MEAT PIES: Mammalian Meat Allergy in Patients Investigated for Gastrointestinal Symptoms: Detection of Mammalian Meat Allergy in the Gastroenterology Outpatient Department, Cairns Hospital, Queensland, Australia

Abstract

Background Alpha-gal syndrome (AGS), an IgE-mediated allergy to galactose-α-1,3-galactose acquired via tick bites, often presents with a delayed gastrointestinal (GI) phenotype without anaphylaxis. We evaluated a local diagnostic guideline in a Far North Queensland gastroenterology outpatient clinic. Methods A retrospective quality assurance audit at Cairns Hospital identified serum-specific IgE (ssIgE) requests to alpha-gal 12 months before and 6 months after guideline implementation (12 March 2025). ImmunoCAP ssIgE ≥ 0.1 kU/L was positive. Results Of 19 patients tested, 5 (26%) were sensitized. All had GI-predominant symptoms-most commonly diarrhea (58%) and abdominal pain (53%)-with no anaphylaxis or respiratory features, and negative preliminary investigations including endoscopy. All three patients completing meat avoidance trials had symptom resolution. Diagnostic yield rose from 2/16 (12.5%) to 3/3 (100%) post-guideline, though testing was driven almost exclusively by a single clinician. Conclusion The GI phenotype of AGS is present and likely underrecognized in this tick-endemic region. Targeted ssIgE testing after careful clinical assessment yields high diagnostic value, supporting consideration of AGS in unexplained GI symptoms and extending the recognized distribution of the condition.