Described in 2015, revolutionary in that allergy is to an oligosaccharide (ie a sugar, not a protein), specifically galactose-alpha-1,3-galactose.

Accounts for anaphylaxis to cetuximab, a cancer drug, but even more bizarrely, allergy to red meat (beef and pork). The latter appears to follow sensitization through a tick bite, so is really only an issue in endemic areas eg parts of United States and Europe, Australia.

Anaphylaxis to red meat can be immediate or delayed, with or without exercise induction!

In a small series of beef allergic patients reported in 2003 (strong family history), skin prick and labial contact tests only positive in minority.  All positive on IgE.  In another series, most beef allergic were also gelatine allergic. Risk from gelatine is mostly from intravenous products, but big dose of jelly sweets as risk??? Interestingly, a proportion of “idiopathic” anaphylaxis turned out SPT positive for gelatine. 

Bovine specific albumin is another possible allergen for beef allergy.

In Asia allergy described to galacto-oligosaccharides in milk formula, also a carbohydrate!

Thought to be T cell independent!

IgE test available. Levels appear to fall over time unless continued tick exposure.

Emerging? Changes in land use (less sheep, more deer)? About 50 cases in Scotland (2025) – certainly not all rural so prob recreational exposure. Youngest 4yrs (Argyll). Mostly strongly co-factor modified; cf America (big steaks?)

Some seem to have associated milk allergy.