","journal-title":"Allergy"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1016\/j.jaad.2017.12.028","article-title":"Repeated Amblyomma testudinarium tick bites are associated with increased galactose-\u03b1-1,3-galactose carbohydrate IgE antibody levels: A retrospective cohort study in a single institution","volume":"78","author":"Hashizume","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpara.2015.12.005","article-title":"Amblyomma sculptum tick saliva: \u03b1-Gal identification, antibody response and possible association with red meat allergy in Brazil","volume":"46","author":"Araujo","year":"2016","journal-title":"Int J Parasitol"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.01210","article-title":"Environmental and molecular drivers of the \u03b1-gal syndrome","volume":"10","author":"Cabezas-Cruz","year":"2019","journal-title":"Front Immunol"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1111\/all.12128","article-title":"Identification of galactose-\u03b1-1,3-galactose in the gastrointestinal tract of the tick Ixodes ricinus; possible relationship with red meat allergy","volume":"68","author":"Hamsten","year":"2013","journal-title":"Allergy"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.01056","article-title":"Discovery of alpha-gal-containing antigens in North American tick species believed to induce red meat allergy","volume":"10","author":"Crispell","year":"2019","journal-title":"Front Immunol"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1080\/14789450.2021.2018305","article-title":"Characterization of tick salivary gland and saliva alphagalactome reveals candidate alpha-gal syndrome disease biomarkers","volume":"18","author":"Villar","year":"2021","journal-title":"Expert Rev Proteomics"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1111\/all.13978","article-title":"Allergenomics of the tick Ixodes ricinus reveals important \u03b1-Gal-carrying IgE-binding proteins in red meat allergy","volume":"75","author":"Apostolovic","year":"2020","journal-title":"Allergy"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1016\/j.ttbdis.2024.102384","article-title":"Identification of Alpha-Gal glycolipids in saliva of Lone-Star Tick (Amblyomma americanum)","volume":"15","author":"Sharma","year":"2024","journal-title":"Ticks Tick-borne Dis"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.15243","article-title":"Tick-host conflict: immunoglobulin E antibodies to tick proteins in patients with anaphylaxis to tick bite","volume":"8","author":"Mateos-Hern\u00e1ndez","year":"2017","journal-title":"Oncotarget"},{"key":"B70","doi-asserted-by":"publisher","first-page":"101506","DOI":"10.1007\/978-3-662-41202-2_301","article-title":"Spatial distribution of alpha-gal in Ixodes ricinus -A histological study","volume":"11","author":"Fischer","year":"2020","journal-title":"Ticks Tick-borne Dis"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.844262","article-title":"Tick intrastadial feeding and its role on IgE production in the murine model of alpha-gal syndrome: the tick \u201cTransmission\u201d Hypothesis","volume":"13","author":"Maldonado-Ruiz","year":"2022","journal-title":"Front Immunol"},{"key":"B72","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3390\/vaccines8010018","article-title":"Alpha-gal and cross-reactive carbohydrate determinants in the N-glycans of salivary glands in the lone star tick, amblyomma americanum","volume":"8","author":"Park","year":"2020","journal-title":"Vaccines (Basel)"},{"key":"B73","doi-asserted-by":"publisher","first-page":"21409","DOI":"10.1038\/s41598-023-48437-2","article-title":"High levels of alpha-gal with large variation in the salivary glands of lone star ticks fed on human blood","volume":"13","author":"Maldonado-Ruiz","year":"2023","journal-title":"Sci Rep"},{"key":"B74","doi-asserted-by":"publisher","first-page":"14224","DOI":"10.1038\/s41598-018-32664-z","article-title":"Tick galactosyltransferases are involved in \u03b1-Gal synthesis and play a role during Anaplasma phagocytophilum infection and Ixodes scapularis tick vector development","volume":"8","author":"Cabezas-Cruz","year":"2018","journal-title":"Sci Rep"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.775371","article-title":"Alpha-gal syndrome: involvement of amblyomma americanum \u03b1-D-galactosidase and \u03b2-1,4 galactosyltransferase enzymes in \u03b1-gal