in your own backyard
LONE STAR AND ALPHA GAL THE DUO RESPONSIBLE FOR ANAPHYLAXIS TO RED MEAT by Nina Sutton
L one Star and Alpha Gal – their names suggest that they are a couple of superheroes. Quite the contrary… saliva from the Lone Star Tick may trigger the human immune system to produce antibodies to a carbohydrate called Alpha-Gal (aka a-gal), which is found in red meat. In the world of tick borne illness, they can be considered a modern day Bonnie and Clyde, responsible for anaphylactic reactions in persons ingesting red meat. It may sound like the stuff of tabloids, but this relatively recent health concern is very real and is happening in your own backyard. The Lone Star Tick is not from Texas, and exposure to it causes an al- lergy that is unrelated to Lyme. Imagine that you enjoyed a delicious dinner earlier in the evening. The lamb chops were exceptional, cooked to perfection. Around four hours later, you begin to experience a se- vere anaphylactic reaction, unaware that this reaction is the result of exposure to the Lone Star Tick. The Lone Star Tick A very aggressive tick that bites humans, the adult Lone Star female is dis- tinguished by a white dot or “lone star” on her back. Lone star tick saliva can be irritating; redness and discomfort at a bite site does not necessarily indicate an infection. The nymph and adult females most frequently bite humans and transmit disease. In indigenous areas, tick bites are a frequent occurrence. Primarily found in the southeastern and eastern United States, adults and nymphs are generally active from early spring through midsum- mer. Larvae are active from late summer through early fall. Lone star ticks are also nonspecific feeders. They feed on a wide range of wild and domestic mammals, ground-feeding birds and humans dur- ing all of their life stages. Pets can be “vectors” despite tick prevention methods. Ticks might not bite or infect a pet, but might hitch a ride into a pet owner’s home, eventually finding its way to a human host. Most of the a-gal cases reported in the medical literature came from southeastern states. However, the Lonestar tick has become ubiquitous on the East End of Long Island, and so it serves to follow that cases of a-gal allergy are on the rise, according to Dr. Erin McGintee, an allergy specialist and native of eastern Long Island. “While the East End is a hotspot for a-gal allergy, it is also a hotspot for tourists and visitors from all over the New York Tri-State area.” For this reason, she expects to see an increase in the incidence of a-gal allergy throughout the entire region. “Any patient with a history of possible tick exposure, who is experienc- ing unexplained allergic reactions, should seek out consultation with an experienced allergist.” Few patients seem aware of the risk, and even doc- tors are slow to recognize it. “Why would someone think they’re allergic to meat when they’ve been eating it their whole life?” With the number of tick-borne illnesses in existence, it is not surpris- ing that it is difficult to keep up with so many variations.
Delayed Anaphylactic Reaction Unique to this particular allergy is that the reactions are delayed. Symp- toms don’t appear until several hours after exposure, which can make them difficult to diagnose. According to Dr. McGintee, patients de- velop allergic reactions 3-6 hours after ingestion of mammalian meat, such as beef, pork, or lamb. Poultry, fish, and shellfish do not trigger allergic reactions in these patients. “Patients with a-gal allergy can pres- ent with symptoms ranging from generalized hives, swelling, and itch- ing, to anaphylaxis, which is a multi-system allergic reaction that, in severe cases, can lead to death. Due to the fact that reactions to a-gal occur 3-6 hours after meat ingestion, the classic patient gives a history
LONE STAR TICK
of awakening in the middle of the night with severe itching, redness, and hives over their entire body. Patients with more severe episodes may also describe abdominal cramping, vomiting, diarrhea, wheezing, shortness of breath, or even loss of consciousness.” Reactions do not necessarily occur each time a patient ingests meat. Reactions are more likely to occur when a large quantity of meat is con- sumed. Meats that are higher in fat are more likely to trigger a reaction than leaner cuts. Gelatin, which is usually derived from beef or pork, contains a-gal, and there have been cases of patients experiencing clinical symptoms after gelatin ingestion. Tick-Borne Diseases: What Your Doctor Doesn’t Know The Centers for Disease Control and Prevention has published “Tickborne Illnesses of the United States,” the 2014 Second Edition Reference Manual for Health Care Providers. However, there is no mention of the meat aller-
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