D3.348 - Alpha‑gal Syndrome in Young People: A Call for Public Health Awareness in Tick‑Endemic Areas of Scotland and North East England

Background

Alpha‑gal syndrome (AGS) is an IgE‑mediated allergy to galactose‑α‑1,3‑galactose, typically triggered by tick bites and characterized by delayed reactions (up to 8 hours) after mammalian meat ingestion. Although increasingly recognised worldwide, AGS remains very rare in the United Kingdom (UK). Recent evidence confirms that Ixodes ricinus, the predominant UK tick, can induce AGS in Scottish residents. Most cases occur in adults (mean age 48.9 years), with pediatric cases comprising a minority, contributing to diagnostic delay. Tick bites are strongly associated with α-gal–specific IgE sensitisation, a risk particularly relevant to individuals with extensive outdoor exposure. We present the first confirmed case in our Pediatric tertiary Allergy service.

Case Summary

A 15-year-old girl presented with delayed-onset urticaria, angioedema, and dysphagia occurring several hours after first-time consumption of venison while travelling in Scotland. Symptoms partially improved with antihistamines but reoccurred. She had a history of recurrent Lyme disease, confirmed Erythema Migrans and engaged in outdoor activities in tick‑dense environments. Examination at the time of the clinic appointment revealed only mild viral rhinitis. Given the delayed onset, tick exposure, and atopic background, AGS was suspected.

Results

Serology demonstrated elevated specific IgE (spIgE) to α‑gal (36.50 kUA/L), spIgE to beef (5.16 kUA/L) and spIgE to pork (1.26 kUA/L), with negative spIgE to poultry and shellfish (<0.35 kUA/L) and a normal mast cell tryptase. Autoimmune, immune, inflammatory and complement studies were normal.

Management included strict avoidance of mammalian meat and α‑gal–containing products, counselling on tick prevention, provision of two adrenaline auto‑injectors and referral to allergy dietetics.

Conclusion

This case represents a rare pediatric presentation of AGS, aligning with literature showing adult predominance and UK rarity. The patient’s exposure to tick‑rich Scottish landscapes reflects recognised ecological pathways for α‑gal sensitisation, consistent with emerging Scottish evidence implicating Ixodes ricinus in AGS onset. The characteristic delayed reaction pattern further supports AGS over other causes of anaphylaxis. This case stresses the need for heightened clinical awareness of AGS in children and adolescents living or travelling in tick‑endemic regions of Scotland and North East England. We propose a Local Guideline for potential national engagement.