Chicken
Summary
Poultry meat is popular worldwide as a protein source with high nutritive value. The United States (US) are the largest poultry meat producer in the world. Gallus gallus domesticus (red jungle fowl) is native to Asia and domesticated worldwide. Poultry meat allergy is rare, with worldwide prevalence ranging from 0-13%. Main route of exposure is reported to be oral (ingestion of meat) and secondary route of exposure includes inhalation (vapor during cooking) or skin contact. The allergy is triggered within 30 mins of exposure, and allergic reaction includes oral symptoms and moderate systemic reactions in skin and gastrointestinal tract including urticaria, angioedema, nausea, emesis, diarrhea, and asthma. Cardiovascular symptoms in case of severe anaphylaxis is rare.
Allergen identified in poultry meat are Gal d 5 (Serum albumin), Gal d 7 (Myosin light chain kinase), Gal d 8 (α-parvalbumin), Gal d 9 (β-enolase), and Gal d 10. Among these, Gal d 5, 7 and 8 are the major allergens responsible for allergic reactions and cross reactivity in sensitized individuals. Chicken and turkey meat are reported to be highly cross reactive and responsible for majority of allergic reactions. Diagnosis of poultry meat allergy can be done with total IgE assay or Basophil Activation Test (to identify specific allergen). An allergic patient should avoid the exposure to the poultry meat in order to prevent the trigger of allergic reaction.
Epidemiology
Worldwide distribution
Poultry meat allergy is regarded as a rare disease. A study by Inam et al. (2016) included 689 adult allergic patients from Rawalpindi and Islamabad in Pakistan, and the results estimated a 7% prevalence of chicken meat allergy among the given population. The result was similar to the previously reported worldwide prevalence of chicken allergy of 0-13%.
Risk factors
Poultry allergy is reported to be triggered by skin contact, or inhalation of vapors during cooking poultry meat.
Route Of Exposure
Main
The main route of exposure to chicken meat allergen is ingestion and the heat resistant meat allergen enters the intestinal mucosa.
Secondary
Vapors inhaled and skin contact during cooking poultry meat.
Clinical Relevance
Other diseases
Poultry meat allergy can be categorized as primary (genuine) food allergy and as secondary food allergy occurring due to cross-reactivity. The reaction to primary (genuine) poultry meat allergy usually starts within 30 minutes and this occurs due to the sensitization of heat-resistant meat allergen in the intestinal mucosa. Mostly the adolescents and young adults show this type of allergy. Primary poultry allergy symptoms are:
In a case study of a 54-year-old patient with severe allergic reactions to poultry products within few minutes of chicken or turkey meat or chicken broth ingestion, the reported allergic reactions included swelling of the tongue, oral mucosa, vomiting and hypotension. However, the patient tolerated chicken eggs. Another case study reported a 20-year-old man who had experienced oropharyngeal and palmar itching, facial hives, lip swelling, dysphagia, dyspnea, and heartburn 15 minutes after eating chicken. The individual tolerated turkey and did not have any other poultry meats or meats including veal, pork, and rabbit. Also, he tolerated eggs and reported no contact with birds.
Other topics
Primary and secondary poultry meat allergies
Diagnostics
In-vitro diagnostic tests for IgE-mediated allergic disease are:
Prevention And Therapy
Prevention strategies
Avoidance
To avoid food allergy the basic step is to avoid food ingredients that cause allergic reactions. Always read the composition of the products given on the labels.
Cross-Reactivity
Gal d 5, is the major allergen and cross-reactivity of chicken meat with other avian meats and egg yolk is due to this allergen. A study by Kuehn et al. (2016) evaluated the importance of clinical cross-reactivity among fish and chicken meat in patients (n = 29) allergic to fish and chicken meat or only to chicken meat (n = 7). The study detected cross reactivity among fish and chicken meat. Patients allergic to fish and chicken meat may develop a food allergy to chicken meat or fish, respectively. Hence, known as “fish–chicken syndrome” and parvalbumins, enolases, and aldolases are identified as major cross-reactive allergens. One previous case study reported about cross reactivity of chicken Gal d 8 (α-parvalbumin) with similar homologs from pig, horse and cattle. Cross reactivity of various avian serum albumin and intake of raw or soft-boiled egg yolk triggers oral and GI allergic reactions along with mild to moderate systemic reactions. Also, poultry meat allergy has close relationship with fish and shellfish allergy because these foods contain cross-reactive homologous allergens. Chicken and turkey meat are highly cross-reactive. Gal d 7, a heat-resistant major allergen in chicken meat shows intense cross reactivity with homologous proteins from turkey, goose, and duck.
References
- Al-Nasser A, Al-Khalaifa H, Al-Saffar A, Khalil F, Albahouh M, Ragheb G, et al. Overview of chicken taxonomy and domestication. World's Poultry Science Journal. 2019;63(2):285-300.
- Klug C, Hemmer W, Roman-Carrasco P, Focke-Tejkl M, Quirce S, Boyano-Martinez T, et al. Gal d 7-a major allergen in primary chicken meat allergy. J Allergy Clin Immunol. 2020;146(1):169-79 e5.
- Inam M, Shafique RH, Roohi N, Irfan M, Abbas S, Ismail M. Prevalence of sensitization to food allergens and challenge proven food allergy in patients visiting allergy centers in Rawalpindi and Islamabad, Pakistan. Springerplus. 2016;5(1):1330.
- Hemmer W, Klug C, Swoboda I. Update on the bird-egg syndrome and genuine poultry meat allergy. Allergo J Int. 2016;25:68-75.
- Kuehn A, Lehners C, Hilger C, Hentges F. Food allergy to chicken meat with IgE reactivity to muscle alpha-parvalbumin. Allergy. 2009;64(10):1557-8.
- González-Mancebo E, Pastor C, González-de-Olano D, Gandolfo-Cano M, Melendez A, Cuesta J, et al. Identification of allergens in chicken meat allergy. J Investig Allergol Clin Immunol. 2011;21(4):326-7.
- Zukiewicz-Sobczak WA, Wroblewska P, Adamczuk P, Kopczynski P. Causes, symptoms and prevention of food allergy. Postepy Dermatol Alergol. 2013;30(2):113-6.
- Wilson JM, Platts-Mills TAE. Meat allergy and allergens. Mol Immunol. 2018;100:107-12.
- Kuehn A, Codreanu-Morel F, Lehners-Weber C, Doyen V, Gomez-Andre SA, Bienvenu F, et al. Cross-reactivity to fish and chicken meat - a new clinical syndrome. Allergy. 2016;71(12):1772-81.