metabolism","volume":"11","author":"Sharma","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"B76","doi-asserted-by":"publisher","first-page":"114","DOI":"10.3390\/vaccines7030114","article-title":"Tick bites induce anti-\u03b1-gal antibodies in dogs","volume":"7","author":"Hod\u017ei\u0107","year":"2019","journal-title":"Vaccines (Basel)"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.1128\/iai.64.2.528-534.1996","article-title":"Bacterial enzymes can add galactose alpha 1,3 to human erythrocytes and creates a senescence-associated epitope","volume":"64","author":"Hamadeh","year":"1996","journal-title":"Infect Immun"},{"key":"B78","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines8040702","article-title":"Anti-Tick Microbiota Vaccine Impacts Ixodes ricinus Performance during Feeding","volume":"8","author":"Mateos-Hern\u00e1ndez","year":"2020","journal-title":"Vaccines"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2018.07.014","article-title":"Could chiggers be contributing to the prevalence of galactose-alpha-1,3-galactose sensitization and mammalian meat allergy","volume":"7","author":"Stoltz","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.18176\/jiaci.0784","article-title":"Could cat flea bites contribute to a-gal serum IgE levels in humans","volume":"32","author":"Stenger","year":"2022","journal-title":"J Investig Allergol Clin Immunol"},{"key":"B81","doi-asserted-by":"publisher","DOI":"10.1515\/iupac.90.0351","article-title":"Characterization of the early local immune response to Ixodes ricinus tick bites in human skin","volume":"26","author":"Glatz","year":"2017","journal-title":"Exp Dermatol"},{"key":"B82","doi-asserted-by":"publisher","DOI":"10.1128\/iai.00282-23","article-title":"Bulk and single-nucleus RNA sequencing highlight immune pathways induced in individuals during an Ixodes scapularis tick bite","volume":"91","author":"Tang","year":"2023","journal-title":"Infect Immun"},{"key":"B83","doi-asserted-by":"publisher","first-page":"e161188","DOI":"10.1172\/jci161188","article-title":"Tick feeding modulates the human skin immune landscape to facilitate tick-borne pathogen transmission","volume":"132","author":"Strobl","year":"2022","journal-title":"J Clin Invest"},{"key":"B84","doi-asserted-by":"publisher","first-page":"11715","DOI":"10.1038\/s41467-025-66821-6","article-title":"Human epidermal Langerhans cells induce tolerance and hamper T cell function upon tick-borne pathogen transmission","volume":"12","author":"Strobl","year":"2025","journal-title":"Nat Commun"},{"key":"B85","doi-asserted-by":"publisher","DOI":"10.1111\/cup.13045","article-title":"Basophils are recruited and localized at the site of tick bites in humans","volume":"44","author":"Kimura","year":"2017","journal-title":"J Cutan Pathol"},{"key":"B86","doi-asserted-by":"publisher","DOI":"10.1111\/all.13794","article-title":"The contribution made by skin-infiltrating basophils to the development of alpha-gal syndrome","volume":"74","author":"Kageyama","year":"2019","journal-title":"Allergy"},{"key":"B87","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1032379","article-title":"Basophils control T cell priming through soluble mediators rather than antigen presentation","volume":"13","author":"M\u00f6bs","year":"2022","journal-title":"Front Immunol"},{"key":"B88","doi-asserted-by":"publisher","DOI":"10.1038\/icb.2010.1","article-title":"New paradigms in basophil development, regulation and function","volume":"88","author":"Siracusa","year":"2010","journal-title":"Immunol Cell Biol"},{"key":"B89","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e33600","article-title":"Molecular analysis of human tick-bitten skin yields signatures associated with distinct spatial and temporal trajectories -A proof-of-concept study","volume":"10","author":"Lee","year":"2024","journal-title":"Heliyon"},{"key":"B90","doi-asserted-by":"publisher","DOI":"10.1111\/cea.13695","article-title":"Individuals with IgE antibodies to \u03b1-Gal and CCD show specific IgG subclass responses different from subjects non-sensitized to oligosaccharides","volume":"50","author":"Rom\u00e1n-Carrasco","year":"2020","journal-title":"Clin Exp Allergy"},{"key":"B91","doi-asserted-by":"publisher","DOI":"10.1111\/all.12948","article-title":"The quantity and quality of \u03b1-gal-specific antibodies differ in individuals with and without delayed red meat