Neurosurgical Management of Patients with Alpha-Gal Syndrome

Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity to galatcose-alpha-1,3-galactose (alpha-gal), a carbohydrate compound present in non-primate mammalian products. Initial exposure to alpha-gal most often occurs through a tick bite, most commonly the lone star tick in the United States. Repeated exposure to alpha-gal may elicit severe allergic reactions, including anaphylaxis. The allergy restricts dietary intake and may significantly impact peri-operative risk, as many medications, anesthetics, and intra-operative surgical products utilize bovine or porcine-derived agents, including those containing magnesium stearate, glycerol, and gelatin. Here, we review the peri-neurosurgical care of two individuals with AGS and highlight pertinent clinical practices and peri-operative management of these patients.