Alpha-Gal Syndrome Managed With Omalizumab for Perioperative Optimization of Total Hip Arthroplasty

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).