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Alpha-Gal Syndrome Managed With Omalizumab for Perioperative Optimization of Total Hip Arthroplasty: A Case Report
Anita Kohli-Pamnani1, Mario Rodenas1, Bianca Audrey Duah2
1Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Case:
A 65-year-old woman with alpha-gal syndrome (AGS) required total hip arthroplasty. Laboratories revealed galactose-alpha-1,3-galactose immunoglobulin E 0.4 kU/L (abnormal ≥ 0.1 kU/L). In the absence of published guidelines for perioperative management of AGS, we used a pragmatic approach incorporating omalizumab.
Conclusion:
Perioperative management of AGS incorporated omalizumab injections, avoidance of high-risk medications and surgical materials containing mammalian derivatives, and pretreatment (corticosteroids, H1 and H2 antihistamines, montelukast). She tolerated hip arthroplasty without perioperative anaphylaxis or AGS symptoms by 4 months of follow-up. High-risk medications include propofol (may contain glycerol), analgesics (gelatin, magnesium stearate, lactose), and heparin (porcine, bovine).
