Perioperative Considerations for Alpha-Gal Syndrome: A Literature Review and Single-Center Experience in a Highly Endemic Area

Alpha-gal syndrome (AGS) is an acquired allergy characterized as a delayed hypersensitivity reaction to the galactose-alpha-1,3-galactose carbohydrate, which is present on mammalian meat. AGS can cause severe anaphylactic reactions and has been implicated in intraoperative reactions to medications or surgical products that are derived from mammalian meat. This narrative review will describe the current literature on alpha-gal etiology, epidemiology, and perioperative management. Additionally, our institution is present in Suffolk County, New York, US, a highly endemic area, and we share our centers’ recommendations for managing AGS patients from their initial preoperative presentation throughout the perioperative period. We propose a detailed pathway for detection, preparedness, and intraoperative management of AGS patients undergoing elective surgery as well as alternative management suggestions for AGS patients undergoing emergency surgery.