AUTHOR=Richards Nathan E. , Wilson Jeffrey M. , Platts-Mills Thomas A. E. , Richards Robert D. 

TITLE=A retrospective review of α-gal syndrome complicating the management of suspected pancreatic exocrine insufficiency in one gastroenterology clinic in central Virginia

JOURNAL=Frontiers in Gastroenterology

VOLUME=Volume 2 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/gastroenterology/articles/10.3389/fgstr.2023.1162109

DOI=10.3389/fgstr.2023.1162109

ISSN=2813-1169

ABSTRACT=The alpha-gal mammalian meat allergy, α-gal syndrome, often includes diarrhea,
abdominal pain and other gastrointestinal (GI) symptoms. Pancreatic exocrine insufficiency
causes similar symptoms. The pancreatic replacement enzymes, referred to here as pancreatic
enzymes, used to treat pancreatic insufficiency are porcine products and contain α-gal. Patients
with pancreatic insufficiency who also have α-gal syndrome may be intolerant of mammalian
products in their diet and of α-gal in pancreatic enzymes. Here we describe 40 patients of one
GI clinic in central Virginia with suspected pancreatic insufficiency and elevated α-gal IgE titers.
Over 50% of these patients had some clinical improvement with stopping mammalian products
in the diet. Most patients could tolerate pancreatic enzymes, 10% could not due to suspected
allergy symptoms, but none developed anaphylaxis. An understanding that α-gal syndrome can
be superimposed upon pancreatic exocrine insufficiency and exacerbate symptoms, and that
treatment with pancreatic enzymes may increase GI and/or allergy symptoms in this group, will
lead to improved medical management of this complex patient population.