Table 3 –
Checklist for providers counseling patients with AGS
| Guidance for all patients at initial AGS diagnosis |
|---|
| FOOD |
| Avoid mammalian meats |
| Be cautious with high fat dairy & large amounts of butter |
| Educate regarding co-factors (esp., alcohol and activity) in setting of alpha-gal food exposure |
| Eating out can be challenging – inquire about fry oil, gravies, sauces and stocks. Some fast food restaurants add lard or suet to fryer (including French fries) |
| If tolerating dairy, full avoidance of this exposure may not be necessary |
| Equally, if dairy is tolerated then gelatin and carrageenan are often not issues |
| Cross-contamination during home cooking is typically ok (e.g., sharing spatulas) |
| Consider emu and duck as sources of meat to supplement chicken, turkey, seafood |
| Reminder about sausage casing as potential source of alpha-gal exposure |
| Consider referral to nutritionist if concern about safe and healthy forms of protein |
| ENVIRONMENT |
| Discuss tick bite prevention; refer to CDC website |
| Additional tick bites can increase sensitivity to various exposures (often transiently) |
| Having pets is fine but educate that pet dander can contain alpha-gal |
| Fumes from cooking mammalian meats are reported as an issue for some patients – consider educating in advance (although avoidance is not typically necessary) |
| Educate that bee, wasp, hornet stings may also lead to increased alpha-gal IgE |
| MEDICATIONS |
| Educate about heparin as possible iatrogenic exposure |
| Gelatin-based capsules are commonly not an issue |
| Lactose, microcrystalline cellulose and magnesium stearate may contain alpha-gal but are frequently not an issue |
| Should not receive vaccines with gelatin, if possible |
| Guidance for patients with continued reactivity despite avoidance diet |
| FOODS |
| Remove dairy in all forms, including butter |
| Remove gelatin and carrageenan |
| Read labels to avoid ‘natural’ flavoring as this often means pork or beef |
| ENVIRONMENT |
| Consider monthly washing of pets |
| Avoid fumes of mammalian meats being cooked |
| MEDICATION |
| Consider starting a daily oral anti-histamine |
| Switch to tablet formulations, consider opening capsules and taking with foods, if appropriate (e.g., medication is not time-release), or consider compounding pharmacy that will use plant-based gelatin capsule. |
| PERSONAL PRODUCTS |
| Switch to natural toothpaste |
| Avoid creams or lotions with lanolin |