Alpha-gal syndrome

I learn about new disorders all the time here in MRI. Normally I’ve at least heard the name of the disease or disorder before, or I know a teeny bit about it.

I have never heard of alpha-gal. At least, I’ve never heard the name.

Turns out, I have heard of the disorder before. I had a patient once tell me he was allergic to pork because of a tick bite.

Alpha-gal is a “sugar molecule found in most mammals (except in people, apes, and monkeys)” (CDC.gov, 2019). Turns out there is a tick (lone star tick) that can transmit the molecule in blood from the animal to humans. We humans don’t normally make the molecule but apparently we can make an immune response to it. If we develop an allergy then we can no longer eat meat from cow, pork, rabbit, deer, lamb, essentially the animals work hooves! The odd thing about it, and what makes it kind of hard to diagnose, is the fact that the reaction tends to take place 3-6 hours after the ingestion of meat. It’s hard for a lot of people to make the association between meat and their allergic reactions.

I found a good podcast about the disorder. Lots of information about how it works and the ongoing research around it.

One of the things I realized while looking further into the disease is how important it is to ask your patient about allergies. Alpha-gal is uncommon, however, patients with it can’t have certain medications. Heparin is typically derived from pork. Some insulin is derived from pigs and cows as well. There are quite a few medications that have porcine or bovine derivatives. A nurse would have to make sure to take this into account for their patient with this particular allergy.

Then again, when is the nurse not taking safety into account, right?

“Do you have any allergies?”

How often do you ask your patients about their allergies? Better yet, do you clarify and ask about medication and any other allergies?

We get in the habit of trusting our doctors who order the meds and the pharmacy that verifies the meds. However, we may need to get into the habit of asking about food, medication, and “any other” allergies on admission.

When doing the admission database I used to always ask whether the patient was allergic to any medications. That’s all I figured I needed to know… until a patient was negatively affected.

Way back when I was a Med-Surg nurse there was a patient that needed a CT scan. No big deal, he tolerated the scan fine but his kidneys, however, did not. We started noticing his BUN and creatinine creeping up, his urine output decreasing, all for no apparent reason. He just didn’t look as good as he should. He said he has had a CT scan before and never had any trouble. He had no known allergies. He was not a renal patient. It didn’t make sense! One of our nurses happened to be in the room giving him a saline bolus to see if we could get his urine output to pick back up. He was questioned about his previous CT scans again and this time he mentions that one time they “put something in his IV “and it “made him sick and put him in the hospital” but “that was years ago.”

Oh really?

Well, guess who had a CT scan with IV contrast… Mind you, he said he had no allergies. Turns out because of his education level he only considered medications to be the pills he took at home so the IV contrast allergy didn’t register with him. I don’t think he even understood that his reaction was an actual allergy.  He didn’t really know what IV contrast was and since we only asked about meds, he didn’t see a reason to mention it.

facepalm.gif

Looks like we found our problem guys.

Needless to say, that changed how I asked about allergies. I try to keep my patient’s education level in mind when asking questions. I want to make sure they understand what I am asking them. It is my job to keep them safe. As the nurse, we are often the last safety check before something reaches the patient. We block all the foolishness from getting to our patients because we are awesome.

blocked.gif