Disclaimer- The posts in this series are intended to improve awareness of this important and potentially deadly disease. I am not an Allergist or Immunologist and I am not offering any medical advice. Please consult with your own physician or health care provider for that. An educated patient and their family are the best advocates for their health care.

This post consists of medications and other medical products that were reported in peer-reviewed publications to either contain or not contain active or inactive ingredients from mammalian sources that could cause a reaction in patients with alpha-gal syndrome (at the time the articles were published). Providers and patients need to verify that status prior to their use in the present, especially with respect to the inactive ingredients because they may switch from plant to mammalian sources or vice versa over time. This is not a complete list.

Dental- Alpha-gal Syndrome: Potential for a Hypersensitivity Reaction After the Use of Dental Products Brooks JK et al Journal of the American Dental Association 156: 538-546, 2025.

Infectious Diseases- vaccines, A Review of Alpha-Gal Syndrome for the Infectious Disease Practitioner Shishido AA and Wormser GP Open Forum Infectious Disease 2025 link

Ophthalmology- Alpha-gal syndrome in Ophthalmology and Medicine Seddon I et al International Ophthalmology Clinics 60:61-75, 2020.

Treatment for macular degeneration

In this article, the author point out several issues related to-

Sterile Preparation– “Glycerin is noteworthy in the surgical field for its role as an inactive ingredient of povidone-iodine (Betadine, Alcon), an essential component of antiseptic surgical preparation. With the capacity to be either plant or animal-derived, a formulation with glycerin could trigger an alpha-gal allergy. To prevent potential complications, surgical centers in the southeastern United States should be prepared to identify and use verified Betadine mixtures in alpha-gal syndrome patients.”

Hyaluronidase– “Hyaluronidase is an enzyme used as an additive to local ocular anesthetic blocks to accelerate the onset of anesthesia and reduce ocular movements during surgery. Traditionally a mammalian-derived compound, there is potential for alpha-gal contamination and thus should be used with caution in alpha-gal syndrome patients. Examples of unsafe ophthalmic hyaluronidase blocks include bovine-derived Vitrase (Siegfried Irvine), bovine-derived Amphadase (Amphastar Pharmaceuticals), and Hylenex (Halozyme), a human recombinant that is derived from Chinese hamster ovary cells.” 

Topical Glycerin, Collagen Shields, and Contact Lenses– “There are no reports of topical corneal exposure to glycerin or glycerin-containing compounds inducing an alpha-gal anaphylactic reaction. Similarly, there is no evidence for or against the use of corneal collagen shields or contact lenses in this patient population. Given the ubiquity of contact lenses, one would expect that if there was an association with alpha-gal allergy that it would have been already reported; that being said, we would recommend making a medical judgment of the necessity of any of the above by weighing benefits of therapy versus theoretical risks.”

Ophthalmic Viscosurgical Devices (OVD)– “These agents are used to create and maintain space in the anterior chamber of the eye and protect the corneal endothelium during cataract surgeries and implantation of an intraocular lens. Many of these agents contain hyaluronidase in their solution and must be vetted for the origin of the hyaluronidase. Vegan OVDs like sodium hyaluronate (Provisc, Alcon) that are obtained through bacterial fermentation can be considered safe for alpha-gal syndrome patients. However, animal-derived OVDs may also be sate depending on the source. As mentioned previously, alpha-gal is found in nonprimate mammals so using OVDs produced from nonmammalian sources should theoretically be safe to use in alpha-gal syndrome patients. Examples of these OVDs include chondroitin sulfate (Viscoat, Alcon) which is derived from shark fin cartilage, and sodium hyaluronate (Healon, Abbot) which is avian-derived.”

Suture Materials– “Certain suture materials should also be avoided. Catgut sutures, which are manufactured from the small intestines of alpha-gal-containing mammals, have been linked to reports of allergic reactions and wound breakdown. Synthetic sutures such as polyglactin 910 (Vicryl, Ethicon Inc.) could also theoretically induce an allergic response due to its animal-derived lactic acid coat; however, this requires further investigation. Although studies are still inconclusive for surgical products such as biologic mesh and other topical hemostatic agents, safety of these therapeutics should be carefully discussed before use.”

Anesthesia- What Does a Red Meat Allergy Have to do with Anesthesia? Perioperative Management of the Alpha-Gal Syndrome Dunkman WJ et al Anesthesia and Analgesia 129: 1242-1248, 2019. This has an old publication date- 2019.

Anesthesia- Perioperative Considerations in Alpha-Gal Syndrome: A Review Leder J et al Cereus 16: e53208, 2024 link

Neurosurgery- Neurosurgical Management of Patients with Alpha-Gal Syndrome Carlstrom LP et al Journal of Neurological Surgery Reports 85: e96-e100, 2024 link

Next- Alpha-Gal Syndrome in the News