Gelatine allergyT78.1

Gelatin (from Latin gelare = to solidify), also known as gelatine, is of animal origin, a purified peptide mixture obtained by hydrolysis of the collagen contained in bones, connective tissue, skin, cartilage and tendons of pigs and cattle. Hydrolysis breaks down the peptide bonds of collagen. This makes the primarily water-insoluble collagen water-soluble and extractable.

Fish gelatine is produced from the collagen of fish skins. Fish gelatine thus complies with the Jewish and Islamic dietary laws.

Cosmetic: Gelatine is colourless, odourless and tasteless. Gelatine is used in cosmetic formulations. It can absorb up to 27 times its own weight in water and acts as a viscosity regulator (increases or decreases the viscosity of cosmetic products). It also forms a film on skin, hair or nails when applied. Gelatine is declared on cosmetic products as gelatine or as "hydrolyzed gelatine".

Food technology: Gelatine is processed in semi-fat and light products such as semi-fat margarine, semi-fat butter and low-fat cheeses, and also as a gelling agent for the production of jelly babies, wine gums, soft caramels, marshmallows, marshmallow wafers, carrots, liquorice and other light products.a. Furthermore in meat and fish products: brawn, aspic, corned beef, canned ham, so-called dipping masses (sausage coating masses), fish and crabs in jelly. Gelatine is used in various types of food. Gelatine is used in various dairy products. So in: Fruit yoghurt, sour milk drinks, some quark preparations, foam desserts, low-fat spreads.

Pharmaceutical: Gelatine is used in hard and soft capsules of medicines. Furthermore in infusion solutions (plasma expanders) and vaccines.

Anaphylactic reactions to gelatine are mainly described after the administration of plasma expanders and various vaccines. A non-specific mediator release is probably responsible for triggering this reaction. Furthermore, true IgE-mediated reactions have also been described.

Vaccines containing gelatine (increasingly rare) with IgE-mediated systemic reactions have been reported several times. In various studies, children with anaphylactic reactions after measles, mumps or varicella vaccinations have been shown to have an IgE-mediated systemic reaction. Some of these reactions were triggered by the gelatine content of the vaccines.

A special case is the observation of a patient who is allergic to the consumption of jelly babies (made of gelatine) as well as to various infused drugs (various plasma expanders, cetuximab). Specific IgE antibodies were detectable. The detection was carried out by scratch test with native gelatine.

The case of a female patient who, after drinking a multivitamin effervescent tablet dissolved in water, developed generalized urticaria, shortness of breath and angioedema is remarkable. A positive test reaction could be demonstrated by means of prick-to-prick testing with the contents of the effervescent tablet. When testing the individual ingredients, a positive test reaction to the "undeclared porcine gelatine" in the effervescent tablet was detectable (Burgdorff et al 2003).

To what extent antibodies have specificity for "pig" or bovine gelatine" is still unclear. Several allergens with molecular weights between 35,000 and 120,000 kD were detected.

Uyttebroek A et al. 2014) described an anaphylactic reaction to gelatine in a patient with a previously known meat allergy (alpha-Gal syndrome). Galactose-α (1,3) -galactose (alpha-gal) could be detected as allergenic determinant. An analogous observation comes from the working group of RJ Mullins RJ. Typical is the latency of the allergic reaction of several hours (cause: the digestion process of the gelatine-containing product - also in meat - by which alpha-gal is first released, can last up to several hours).

Patients with alpha-Gal syndrome (clinically usually manifests itself as a meat allergy) should avoid gelatine-containing products such as jelly babies, puddings, yoghurt preparations etc. due to the cross-reactivity to gelatine.

Animal heart valves can also contain gelatine. This must be pointed out in the allergy passport.

However, only isolated IgE-mediated anaphylactic reactions have been observed after oral application of gelatine-containing drugs and foodstuffs (edible gelatine). However, an oral allergy syndrome and the delayed occurrence of urticarial exanthema have been described. Possibly, the denaturation of gelatine in the gastrointestinal tract leads to a loss of allergenicity.

In case of causally unexplained anaphylactic reactions to drugs and food, a potential gelatine allergy should also be considered, especially since gelatine is an additive that does not have to be declared.

1. Burgdorff et al (2003) Anaphylactic reaction to multivitamin effervescent tablets in case of gelatine intolerance. Allergology 26: 72-77
2. Raveendran R et al (2017) Gelatin Anaphylaxis During Surgery: A Rare Cause of Perioperative Anaphylaxis. J Allergy Clin Immunol Pract 5: 1466-1467.
3. Uyttebroek A et al (2014) Anaphylaxis to succinylated gelatin in a patient with a meat allergy: galactose-α(1,3)-galactose (α-gal) as antigenic determinant. J Clin Anesth. 26:574-576.
4. Caubet JC et al (2014) Vaccine allergy. Immunol Allergy Clin North Am 34:597-613
5. Caponetto P et al (2013) Gelatin-containing sweets can elicit anaphylaxis in a patient with sensitization to galactose-α-1,3-galactose. J Allergy Clin Immunol Pract 1:302-303.
6. Mullins RJ et al (2012) Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose. J Allergy Clin Immunol 129:1334-1342.
7. Nakayama T et al (2004) Gelatin allergy. Pediatrics. 2004 Jan;113(1 Pt1):170-171
8. Sakaguchi M et al (2000) IgE antibody to fish gelatin (type I collagen) in patients with fish allergy. J Allergy Clin Immunol 106: 579-584.
9. Sakaguchi M et al (1996) Food allergy to gelatin in children with systemic immediate-type reactions, including anaphylaxis, to vaccines. J Allergy Clin Immunol 98:1058-1061.