For the first time, a death has been linked to the alpha-gal meat allergy that is spread by ticks, primarily the lone star tick.
According to researchers at the University of Virginia School of Medicine, in the summer of 2024 a healthy 47-year-old man from New Jersey died abruptly four hours after consuming beef.
Alpha-gal is a sugar molecule found in most mammals, though not in humans. An allergic reaction, alpha-gal syndrome, can develop after a person is bitten by a tick, which transmits the alpha-gal molecule into their bloodstream. This can cause an allergy to red meat, resulting in a delayed reaction that can include hives, swelling, nausea, and in severe cases, anaphylaxis.
“We have a lot of cases here. Fortunately, we haven’t had a death,” said George Dempsey of East Hampton Family Medicine. “There only being one, with all these cases around the country, is actually somewhat reassuring.”
In the case of the New Jersey man, the University of Virginia School of Medicine researchers said that two weeks before his death, he had been camping with his family, and four hours after a 10 p.m. steak dinner he awoke with severe abdominal pain, diarrhea, and vomiting. He recovered by the morning, but told his son that he had thought he was going to die.
Unaware that he had contracted a meat allergy, according to UVA Health, two weeks later he ate a hamburger, started feeling ill at 7 p.m., and was found collapsed at 7:37 p.m.
The man’s wife asked a doctor to review the autopsy report, and the doctor contacted UVA Health’s Thomas Platts-Mills, who had discovered the alpha-gal allergy. Dr. Platts-Mills found that the man had been sensitized to alpha-gal, and that a blood sample indicated that he had had an extreme reaction such as is seen in fatal anaphylaxis, an allergic reaction that can arise suddenly.
“The clinical presentation of the patient in the case report was actually not unusual, among severe cases,” said Erin McGintee of ENT and Allergy Associates in Southampton. “I’ve seen similar reactions. It was a somewhat typical presentation, just very severe.” As with any allergy that can cause anaphylaxis, “it was only a matter of time” until a fatality occurred, Dr. McGintee said. But “only a very small minority have serious reactions,” she said.
“The lone star tick has really become the dominant tick in town,” said Gerald Simons, who has a private practice in Southampton and is a physician assistant teaching at Stony Brook Southampton Hospital. “At least in my practice in Southampton, I’m probably seeing up to 10 lone star tick bites for every deer tick bite. But the thing people need to remember is the transmission time of alpha-gal can be less than an hour, whereas for Lyme, the tick could stay on for a day, it could take that long to transmit. People who have gotten a lone star tick bite would need to remove it very, very quickly. I tell everybody to be very concerned if you have a lone star tick bite. That can give you alpha-gal.”
The South Fork is considered high risk for ticks and tick-borne diseases, and ticks can be active through the year if temperatures are above freezing. Experts here urged the public this week to educate themselves as to the risk of severe allergic reaction after consuming red meat, but also said that the alpha-gal allergy has not become more severe, nor does the fatality mean that everyone should be tested for the allergy.
The man who died “was living in an area where there was not a lot of knowledge about this,” Dr. McGintee said. “With his initial reaction, two weeks before his fatal reaction, he’d eaten a steak and had very, very severe abdominal symptoms, but since he didn’t have hives he didn’t see it as an allergic reaction.”
“Ninety percent will have skin findings, meaning 10 percent don’t,” she continued. “It’s important to know that this is a thing, so if someone eats meat and experiences severe [gastrointestinal] symptoms hours later, it could be an allergic reaction and something they should see an allergist and be evaluated for.”
Dr. Dempsey said that many of his patients with allergies are given an epinephrine auto-injector, commonly known by the brand name EpiPen, which is used for emergency treatment of anaphylaxis. “I always recommend everybody have Benadryl, in general,” he added. “Regular, non-coated aspirin and Benadryl, in general, in case someone is having a heart attack, stroke, or allergic reaction. It does work for this allergy unless it’s really severe, which is why we give an EpiPen to our patients who have it. For someone who has the allergy, it’s a good idea in case it suddenly worsens.”
Dr. McGintee agreed that milder alpha-gal reactions will respond to antihistamine. “It’s more about recognizing when someone’s having a significant reaction, and it’s a new allergy,” she said. “Then you have to call 911 immediately.”
But “there is a not-insignificant number of people who will have a positive test for alpha-gal who do not have an allergic reaction to meat,” she said. “I see them all the time in my office. So I don’t think it’s time for alarm and immediately running out and having a doctor test you for alpha-gal. We see a lot of false positives.”
Dr. Dempsey likewise said that “I don’t recommend everyone to get tested for it, because you can have a test that shows you have the antibodies but it doesn’t mean you’re going to get the allergy.”
Ticks are a risk throughout the year, Mr. Simons said. “Right now, what upsets me the most is when you drive past a big, beautiful leaf pile and see kids rolling around. That leaf pile is like a solar panel: It heats up, all of the ticks are there, plus it could attract mice that bring ticks into your yard. I tell people to stay away from leaf piles. Definitely get rid of your birdbath and bird feeder, because birds carry a lot of ticks. Any of that bird food that falls into your yard is attracting mice and chipmunks, which bring even more ticks into your yard.”
Though he cautioned that he was expressing an opinion, Mr. Simons said that he tells his patients who have been bitten by a lone star tick to avoid consuming meat for a month. “It may not activate the allergen,” he said. “I’ve got several hundred patients in my database, and there seems to be something to it.”
“When you look at a healthy gut, it is lined with mucus, and they make an immune protein, immunoglobulin A,” he said. “I’ve found many with alphagal have low immunoglobulin A. For some, fixing that immune issue may make them more resilient against getting alpha-gal.”
People with a meat allergy are also more susceptible to a reaction “when they eat fatty meats, like sausage, bacon,” Dr. Dempsey said. “Fat seems to make it more severe. Very lean meat is less likely to cause a stronger reaction. But those are rules of thumb, and everybody’s different.” Nonetheless, pointing to the quantity of meat Americans consume, “a much more vegetable-based diet is definitely recommended,” he said.
Dr. McGintee agreed. “Maybe don’t have your next meal be a huge burger,” she said. “Eat some lean meat, make sure you’re feeling okay. We know that, for certain people, there’s a lot of not-good things about eating too much saturated fat. Maybe,” she said, “this is nature’s way of teaching us to eat healthier.”