Pancreatic Enzymes

A guide to pancreatic enzymes & alpha-gal syndrome (AGS)

Pancreatic Enzymes

Pancreatic enzymes: The enzymes used for replacement of pancreatic function (e.g., pancrealipase) are purified from the pancreas of large mammals. These proteins, and other mammalian-derived enzymes, have been shown to elicit positive skin tests yet have been administered successfully in several patients. Alternatively, we have patients who were not diagnosed with AGS (due to their dietary choices) until beginning pancreatic enzymes, and this mammalian exposure produced symptoms (predominantly pruritus).18

Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol. 2020;16(7):667-677.

Enzyme replacement: The pancreatic enzymes which are used for replacement in some cases of cystic fibrosis or other causes of pancreatic failure are purified from the pancreas of large mammals. These proteins, and also other mammalian-derived enzymes, have been shown to express α-Gal and have functional activity in basophil activation tests.17

Platts-Mills TAE, Li RC, Keshavarz B, Smith AR, Wilson JM. Diagnosis and Management of Patients with the α-Gal Syndrome. J Allergy Clin Immunol Pract. 2020;8(1):15-23.e1.

Pancreatic enzymes are derived from mammals and contain alpha-gal.18,95, 96, 97 However, some people with AGS tolerate these products or a subset of them.17,18,95, 96, 97

Pancreatic enzymes that contain mammal-derived ingredients include, but are not limited to (,36,103):17,18

  • Viokase
  • Pertzye
  • Zenpep (Allergan)
  • Creon

Pancreatin (Now Foods, Bloomingdale, IL) is an over-the-counter dietary aid (103) that also contains mammal-derived ingredients.

Select publications on pancreatic enzymes and AGS: