aGal Proposed case definition 102419.docx (20.6 KB)

Do we need to define low blood pressure?  My understanding is, for people, low BP is defined as less than 90 systolic and/or less than 60 diastolic.  Wasn't sure if we needed to be that prescriptive.  I've been trying to find case reports or other literature where BP is measured to get a sense of any trends during an alpha gal allergic response and have only been able to find one.  (It's Delayed Anaphylaxis to Red Meat Masquerading as Idiopathic Anaphylaxis by Tripathi, et al in the May/June 2014 edition of J ALLERGY CLIN IMMUNOL PRACT).  It may just be that if we have clinical information where "low blood pressure" is noted, we just go with that.

Also, I would be in favor of a suspect case category that captured confirmatory lab evidence, but where no clinical information was available.  This would make it consistent with other definitions that have this category and may, even though this is not reportable to CDC, help us assess trends in testing. 

Finally, not sure where we were in discussions about this, but I would be in favor of only counting cases once.  My thought here is that if we wanted to explore the long term impact of this syndrome, we could partner with universities to study a cohort of patients over time to see how many have recurring symptoms and explore why that might be.  Also, not fully knowing how many lab reports any state that chooses to make this reportable might receive, I think it may help make surveillance more manageable.   

Thanks to everyone for your efforts.  If anyone has any questions about my comments, please let me know.
julie       

Not sure how best to comment (here or on the document), but the way it is written in the current case definition, I don't think low BP should be included as a separate symptom - it isn't specific enough for alpha-gal - if it is important to include that, maybe it should be as part of a syndrome (e.g., anaphylaxis). On lab testing, I think we discussed a couple times deleting the "Serum IgE ≥ 0.1 IU/mL to pork, beef, lamb and any other alpha-gal containing meat, AND not tested for alpha-gal specific IgE", since it was said on the call that the large majority of persons who are laboratory tested would be tested for alpha-gal specifically; and from a reporting perspective, not wanting to receive all of these specific meat IgE reports. I may not be remembering the outcome of that discussion, but I thought it was removed? And, I agree with Julia, keep suspect category, which is consistent with other case definitions, and count cases only once.