f27 Beef

Cow is a large and sturdy animal, native from Africa, Europe, and southern Asia but nowadays distributed worldwide. Their color varies from black, brown, grey and white and they have humps. They weigh around 147 – 1,363 kg and have a height of 49-52 inches. Their preferred living habitats are slopes, forest edges, and wet meadows. Beef allergy is a rare food allergy affecting children and adults. The prevalence of beef allergy ranges from 1–10 % worldwide, and most commonly reported in European countries. In sensitized individuals, ingestion of beef can trigger allergic symptoms such as urticaria, angioedema, anaphylaxis and gastrointestinal symptoms. Major allergen identified are Bovine serum albumin (Bos d 6), other reported allergens are Bovine immunoglobulin (Bos d 7) and galactose-alpha-1, 3-galactose (α-gal). Bos d 6 allergen is found in muscle and milk of mammals, hence, it is responsible for cross-reactivity among Bovine serum albumin and milk. The allergenicity of beef is reduced by industrial heating, freeze-drying, and homogenization. Red meat allergic patients or α-gal allergic patients are instructed to avoid all forms of red meat. 

Worldwide distribution

Beef allergy is a rare food allergy (3). It is more common in children than adults, however with often unknown pathogenic mechanism (4). The prevalence of meat allergy in children is significant in some European countries, including Italy (3). Beef allergy has been commonly found among children in the east Black Sea region of Turkey especially Giresun (5). Red meat allergy is reported from all over the world (6) and beef allergy prevalence ranges from 1–10 % (7).  In children with atopic dermatitis (AD), beef allergy incidence ranges from 3.28% - 6.52% and 0.3% in the general population (8). Moreover, in children with cow milk allergy, the prevalence of beef allergy was found to be 20% (5).

A study by Orhan and Sekerel (2003) evaluated allergy work-up of 12 beef allergy patients (10 children and 2 adults) in Turkey. Results showed that 67% (8/12) patients had a family history of beef allergy, 3 patients had positive skin prick test (SPT) responses to beef and 10 (83%) patients had elevated serum IgE concentrations, while all the patients were positive for beef-specific IgE (9).

Another study conducted in Turkey included 6000 urban schoolchildren and based on their parental report 2.6% of children had IgE-mediated beef allergy. However, a double-blind, placebo-controlled food challenge confirmed only 0.3% of children with IgE-mediated beef allergy (5).

A double-blind, placebo-controlled food challenge was conducted in 2,417 food-allergic patients of different age groups (including infants, toddlers, children, adolescents, adults and elderly) with repeated eczema and aggravation of AD in Korea. The results showed beef allergy prevalence of 9.2% and reported the minimum and maximum onset time of beef allergic reactions were 0.5 hrs. (minimum) to 48 hrs. (maximum) (10).

Living environment

Beef prefers areas such as slopes, forest edges, wet meadows and usually avoid areas which are far from water resource (11).

Worldwide distribution

Beef is distributed worldwide and native to northern Africa, Europe, and southern Asia (1). 

Main

Ingestion (via gastrointestinal tract)  of beef meat can trigger allergic reactions in sensitized children or adults (8, 12). 

Secondary

Another route of exposure identified for beef allergic reaction is through skin contact (8, 12).  

Main methods

Diagnosis of meat allergy is done through case history, skin prick tests, and specific serum IgE blood tests (12).

Food allergy and anaphylaxis

Allergic reaction to beef usually starts immediately after ingestion and symptoms are nausea, vomiting, urticaria and anaphylaxis. However, few studies have reported exacerbation of underlying eczema, as a major manifestation (12). In adults, beef allergy is known to manifest urticaria, angioedema, anaphylaxis and gastrointestinal (GI) symptoms (4). A study by Jeong et al. (2009) included 300 subjects (19 to 24 years old) and investigated causative food allergens based on questionnaires. Results showed 11.33% of subjects had food hypersensitivity and the main cause was fish, beef, chicken, milk, egg, and pork. Beef allergy was present in 2.33% study population. Also, the study showed that bovine serum albumin (BSA) (67kDa) as a major allergen in beef (13).

Alpha-gal allergy can lead to skin reactions or anaphylaxis, GI manifestation (abdominal pain, vomiting and diarrhea), or sustained and severe abdominal pain. A study in the United States reported that adults show higher severe reactions compared to children and the onset of symptoms is usually delayed (3-5 hrs. after ingestion of beef). However, a study in South Africa detected rapid onset of mainly gastrointestinal symptoms after beef consumption and in some patients, the key symptom was abdominal pain rather than skin manifestations. Moreover, children showed more severe symptoms compared to adults. (6).

A study by Morisset et al. (2012) evaluated the association of anaphylaxis to α-Gal allergen-specific IgE in 14 patients who showed anaphylactic reactions after consumption of pork or beef kidney. The results showed that allergic reactivity to kidney is higher than mammalian meat. Anaphylaxis was usually severe (12 anaphylactic shocks) and four patients reported a loss of consciousness. Anaphylaxis occurred within 10 min to 5 h of consumption of beef and pork kidney ingestion. Immediate anaphylaxis was observed in nine patients and semi-delayed anaphylaxis in four patients (14).

Prevention strategies

Avoidance

Industrial heating, freeze-drying, and homogenization reduce the allergenicity of beef meat  (8). Red meat allergic patients are instructed in some countries to wear bracelets that warn about “alpha-gal hypersensitivity or red meat allergy” (6).

Beef-allergic patients must carefully investigate the presence of alternative beef meat in the products and avoid beef meat  (8). An alpha-gal allergic individuals should avoid all forms of red meat. (6). 

Allergenic molecules

Major beef allergens are serum albumins, immunoglobulins and muscle proteins (actin, myosin and tropomyosin) (3). Major allergenic molecules identified in beef include Bos d 6, Bos d 7, Gal d 5 and α-gal (4). Bos d 6 or Bovine Serum albumin (BSA) and Bos d 7 or Immunoglobulin have molecular weights of 67 kDa and 160 kDa respectively (3) It is reported that BSA (Bos d 6) is a major allergen in children and, gamma-globulin and myoglobulin are important allergens in adults  (15). 

Cross-reactivity

Beef allergic patients are reported to be allergic to egg or cow milk because of sera cross-reactivities with the protein of egg or cow milk. Studies have reported 73% and 93% of children allergic to beef were also found allergic to cow’s milk and the main allergen in cow’s milk was sensitized to BSA (3). Beef allergy can co-exist with a milk allergy as per a  study, which included 28 Italian beef allergic children, among which 26 children were sensitized specifically to Bos d 6 and all of them reacted immediately after milk challenge (16).

Author: Turacoz Healthcare Solutions

Reviewer: Dr. Magnus Borres

Last reviewed: November 2020