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Why Is Alpha-Gal Allergy So Misunderstood and Misdiagnosed?

Imagine experiencing a life-threatening allergic reaction after eating a burger or barbecue. A marshmallow can also trigger an attack of alpha-gal allergy. Many doctors don't recognize it.

According to the CDC, “illnesses from mosquito, tick, and flea bites have tripled in the U.S.” in recent years (May 1, 2018).  Ticks are on the move. These disease vectors are found from California to Maine. They transmit Lyme disease, Rocky Mountain Spotted Fever, anaplasmosis, ehrlichiosis, Powassan virus and several other nasty conditions. One mysterious and potentially deadly allergic reaction often goes unrecognized. Alpha-gal allergy results from a lone star tick bite. No viruses or bacteria are involved. Many physicians are not aware of this potentially deadly disorder.

Alpha-Gal Allergy Is NOT New!

Doctors are busy. They put in long hours seeing more and more patients. By the time health professionals get home, they are usually exhausted. Spending additional hours poring through medical journals can be overwhelming. That’s why it can take longer than you would imagine for doctors to learn about a new health threat.

For example, health care providers are not yet thoroughly informed about the sensitivity to a mammalian sugar called alpha-gal. That’s short for galactose-alpha-1, 3-galactose. It is a carbohydrate found in the meat of mammals such as cows, pigs, sheep, goats, bison and deer.

Alpha-gal allergy occurs following a bite from a lone star tick (Amblyomma americanum). Saliva from the tick triggers an immune reaction that can cause life-threatening allergic symptoms. Experts have known about this condition for at least a decade, although primary care providers and emergency physicians did not pick up on it immediately. We have been writing about it for many years and have interviewed Dr. Thomas Platts-Mills, who started researching alpha-gal allergy over a decade ago (Journal of Allergy and Clinical Immunology, March, 2015).

Symptoms of Alpha-Gal Allergy:

Most allergic reactions occur pretty quickly after exposure to the allergen. If you are highly sensitive to bee stings, the signs of an anaphylactic reaction can occur within minutes. People who are allergic to peanuts can start experiencing hives or breathing difficulties shortly after exposure to food containing peanuts.

Symptoms of alpha-gal allergy can take hours to show up. Someone could have a burger or steak for dinner around 8:00 pm and not begin to feel bad until 1 or 2 in the morning (Current Allergy and Asthma Reports, Feb. 2013).

That’s why many health professionals have a hard time identifying alpha-gal allergy. Some people show up in the emergency department with nausea, severe stomach cramps and diarrhea at 2 or 3 am. The nurse who takes the initial report could easily think the problem is digestive in nature. By the time the emergency physician shows up she is already primed to consider food poisoning, not allergy.

Symptoms of Alpha-Gal Allergy:

  • Skin reactions (rash, hives, itching especially on palms or soles)
  • Digestive upset (nausea, diarrhea, heartburn, abdominal pain)
  • Respiratory tract problems (runny nose, sneezing, breathing difficulties, wheezing)
  • Headache
  • Low blood pressure, anaphylaxis, collapse

Several readers recount their own experiences with alpha-gal allergy below.

Ground Beef Reaction Led to Emergency Treatment:

Q. Several years ago, I had a tick bite that resulted in a very pronounced rash. A week or so later, I had ground beef for supper and landed in the ER with anaphylaxis at 3 in the morning. They told me to consult an allergist, who was very familiar with alpha-gal syndrome. He immediately made a preliminary diagnosis that was confirmed by a blood test.

The interesting thing is that this allergic reaction can go into remission. I went for three years with a very strict no-red-meat diet. We tested my blood titer annually, and it fell each year. I still eat very little red meat on a weekly basis, but now I sometimes eat a hamburger without any symptoms.

To repeat, I was under the care of an allergist. I wouldn’t recommend anyone just winging it after a few years. That could result in disaster.

I have been extremely careful to avoid tick bites ever since. Fortunately, insect repellent that repels ticks keeps chiggers away too.

Staying Away from Meat Makes a Difference:

A. Thank you for sharing your experience with alpha-gal allergy. This potentially severe allergic reaction to eating mammalian meat (beef, lamb, pork, but not chicken or fish) is triggered by the bite of a lone star tick (Amblyomma americanum). People’s reactions to this problem vary widely. Not everyone gets over it as you apparently have.

It is prudent to avoid tick bites. Ticks can transmit a wide range of pathogens responsible for severe diseases.

Wear long pants tucked into your socks and, if possible, gaiters treated with permethrin. You are correct that this strategy repels chiggers as well as many varieties of ticks.

Removing clothing and doing a tick check as soon as you get into the house from walking in woods or fields is also essential. A shower is a good opportunity to check all the secret spots ticks love and also helps wash away chiggers.

How Long Do These Problems Last?

Q. Does alpha-gal allergy ever go away? Ten years ago, I was bitten by a lone star tick. Since then, I’ve had two anaphylactic reactions to eating meat. Will I ever be able to enjoy bacon again?

A. Alpha-gal allergy is a reaction to eating mammalian meat (beef, pork, lamb or goat, but not chicken or fish) triggered by a bite from the lone star tick. Reactions vary widely, from the life-threatening allergic reaction that you experienced to unpleasant stomach cramps and diarrhea. Certain people don’t have any trouble with dairy products like milk or cheese, while other are sensitive to these or even to the smoke rising from a barbecue grill.

