By Phil Schafer, Grace Cottage Emergency Department Physician Assistant

 Have you developed a new allergy, or had allergy symptoms such as hives, rash, and itching for no apparent reason? Have you had allergic reactions and abdominal cramping after eating red meat? If so, you may have developed Alpha-gal syndrome.

Alpha-gal syndrome (AGS) is an allergy to the sugar molecule galactose-alpha-1,3-galactose (alpha-gal). This allergy is caused by a tick bite, which causes the person to become allergic to this sugar, which is most commonly found in red meats.

Alpha-gal Syndrome is most often caused by a bite from the Lone Star Tick, but it can be transmitted by several species of ticks, including the Black Legged tick (Deer tick), which is the most prevalent species of tick in Vermont. The Deer tick also transmits Lyme and other diseases throughout Vermont.

AGS usually develops a few weeks to 3 months after the tick bite. While many people who receive bites from the Lone Star tick become sensitized to the alpha-gal glucose, research suggests that going on to develop Alpha-gal syndrome is rare.

The most common signs of an AGS reaction include:

• Hives or rash that appears after eating red meat or animal products.
• Gastrointestinal symptoms like nausea, vomiting, or diarrhea.
• Abdominal pain or cramping shortly after consumption.
• Swelling of the lips, face, or throat.
• Difficulty breathing or wheezing in severe cases.
• Anaphylaxis, a life-threatening reaction that includes the above signs as well as low blood pressure, and sometimes swelling of the airways, which can lead to death.

These reactions typically occur 2-6 hours after ingestion of the food. This makes diagnosis of AGS difficult because people and clinicians often don’t associate the reaction with something ingested several hours earlier.

While red meats including pork are responsible for the majority of reactions, other products from mammals can also trigger the allergy, including the following;

• Red meat (beef, lamb, pork).
• Gelatin (found in some desserts, candies, and capsules).
• Dairy products (milk, cheese, yogurt).
• Processed meats (bacon, sausage, hot dogs).
• Certain organ meats (liver, kidney).
• Some shellfish (like shrimp and crab).
• Certain seaweeds also contain the alpha-gal sugar.

In addition to the above foods, other non-food products can trigger AGS. These include:

• Certain medications: Some drugs and vaccines contain gelatin or other mammalian-derived ingredients.
• Personal care products: Lotions and creams that use animal-derived ingredients.
• Leather goods: Items made from cowhide or other animal skins.
• Wool products: Items containing lanolin, which is derived from sheep.
• Insect repellents: Some may contain ingredients derived from animal sources.

Over 90,000 cases have been reported in the United States so far, with only a small percentage of these in New England. Most cases are in Missouri, Kansas, Arkansas, Kentucky, Oklahoma, Mississippi, and Alabama—states where the Lone Star Tick is mostly found. The total number of cases is undoubtedly higher due to the difficulty of making this diagnosis.

Determining if you have AGS involves blood tests that measure your antibody level to this sugar molecule, along with a correlation of symptoms to the syndrome.

Treatment: The most important treatment of any allergy is avoiding the thing you are allergic to. If you suspect you have AGS, you should avoid things with the Alpha-gal sugar, which can be difficult due to the wide variety of things that contain it. AGS can decrease in severity over time if the allergen is avoided. It will often worsen over time if a person continues to ingest the sugar and they have repeated reactions. AGS can also worsen with subsequent tick bites.

Mild reactions involving an itchy rash can be treated with antihistamines such as Diphenhydramine (Benadryl) or Cetirizine (Zyrtec).  More severe reactions such as throat or tongue swelling, vomiting, dizziness, or difficulty breathing should be treated in the Emergency Department.

If you believe you have developed Alpha-gal Syndrome, you should avoid products that contain this allergen and see your doctor or health care practitioner as soon as you can.