Heparin-Induced Anaphylaxis With Cardiac Arrest in a Patient With Alpha-Gal Syndrome: A Case Report

Alpha-gal syndrome (AGS) is a delayed allergic reaction to red meat linked to bites of various species of ticks around the world, with the common culprits in North America identified as the Ixodes and Lone Star ticks. Most cases are asymptomatic, but some may result in mild allergic reactions or could progress to severe anaphylaxis. This report presents the case of a 64-year-old male with a history of coronary artery disease who presented with chest pain. During his hospitalization, he experienced two episodes of ventricular fibrillation (VF) with successful resuscitation. Following discharge, he continued to experience episodic palpitations, abdominal pain, nausea, vomiting, and diarrhea. An immunologist later diagnosed him with AGS and introduced the possible association of the VF events with a severe hyperacute reaction to intravenous heparin exposure, either in conjunction with or independent of the STEMI the patient was experiencing. His chronic longitudinal symptoms resolved entirely with dietary restrictions, specifically avoiding beef and porcine meat derivative products. This report highlights the importance of considering AGS in patients with unexplained allergic or periprocedural reactions following exposure to mammalian-derived products such as heparin.