The full dictionary behind the tool, with the same notes it shows in results. Every entry is sourced from the CDC, the peer-reviewed AGS literature, or FDA records.
Gelatin
Made from collagen in cattle and pig hides, bones, and connective tissue. Gelatin contains alpha-gal. It is the shell of most softgel and many hard capsules, and a stabilizer in several vaccines. Not every AGS patient reacts to oral gelatin, but it is the most common hidden exposure in medications. Vegetable-capsule (HPMC) versions of many drugs exist. (Marine collagen, from fish, does not carry alpha-gal; pharmaceutical gelatin is essentially always bovine or porcine.)
Heparin (unfractionated)
Derived from porcine intestinal mucosa and contains alpha-gal. The most important hidden alpha-gal exposure in hospital medicine: it appears in IV flushes, surgery, dialysis, and cardiac procedures, often without being named to the patient. Synthetic or non-porcine alternatives (argatroban, bivalirudin, fondaparinux) exist; the choice belongs to your care team.
Low-molecular-weight heparins
Enoxaparin, dalteparin, and tinzaparin are made from porcine intestinal mucosa, like unfractionated heparin, and contain alpha-gal. Fondaparinux is a fully synthetic alternative in the same drug family.
Pancreatic enzymes
Pancreatic enzyme replacement products are extracted from porcine pancreas and contain alpha-gal. There is currently no non-porcine enzyme replacement with equivalent evidence, so AGS patients who need these face a real trade-off to work through with their gastroenterologist and allergist together.
Desiccated thyroid
Natural desiccated thyroid products are made from porcine thyroid glands, and their labels often list the active ingredients only as levothyroxine and liothyronine or as thyroid, unspecified. Synthetic levothyroxine and liothyronine are non-animal alternatives, though their capsule or tablet excipients still deserve a check.
Hyaluronidase from animal testes
Hyaluronidase is an enzyme injected to help other injected drugs and fluids spread and absorb. According to their FDA labels, Amphadase and Hydase are purified from cow (bovine) testes and Vitrase from sheep (ovine) testes. Hylenex, and the hyaluronidase in under-the-skin versions of drugs such as Darzalex Faspro, is human hyaluronidase made in genetically engineered hamster cells rather than purified from animal testes. Because hyaluronidase is often mixed with another medicine at the point of care, ask which product will be used.
Conjugated estrogens (equine)
Premarin (conjugated estrogens, USP) is derived from pregnant mares' urine, and horses are non-primate mammals, so it is an alpha-gal concern. Important distinction: SYNTHETIC conjugated estrogens products (Cenestin, Enjuvia) are plant-derived and are different products; if your label says 'synthetic conjugated estrogens,' this flag does not apply to the estrogen itself, though the tablet's excipients still deserve a look.
Ingredient labeled with a mammalian source
This label says an ingredient comes from a non-primate mammal, either in its ingredient data (porcine, bovine, ovine, equine or caprine, or the Latin names for pig, cow, sheep, horse or goat) or in its description (for example, derived from porcine intestinal tissue, or produced in the milk of transgenic rabbits or goats). Whatever the ingredient is, a mammalian source makes it an alpha-gal question worth raising with your pharmacist and allergist.
Lung surfactants (neonatal)
Beractant and calfactant are bovine-derived; poractant alfa is porcine-derived. Relevant for NICU care of infants of mothers managing AGS decisions, and for documentation completeness.
Cetuximab
The drug that revealed hidden alpha-gal. Produced in mouse Sp2/0 cells, cetuximab carries alpha-gal residues, and first-dose anaphylaxis in patients with pre-existing alpha-gal IgE is documented in the New England Journal of Medicine. Oncologists in high-AGS regions often screen before prescribing.
Anti-thymocyte globulin (rabbit)
Produced in rabbits, a non-primate mammal. Used in transplant medicine; flag AGS to the transplant team so premedication or alternatives can be planned.
Antivenoms (ovine and equine)
CroFab is produced in sheep and Anavip in horses; both are mammalian-derived. In a true envenomation the antivenom is usually still given, with the team prepared to manage a reaction. The point of flagging it is informed, prepared use, not refusal.
Magnesium stearate
The most common tablet lubricant in the pharmacy. It can be made from animal tallow or from vegetable sources, and the label does not say which. Excipient suppliers report that modern pharmaceutical magnesium stearate is usually plant-derived, but that is an industry norm rather than a guarantee, and it varies by manufacturer and lot.
Stearic acid
Stearic acid and its derivatives can come from animal tallow or plant oils; labels do not disclose the source.
Glycerin
Found in liquid medications, suppositories, and softgels. Can be produced from animal fats, plant oils, or synthetically; the label does not say which. Much US pharmaceutical glycerin is plant-based or synthetic, but it varies by product.
Bile acid products
Some bile acid products are animal-derived and some are synthetic, and it differs by specific product. Ursodiol is synthetic and is not an alpha-gal concern, but cholic acid and chenodeoxycholic acid products should be verified individually.
Lactose
Lactose is milk-derived, and milk comes from mammals, but lactose itself is a sugar that carries little to no alpha-gal protein. Most people with AGS tolerate lactose-containing medications without issue. A subset of highly sensitive patients who also react to dairy foods may choose to avoid it; if dairy bothers you, mention lactose-containing pills to your allergist.
Lanolin
Lanolin is the grease of sheep's wool, so it is mammalian in origin, and it appears in ointments, creams, and some suppositories. Documented alpha-gal reactions to topical lanolin are rare, and most AGS patients use lanolin-containing products without trouble. Highly sensitive patients who react to topical products should raise lanolin with their allergist.
Cholecalciferol (vitamin D3)
Most vitamin D3 is made from lanolin, the grease of sheep's wool. Documented alpha-gal reactions to lanolin-derived D3 are rare, and most AGS patients take it without trouble. Lichen-derived (vegan) D3 exists for those who prefer zero mammalian sourcing. The capsule around it (often gelatin) is usually the bigger question than the D3 itself.
Infliximab and Sp2/0-produced biologics
Biologics produced in mouse cell lines (Sp2/0, NS0) can carry more alpha-gal than those made in CHO cells, and there are case reports of reactions to infliximab and abciximab in AGS patients. This is a discuss-with-your-prescriber flag, not an avoid flag: many AGS patients receive these drugs uneventfully, biosimilars may use different cell lines, and the decision depends on your sensitivity and alternatives.