allergy","volume":"72","author":"Kollmann","year":"2017","journal-title":"Allergy"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0055566","article-title":"IgE production to \u03b1-gal is accompanied by elevated levels of specific IgG1 antibodies and low amounts of IgE to blood group B","volume":"8","author":"Rispens","year":"2013","journal-title":"PloS One"},{"key":"B93","doi-asserted-by":"publisher","DOI":"10.1002\/clt2.12396","article-title":"Recurrent tick bites induce high IgG1 antibody responses to \u03b1-Gal in sensitized and non-sensitized forestry employees in Luxembourg","volume":"14","author":"Chakrapani","year":"2024","journal-title":"Clin Transl Allergy"},{"key":"B94","doi-asserted-by":"publisher","DOI":"10.1111\/all.13400","article-title":"Immunoprofile of \u03b1-Gal- and B-antigen-specific responses differentiates red meat-allergic patients from healthy individuals","volume":"73","author":"Apostolovic","year":"2018","journal-title":"Allergy"},{"key":"B95","doi-asserted-by":"publisher","first-page":"81","DOI":"10.3390\/biochem1020008","article-title":"Purification and characterization of antibodies directed against the \u03b1-gal epitope","volume":"1","author":"Zappe","year":"2021","journal-title":"Biochem"},{"key":"B96","doi-asserted-by":"publisher","DOI":"10.1111\/cea.13322","article-title":"An integrated framework using high-dimensional mass cytometry and fluorescent flow cytometry identifies discrete B cell subsets in patients with red meat allergy","volume":"49","author":"Cox","year":"2019","journal-title":"Clin Exp Allergy"},{"key":"B97","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.791028","article-title":"Chemokine receptor activation enhances memory B cell class switching linked to IgE sensitization to alpha gal and cardiovascular disease","volume":"8","author":"Pattarabanjird","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B98","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1629310","article-title":"Single-cell mRNA analysis and surface marker expression profiling of circulating immune cells in humans with alpha-gal syndrome","volume":"16","author":"Choudhary","year":"2025","journal-title":"Front Immunol"},{"key":"B99","doi-asserted-by":"publisher","first-page":"288","DOI":"10.18176\/jiaci.1028","article-title":"Longitudinal follow-up reveals peripheral immunological changes upon tick bite in \u03b1-gal-sensitized individuals","volume":"35","author":"Swiontek","year":"2025","journal-title":"J Investig Allergol Clin Immunol"},{"key":"B100","doi-asserted-by":"publisher","first-page":"3185","DOI":"10.3390\/ijms22063185","article-title":"T and B lymphocyte transcriptional states differentiate between sensitized and unsensitized individuals in alpha-gal syndrome","volume":"22","author":"Iweala","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B101","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1801156","article-title":"Cutaneous exposure to clinically relevant lone star ticks promotes IgE production and hypersensitivity through CD4(+) T cell- and MyD88-dependent pathways in mice","volume":"203","author":"Chandrasekhar","year":"2019","journal-title":"J Immunol"},{"key":"B102","doi-asserted-by":"publisher","DOI":"10.1002\/iid3.457","article-title":"Tick salivary gland extract induces alpha-gal syndrome in alpha-gal deficient mice","volume":"9","author":"Choudhary","year":"2021","journal-title":"Immun Inflammation Dis"},{"key":"B103","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1016\/j.jaci.2023.12.003","article-title":"IgE and anaphylaxis specific to the carbohydrate alpha-gal depend on IL-4","volume":"153","author":"Hils","year":"2024","journal-title":"J Allergy Clin Immunol"},{"key":"B104","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1336883","article-title":"Tick bite-induced alpha-gal syndrome and immunologic responses in an alpha-gal deficient murine model","volume":"14","author":"Sharma","year":"2023","journal-title":"Front Immunol"},{"key":"B105","doi-asserted-by":"publisher","DOI":"10.1172\/jci42680","article-title":"Selective ablation of basophils in mice reveals their nonredundant role in acquired immunity against ticks","volume":"120","author":"Wada","year":"2010","journal-title":"J Clin Invest"},{"key":"B106","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01348","article-title":"Skin CD4(+) memory T cells play an essential role in acquired anti-tick immunity through interleukin-3-mediated basophil recruitment to tick-feeding sites","volume":"8","author":"Ohta","year":"2017","journal-title":"Front Immunol"},{"key":"B107","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.601504","article-title":"Immunobiology of acquired resistance to ticks","volume":"11","author":"Karasuyama","year":"2020","journal-title":"Front Immunol"},{"key":"B108","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.180.9.6186","article-title":"Tick saliva inhibits dendritic cell migration, maturation, and function while promoting development of Th2 responses","volume":"180","author":"Skallov\u00e1","year":"2008","journal-title":"J Immunol"},{"key":"B109","doi-asserted-by":"publisher","DOI":"10.1111\/xen.12718","article-title":"Genetically engineered pig kidney transplantation in a brain-dead human subject","volume":"28","author":"Cooper","year":"2021","journal-title":"Xenotransplantation"},{"key":"B110","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1711.2005.01398.x","article-title":"\u03b11,3-Galactosyltransferase knockout pigs are available for xenotransplantation: Are glycosyltransferases still relevant","volume":"83","author":"Milland","year":"2005","journal-title":"Immunol Cell Biol"},{"key":"B111","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1358178","article-title":"Gene-edited pigs: a translational model for human food allergy against alpha-Gal and anaphylaxis","volume":"15","author":"Wang","year":"2024","journal-title":"Front Immunol"},{"key":"B112","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.00078","article-title":"Allergic reactions and immunity in response to tick salivary biogenic substances and red meat consumption in the zebrafish model","volume":"10","author":"Contreras","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"key":"B113","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2023.115829","article-title":"Multi-omics analysis of zebrafish response to tick saliva reveals biological processes associated with alpha-Gal syndrome","volume":"168","author":"Vaz-Rodrigues","year":"2023","journal-title":"Biomedicine Pharmacotherapy"},{"key":"B114","doi-asserted-by":"publisher","DOI":"10.3791\/64378","article-title":"Zebrafish animal model for the study of allergic reactions in response to tick saliva biomolecules","volume":"187","author":"Contreras","year":"2022","journal-title":"J Vis Exp"},{"key":"B115","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1186\/s13071-023-05874-2","article-title":"Allergic reactions to tick saliva components in zebrafish model","volume":"16","author":"Contreras","year":"2023","journal-title":"Parasit Vectors"},{"key":"B116","doi-asserted-by":"publisher","first-page":"8849","DOI":"10.1038\/s41598-025-93031-3","article-title":"Tick salivary proteins metalloprotease and allergen-like p23 are associated with response to glycan \u03b1-Gal and mycobacterium infection","volume":"15","author":"Vaz-Rodrigues","year":"2025","journal-title":"Sci Rep"},{"key":"B117","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpara.2024.07.002","article-title":"Tick salivary proteome and lipidome with low glycan content correlate with allergic type reactions in the zebrafish model","volume":"54","author":"Vaz-Rodrigues","year":"2024","journal-title":"Int J Parasitol"},{"key":"B118","doi-asserted-by":"publisher","first-page":"127786","DOI":"10.1016\/j.micres.2024.127786","article-title":"Zebrafish gut microbiota composition in response to tick saliva biomolecules correlates with allergic reactions to mammalian meat consumption","volume":"285","author":"D\u00edaz-S\u00e1nchez","year":"2024","journal-title":"Microbiol Res"},{"key":"B119","doi-asserted-by":"publisher","DOI":"10.1096\/fj.202500687r","article-title":"Is zebrafish a good model for the alpha-gal syndrome","volume":"39","author":"Vaz-Rodrigues","year":"2025","journal-title":"FASEB J"},{"key":"B120","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.alit.2025.03.004","article-title":"Pre-clinical strategies and emerging technologies driving advances in the alpha-gal syndrome","volume":"74","author":"Erickson","year":"2025","journal-title":"Allergol Int"},{"key":"B121","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2567.1999.00683.x","article-title":"Successive tick infestations selectively promote a T-helper 2 cytokine profile in mice","volume":"96","author":"Ferreira","year":"1999","journal-title":"Immunology"},{"key":"B122","article-title":"In vitro production of interleukin-4 and interferon-gamma by lymph node cells from BALB\/c mice infested with nymphal Ixodes ricinus ticks","volume":"85","author":"Ganapamo","year":"1995","journal-title":"Immunology"},{"key":"B123","doi-asserted-by":"publisher","first-page":"e158357","DOI":"10.1172\/jci158357","article-title":"Th2-skewed T cells correlate with B cell response to \u03b1-Gal and tick antigens in \u03b1-Gal syndrome","volume":"133","author":"Apostolovic","year":"2023","journal-title":"J Clin Invest"},{"key":"B124","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.transproceed.2008.10.054","article-title":"CD1d-mediated interaction between activated T cells and B cells is essential to B-cell proliferation and anti-alpha-Gal antibody production","volume":"41","author":"Liu","year":"2009","journal-title":"Transplant Proc"},{"key":"B125","doi-asserted-by":"publisher","first-page":"12684","DOI":"10.1038\/s41598-018-30887-8","article-title":"\u03b1-Gal on the protein surface affects uptake and degradation in immature monocyte derived dendritic cells","volume":"8","author":"Ristivojevi\u0107","year":"2018","journal-title":"Sci Rep"},{"key":"B126","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2007.07.138","article-title":"Prostaglandin E2 is a major inhibitor of dendritic cell maturation and function in Ixodes scapularis saliva","volume":"179","author":"S\u00e1-Nunes","year":"2007","journal-title":"J Immunol"},{"key":"B127","doi-asserted-by":"publisher","DOI":"10.1093\/intimm\/dxm019","article-title":"Splenic dendritic cells pulsed with Ixodes ricinus tick saliva prime naive CD4+T to induce Th2 cell differentiation in vitro and in vivo","volume":"19","author":"Mejri","year":"2007","journal-title":"Int Immunol"},{"key":"B128","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1084\/jem.20040035","article-title":"Essential role of lung plasmacytoid dendritic cells in preventing asthmatic reactions to harmless inhaled antigen","volume":"200","author":"de Heer","year":"2004","journal-title":"J Exp Med"},{"key":"B129","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3038.2008.00818.x","article-title":"Lower levels of plasmacytoid dendritic cells in peripheral blood are associated with a diagnosis of asthma 6 yr after severe respiratory syncytial virus bronchiolitis","volume":"20","author":"Silver","year":"2009","journal-title":"Pediatr Allergy Immunol"},{"key":"B130","doi-asserted-by":"publisher","DOI":"10.1016\/j.ttbdis.2020.101529","article-title":"Repeat tick exposure elicits distinct immune responses in Guinea pigs and mice","volume":"11","author":"Kurokawa","year":"2020","journal-title":"Ticks Tick-borne Dis"},{"key":"B131","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s11882-025-01237-2","article-title":"Ticked off: Allergic effector cells in the pathogenesis of alpha-gal syndrome","volume":"25","author":"Kepley","year":"2025","journal-title":"Curr Allergy Asthma Rep"},{"key":"B132","doi-asserted-by":"publisher","first-page":"eaat6280","DOI":"10.1126\/science.aat6280","article-title":"Commensal-specific T cell plasticity promotes rapid tissue adaptation to injury","volume":"363","author":"Harrison","year":"2019","journal-title":"Science"},{"key":"B133","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.168.3.1479","article-title":"The role of T cell help in the production of antibodies specific for Gal\u03b11\u20133Gal1","volume":"168","author":"Cretin","year":"2002","journal-title":"J Immunol"},{"key":"B134","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-020-00452-4","article-title":"\u03b3\u03b4 T cells in tissue physiology and surveillance","volume":"21","author":"Ribot","year":"2021","journal-title":"Nat Rev Immunol"},{"key":"B135","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-018-0034-2","article-title":"Tissue-specific functions of invariant natural killer T cells","volume":"18","author":"Crosby","year":"2018","journal-title":"Nat Rev Immunol"},{"key":"B136","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01532","article-title":"B cell responses in the development of mammalian meat allergy","volume":"11","author":"Chandrasekhar","year":"2020","journal-title":"Front Immunol"},{"key":"B137","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/j.jaci.2014.03.036","article-title":"Human