The length of time people may suffer with their symptoms also differs from one to another, with some recovering within a few years and others needing to avoid mammalian products for an indefinite time.

Surprising Health Hazards for People with Alpha-Gal Allergy:

Q. I have tested positive for alpha gal syndrome. I recently developed elevated blood pressure and I have had an allergic reaction to every BP medication my doctor has prescribed. One drug gave me a red rash over my entire body.

The physician who diagnosed my alpha-gal allergy, Dr. Commins, suggested having a compounding pharmacy make my BP meds. He thinks that way I can avoid the fillers that may be causing the hives and swelling. People should know that alpha gal may trigger a reaction to chemicals in many medications.

A. Thank you for the warning. You are in good hands for alpha gal syndrome, since Dr. Scott Commins of the University of North Carolina is one of the world’s experts on this condition. He helped Dr. Platts-Mills with the discovery of this potentially life-threatening reaction to mammalian meat (beef, pork, lamb, rabbit, goat, etc.).

The reaction begins with the bite of a lone star tick. After that, exposure to red meat can cause a delayed allergic reaction that could range from hives or digestive distress to trouble breathing. The diagnosis can be confirmed with a blood test.

Prevention is the only available treatment: avoid eating meat. Some people must also avoid milk, cheese and yogurt. Highly sensitive individuals may be vulnerable to smoke from a barbecue. Even products containing carageenan could trigger a reaction.

Your note on medications is important. Few people react to pills, but medicines or vaccines that contain gelatin, glycerin, magnesium stearate or bovine extract can cause trouble for highly sensitive individuals. Heparin, heart valves from pigs or cows and monoclonal antibodies may also trigger an allergic response. You may want to listen to our recent interview with Dr. Commins and his colleague, gastroenterologist Sarah McGill. It is Show 1344: Managing Meat Allergy and Other Tick-Borne Diseases.

A Doctor Shares His Experience and Outrage:

We recently received a letter from a physician in North Carolina.

“Seven months ago I was bitten by a Lone Star tick. I now have the alpha-gal disorder.

“I’ve had 25 significant allergic reactions since then while I’ve learned to cope by avoiding things that cause attacks. I had serious problems for months before the diagnosis was made. Because of a variety of symptoms, I consulted family physicians, an internist, an ear, nose and throat specialist, a health department physician and a neurologist before my wife made the diagnosis while listening to a program about alpha-gal on The Peoples Pharmacy radio show.

“My symptoms were just as described on your radio program, and I had had a tick bite. I went to see an allergist and he told me I probably didn’t have alpha-gal because my symptoms were not typical, despite the fact that my blood test was 15 times higher than normal.

“When I spoke with each of the other physicians and told them what I had, they admitted they had never heard of the problem. What is wrong with this picture? When a life-threatening problem exists, it seems there is little professional education or knowledge of how to prevent, diagnose or treat it.

“During a typical attack my face, head, tongue and lips swell. The lips have gone to the point of bursting (requiring ice packs for six hours). I also suffer from cloudy thinking, visual disturbances, shortness of breath and increased phlegm, abdominal swelling, pain and eventually diarrhea.

“I take a course of steroids for the worst episodes and I take a daily antihistamine. I keep an EpiPen handy but have only come close to using it twice.

“I now go to a specialist who understands my condition. I have learned what causes the episodes. In my case that includes, in addition to all mammalian meats, at least these following ingredients: stearic acid (as in Advil and other pills), mono-, di- and triglycerides, glycerin, whey, milk, cheese, butter, gelatin and vitamin D3 (cholecalciferol) in some orange juice. Natural flavors made from meat products are found in lots of foods. I have my medicine made in vegetable capsules to avoid gelatin.

“I have a set of foods that I can eat safely and I stick with them carefully. A simple mistake will make me sick for a week. I’ve found great fish and fowl. I eat a lot of eggs. You can lead a really good life despite alpha-gal with education, but a casual approach to food won’t work.”

What to Learn from This Story:

People who live in areas where the lone star tick is common must be aware of this potentially life-threatening reaction. In addition to pork, beef, lamb and venison, alpha-gal shows up in dairy products like ice cream and in gelatin found in Jell-O, marshmallows, gummy vitamins and many capsules. The only protection is avoidance.

You can listen for free to our most recent interview with Dr. Thomas Platts-Mills at this link:

Show 1003: From Lyme to Alpha-Gal: The Latest on Tick-Borne Diseases

If you experience symptoms of alpha-gal allergy, head for the emergency department pronto! And if the emergency physicians there are unfamiliar with this allergic condition, tell them to log onto our website and search for alpha-gal.

This article provides access to journal articles that will help your doctor better understand this still mysterious illness. Our earliest interview with Dr. Platts-Mills was in 2013. You can listen to our interview with Dr. Platts-Mills at this link (Show 830: Alpha-Gal Allergy). The mp3 download is free.

You might also want to listen to more recent interviews. Show 1167: Will a Tick Bite Make You Allergic to Meat? is an interview with Scott Commins, MD, one of Dr. Platts-Mills’ colleagues. Show 1344: Managing Meat Allergy and Other Tick-Borne Diseases focuses more specifically on the gastrointestinal symptoms. You can also listen to our free podcast “Show 1380: Avoiding Lyme and Other Tick-Borne Diseases” for more information.

Share your own story about tick-borne illness below in the comment section.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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