Case Report: Alpha Gal Syndrome

We report a case of a 40-year-old male who presented with sensation of throat closing and shortness of breath while at work at a meat processing facility. The differential diagnosis of shortness of breath is throat closing includes, but is not limited to, allergic reactions to antibiotics in meat, allergy to food additives, Symptom triggers are useful in identifying causes and a good supporting history and exposures can help with diagnosis. In this case, the patient had a known diagnosis of Alpha-gal syndrome (AGS) which is a tick-bite associated, possibly life-threatening immunoglobin E-mediated (IgE) hypersensitivity to galactose-alpha-1,3-galactose (alpha-gal). The patient noted he typically wore a respirator while working directly with animals but did not always wear a respirator in certain locations in the meat packing facility. He noted he had not been wearing his respirator prior to the onset of symptoms because he was working in a separate section of the facility. He received methylprednisolone intravenously (IV) 125 mg, famotidine IV 20 mg, diphenhydramine IV 50 mg, and 1 L IV sodium chloride in the emergency department. An hour after receiving the medications, he noted resolution of symptoms. He was observed in the ED for an additional hour with no recurrence of symptoms and discharged with oral prednisone oral cetirizine, oral famotidine, and an epinephrine pen with strict return to ED precautions. He was advised about his work-related risks.