IgE(+) B cells are derived from T cell-dependent and T cell-independent pathways","volume":"134","author":"Berkowska","year":"2014","journal-title":"J Allergy Clin Immunol"},{"key":"B138","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.586924","article-title":"The history of carbohydrates in type I allergy","volume":"11","author":"Hils","year":"2020","journal-title":"Front Immunol"},{"key":"B139","doi-asserted-by":"publisher","DOI":"10.1111\/all.13156","article-title":"Prevalence of type I sensitization to alpha-gal in forest service employees and hunters","volume":"72","author":"Fischer","year":"2017","journal-title":"Allergy"},{"key":"B140","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12326","article-title":"IgE antibodies to alpha-gal in the general adult population: relationship with tick bites, atopy, and cat ownership","volume":"44","author":"Gonzalez-Quintela","year":"2014","journal-title":"Clin Exp Allergy"},{"key":"B141","doi-asserted-by":"publisher","DOI":"10.1111\/cea.70011","article-title":"Alpha-Gal sensitization dynamics in individuals after tick bites with or without erythema migrans","volume":"55","author":"van Gorkom","year":"2025","journal-title":"Clin Exp Allergy"},{"key":"B142","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1111\/all.16360","article-title":"Increasing prevalence of galactose-\u03b1-1,3-galactose sensitization in the Danish general adult population","volume":"80","author":"Leth-M\u00f8ller","year":"2025","journal-title":"Allergy"},{"key":"B143","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.16570","article-title":"Cohort study of subclinical sensitization against galactose-\u03b1-1,3-galactose in Japan: Prevalence and regional variations","volume":"49","author":"Nakagawa","year":"2022","journal-title":"J Dermatol"},{"key":"B144","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.jaip.2023.10.046","article-title":"Alpha-Gal IgE prevalence patterns in the United States: An investigation of 3,000 military recruits","volume":"12","author":"Ailsworth","year":"2024","journal-title":"J Allergy Clin Immunology: In Pract"},{"key":"B145","doi-asserted-by":"publisher","first-page":"2348","DOI":"10.1016\/j.jaip.2019.03.031","article-title":"Investigation into the \u03b1-Gal syndrome: Characteristics of 261 children and adults reporting red meat allergy","volume":"7","author":"Wilson","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B146","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-2585","article-title":"Galactose-\u03b1-1,3-galactose and delayed anaphylaxis, angioedema, and urticaria in children","volume":"131","author":"Kennedy","year":"2013","journal-title":"Pediatrics"},{"key":"B147","doi-asserted-by":"publisher","DOI":"10.1111\/pai.12969","article-title":"Predictive values of alpha-gal IgE levels and alpha-gal IgE: Total IgE ratio and oral food challenge-proven meat allergy in a population with a high prevalence of reported red meat allergy","volume":"29","author":"Mabelane","year":"2018","journal-title":"Pediatr Allergy Immunol"},{"key":"B148","doi-asserted-by":"publisher","DOI":"10.1159\/000503966","article-title":"Prevalence and impact of type I sensitization to alpha-gal in patients consulting an allergy unit","volume":"181","author":"Fischer","year":"2020","journal-title":"Int Arch Allergy Immunol"},{"key":"B149","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3390\/antib14020043","article-title":"IgG to galactose-alpha-1,3-galactose: Impact of alpha-gal IgE sensitization, blood type, and tick bites","volume":"14","author":"Ailsworth","year":"2025","journal-title":"Antibodies (Basel)"},{"key":"B150","doi-asserted-by":"publisher","first-page":"2817","DOI":"10.1016\/j.jaip.2024.06.035","article-title":"Mammalian meat allergy and IgE to alpha-gal in Central Virginia: Findings from a COVID-19 vaccine and patient cohort","volume":"12","author":"Richards","year":"2024","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B151","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pclm.0000528","article-title":"Environmental risk and alpha-gal syndrome (AGS) in the Mid-Atlantic United States","volume":"4","author":"Hollingsworth","year":"2025","journal-title":"PloS Clim"},{"key":"B152","doi-asserted-by":"publisher","first-page":"100500","DOI":"10.1016\/j.jacig.2025.100500","article-title":"Living close to the forest