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Wake-up stroke with large-vessel occlusion — ABIM Board MCQ

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HardNeurologyWake-up stroke with large-vessel occlusionABIM Board

A 52-year-old develops urticaria, abdominal cramping, and hypotension four hours after eating beef on two occasions. Immediate skin testing to common foods is unrevealing. He recalls numerous lone-star tick bites. Which diagnostic and counseling strategy is most appropriate?

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Correct answer: A — Test alpha-gal-specific IgE and counsel on delayed mammalian-product reactions

The best answer is “Test alpha-gal-specific IgE and counsel on delayed mammalian-product reactions”. Alpha-gal syndrome characteristically causes delayed allergic reactions after mammalian meat or other alpha-gal-containing exposure, often following tick bites. Serum alpha-gal-specific IgE supports the diagnosis in the appropriate history. Patients need individualized mammalian-product avoidance, epinephrine preparedness, and review of medications or biologic products that may contain alpha-gal. Poultry and fish do not carry the same mammalian carbohydrate antigen.

Reference: CDC: Clinical care for alpha-gal syndrome: https://www.cdc.gov/alpha-gal-syndrome/hcp/clinical-care/index.html