Intraoperative Anaphylaxis in the Setting of Undiagnosed Alpha-Gal Syndrome: A Heart Team Clinical Conundrum

Alpha-gal syndrome (AGS) is a delayed allergic reaction to galactose-α-1,3-galactose, a carbohydrate in nonprimate mammalian tissue. Reactions can occur in individuals exposed to lone star ticks after consuming red meat and dairy products and/or exposure to mammal-derived medications or bioprosthetic materials.

A 74-year-old man undergoing valve and ascending aortic replacement experienced hemodynamic collapse after transfusion of heparin, fresh frozen plasma, and platelets. Transfusion reaction, cardiogenic shock, and sepsis were ruled out. Recovery occurred within 6 hours of medical treatment. After an otherwise uncomplicated hospitalization, he was diagnosed with AGS and treated with diet restriction and omalizumab.

In addition to anaphylaxis, AGS may also have long-term cardiovascular effects such as early bioprosthetic valve failure, accelerated atherosclerosis, and coronary artery disease. Understanding of clinical subtleties of AGS and its cardiovascular implications is important for clinicians who manage these patients both in the short and long terms.