is a risk factor for galactose-\u03b1-1,3-galactose sensitization","volume":"4","author":"Leth-M\u00f8ller","year":"2025","journal-title":"J Allergy Clin Immunology: Global"},{"key":"B153","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12655","article-title":"High prevalence of sIgE to galactose-\u03b1-1,3-galactose in rural pre-Alps area: a cross-sectional study","volume":"46","author":"Villalta","year":"2016","journal-title":"Clin Exp Allergy"},{"key":"B154","doi-asserted-by":"publisher","DOI":"10.18176\/jiaci.0373","article-title":"IgE-mediated sensitization to galactose-\u03b1-1,3-galactose (\u03b1-Gal) in urticaria and anaphylaxis in Spain: Geographical variations and risk factors","volume":"29","author":"Mateo Borrega","year":"2019","journal-title":"J Investig Allergol Clin Immunol"},{"key":"B155","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1016\/j.jaci.2020.12.650","article-title":"\u03b1-Gal specific-IgE prevalence and levels in Ecuador and Kenya: Relation to diet, parasites, and IgG(4)","volume":"147","author":"Wilson","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"B156","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.01.033","article-title":"Impaired allergy diagnostics among parasite-infected patients caused by IgE antibodies to the carbohydrate epitope galactose-\u03b1 1,3-galactose","volume":"127","author":"Arkest\u00e5l","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"B157","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.anai.2020.12.019","article-title":"Diagnostic testing for galactose-alpha-1,3-galactose, United States, 2010 to 2018","volume":"126","author":"Binder","year":"2021","journal-title":"Ann Allergy Asthma Immunol"},{"key":"B158","doi-asserted-by":"publisher","DOI":"10.18176\/jiaci.0218","article-title":"IgE to \u03b1-Gal in foresters and forest workers from La Rioja, North of Spain","volume":"28","author":"Venturini","year":"2018","journal-title":"J Investig Allergol Clin Immunol"},{"key":"B159","doi-asserted-by":"publisher","DOI":"10.1080\/23744235.2022.2057583","article-title":"Sensitisation and allergic reactions to alpha-1,3-galactose in Podlasie, Poland, an area endemic for tick-borne infections","volume":"54","author":"Rutkowski","year":"2022","journal-title":"Infect Dis (Lond)"},{"key":"B160","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2020.12.021","article-title":"Prevalence of alpha-gal sensitization among Kentucky timber harvesters and forestry and wildlife practitioners","volume":"9","author":"Bellamy","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B161","doi-asserted-by":"publisher","DOI":"10.1056\/nejmra2200092","article-title":"Climate change and vectorborne diseases","volume":"387","author":"Thomson","year":"2022","journal-title":"N Engl J Med"},{"key":"B162","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-024-01026-0","article-title":"Effects of climate change and human activities on vector-borne diseases","volume":"22","author":"de Souza","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"B163","doi-asserted-by":"publisher","DOI":"10.1093\/jme\/tjaa220","article-title":"Possible effects of climate change on ixodid ticks and the pathogens they transmit: Predictions and observations","volume":"58","author":"Ogden","year":"2021","journal-title":"J Med Entomol"},{"key":"B164","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1016\/j.jaip.2018.02.010","article-title":"The B antigen protects against the development of red meat allergy","volume":"6","author":"Brestoff","year":"2018","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B165","doi-asserted-by":"publisher","DOI":"10.1111\/all.13206","article-title":"Prevalence of type I sensitization to alpha-gal in forest service employees and hunters: Is the blood type an overlooked risk factor in epidemiological studies of the \u03b1-Gal syndrome","volume":"72","author":"Cabezas-Cruz","year":"2017","journal-title":"Allergy"},{"key":"B166","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-021-00538-7","article-title":"Does the epithelial barrier hypothesis explain the increase in allergy, autoimmunity and other chronic conditions","volume":"21","author":"Akdis","year":"2021","journal-title":"Nat Rev Immunol"},{"key":"B167","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1002\/9781444300062.ch38","article-title":"Prevention of food