Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

By Lorraine L. Janeczko

January 13, 2019

NEW YORK (Reuters Health) - People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.

The syndrome "is characterized by a delayed allergic reaction to mammalian meat associated with the presence of specific IgE-antibodies to galactose-alpha-1,3-galactose," researchers explain in The Journal of Allergy and Clinical Immunology: In Practice, online December 15.

"Sensitized patients are at risk upon ingestion of red meat, in particular pork kidney and innards. However, diverse other products of mammalian origin have been shown to carry the alpha-Gal epitope and to trigger allergic symptoms," Dr. Christiane Hilger of the Luxembourg Institute of Health in Esch-sur-Alzette and colleagues write.

Dr. Hilger and her colleagues investigated the potential ability of two drugs derived from pigs to cause allergic reactions: Creon (from AbbVie), also known as pancrelipase or pancreatin, and Enzynorm f (from Nordmark).

Creon is a pancreas extract containing amylases, lipases and proteases and is used to treat exocrine pancreatic insufficiency in the context of cystic fibrosis, pancreatitis and pancreatic cancer. Enzynorm f contains pepsin and hydrolyzed cow blood proteins and is used to treat gastric problems.

For their study, the research team recruited 17 patients between 13 and 67 years of age with alpha-gal syndrome at medical centers in Luxembourg and Germany.

The presence of alpha-gal was detected by immunoblot in protein extracts from both Creon and Enzynorm f. An alpha-Gal reactive band at about 27 kDa and diffuse reactivity in the low molecular weight range was detected in Creon, while Enzynorm f showed a prominent band at 42 kDa.

Prick-to-prick skin tests with the drugs were performed by crushing the content of a Creon capsule or an Enzynorm f pill, adding a few drops of saline, and applying the mixture to the skin. Prick-to-prick tests were also performed with gelafundin 4%, raw beef and pork, and raw pig kidney.

The skin tests showed strong positive reactions to the drugs, with Enzynorm f producing significantly larger wheals than pig kidney. Eleven controls with specific IgE to alpha-gal < 0.1 kUA/L showed either no reactivity or much smaller wheals.

Basophil activation tests were performed with pig kidney, Creon and Enzynorm f. Both drugs strongly activated basophils in participants with delayed allergy to red meat. Only one patient was below the threshold of 15% activated basophils for stimulation with Creon. None of the extracts stimulated basophils in two atopic controls.

Sensitivity of the basophils was significantly higher to Creon and Enzynorm f than to pig kidney. The specificity of the IgE-mediated reactions was confirmed by inhibition ELISA.

"Both drugs showed a strong reactivity in skin tests and basophil activation, pointing to a potential risk for alpha-Gal sensitized patients upon ingestion of these drugs," the researchers note.

"In our study, we report a theoretical risk as no case has been reported so far," they caution. "However, these drugs should be administered with caution in patients with alpha-Gal syndrome until the actual risk has been cleared or established."

AbbVie, Nordmark and Dr. Hilger did not respond to requests for comment.

SOURCE: https://bit.ly/2LWcgze

J Allergy Clin Immunol Pract 2018.