allergy","volume":"137","author":"du Toit","year":"2016","journal-title":"J Allergy Clin Immunol"},{"key":"B168","unstructured":"The \u03b1-gal syndrome - investigating immune reactions to tick bites (ImmunoGal) clinicalTrials.gov: NCT07177729"},{"key":"B169","unstructured":"National institutes of health (NIH): NIH research portfolio online reporting tools (RePORTER)"},{"key":"B170","unstructured":"Project number 527318848"},{"key":"B171","doi-asserted-by":"publisher","DOI":"10.1097\/mop.0000000000000955","article-title":"'Doc, will I ever eat steak again?': diagnosis and management of alpha-gal syndrome","volume":"32","author":"Patel","year":"2020","journal-title":"Curr Opin Pediatr"},{"key":"B172","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.jaip.2019.08.045","article-title":"IgE to galactose-\u03b1-1,3-galactose wanes over time in patients who avoid tick bites","volume":"8","author":"Kim","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B173","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjms.2024.11.015","article-title":"Alpha-gal syndrome: A review for the general internist","volume":"369","author":"Peterson","year":"2025","journal-title":"Am J Med Sci"},{"key":"B174","doi-asserted-by":"publisher","DOI":"10.1080\/1744666x.2020.1782745","article-title":"Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients","volume":"16","author":"Commins","year":"2020","journal-title":"Expert Rev Clin Immunol"},{"key":"B175","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jaip.2019.09.017","article-title":"Diagnosis and management of patients with the \u03b1-Gal syndrome","volume":"8","author":"Platts-Mills","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B176","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2016.12.008","article-title":"Successful beef desensitization in 2 adult patients with a delayed-type reaction to red meat","volume":"5","author":"Unal","year":"2017","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B177","doi-asserted-by":"publisher","DOI":"10.1111\/all.15840","article-title":"Oral immunotherapy in alpha-gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management","volume":"78","author":"\u00dcnal","year":"2023","journal-title":"Allergy"},{"key":"B178","doi-asserted-by":"publisher","DOI":"10.1111\/pai.13092","article-title":"Red meat desensitization in a child with delayed anaphylaxis due to alpha-Gal allergy","volume":"30","author":"Yucel","year":"2019","journal-title":"Pediatr Allergy Immunol"},{"key":"B179","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-65433-7_17","article-title":"Successful home reintroduction of mammalian meat in patients with alpha gal syndrome","volume":"14","author":"Owusu-Asare","year":"2025","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B180","doi-asserted-by":"publisher","DOI":"10.3389\/falgy.2024.1437523","article-title":"Immunotherapy with biodegradable nanoparticles encapsulating the oligosaccharide galactose-alpha-1,3-galactose enhance immune tolerance against alpha-gal sensitization in a murine model of alpha-gal syndrome","volume":"5","author":"Saunders","year":"2024","journal-title":"Front Allergy"},{"key":"B181","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.873019","article-title":"Poly-L-lysine-based \u03b1Gal-glycoconjugates for treating anti-\u03b1Gal IgE-mediated diseases","volume":"13","author":"Olivera-Ardid","year":"2022","journal-title":"Front Immunol"},{"key":"B182","unstructured":"Human immune responses to ixodes scapularis tick bites clinicalTrials.gov: NCT05036707"},{"key":"B183","unstructured":"The uninfected ixodes scapularis human tick challenge model (TICK ME) clinicaltrials.gov: NCT05965635"},{"key":"B184","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.abj9827","article-title":"mRNA vaccination induces tick resistance and prevents transmission of the Lyme disease agent","volume":"13","author":"Sajid","year":"2021","journal-title":"Sci Transl Med"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1838920\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:47:37Z","timestamp":1779252457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1838920\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":184,"alternative-id":["10.3389\/fimmu.2026.1838920"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1838920","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"article-number":"1838920"}}