​​An emerging allergy to red meat called Alpha-gal Syndrome(AGS) has been making national news in recent months due to the rising number of cases, the vector parasite known as the lone star tick believed to be partly responsible for the spread, and recent data from the U.S. Centers for Disease Control (CDC) that indicates that more than 40 percent of surveyed providers, mostly primary care, are not even aware of its existence.

In spite of the increasing attention, Thomas Lamarre, MD, with The Christ Hospital Physicians – Infectious Diseases, says there’s not a lot of reason for concern, especially in the Greater Cincinnati region, due to a very low number of reported cases and the fact that most reported cases are not severe. “Fewer than ten percent of cases require emergency treatment, and the CDC has no confirmed reports of deaths,” he says.

However, Dr. Lamarre warns, it’s always good to be on the lookout for ticks of any kind if you spend a considerable amount of time outdoors. “We’re actually seeing an increase in cases of Lyme disease, which coincides with a growing local tick population,” he says.

What is Alpha-gal Syndrome?

Alpha-gal is a sugar molecule found in most mammals, but not found in humans. Scientists also suspect that it may be produced in the saliva of lone star ticks. The ticks feed on those mammals, as well as humans, so regardless of whether or not they produce the molecule, there is strong evidence that they are responsible for its spread. The CDC says the alpha-gal molecule can also be found in certain medications made with animal products.

Alpha-gal Syndrome is an allergy to red meat triggered by Immunoglobulin E (IgE) antibodies developed by the immune system as an overreaction to exposure to the alpha-gal molecule. The CDC reports about 110,000 known cases of AGS since 2010, however, they estimate that due to the low awareness of the allergy, that number may be closer to 450,000.

According to Dr. Lamarre, one unique aspect of AGS compared to more common food allergies such as peanuts and shellfish, is the delayed development of symptoms, which typically appear 4-6 hours after those with the allergy consume red meat. The most common symptoms are:

• Hives, itching, or itchy, scaly skin

• Swelling of the lips, face, tongue and throat, or other body parts

• Wheezing or shortness of breath

• Stomach pain, diarrhea, upset stomach or vomiting

In some cases, individuals may experience a sever reaction, or anaphylaxis. Symptoms of anaphylaxis often include trouble breathing, severe swelling and irritation of the tongue and throat and noticeable fluctuation in blood pressure. In these cases, Dr. Lamarre says you should seek emergency medical attention. Otherwise, he recommends asking your doctor if you have less severe symptoms and suspect you may have a red meat allergy. “Testing for the AGS IgE is becoming more common for patients presenting with these symptoms,” he says, “Especially in cases where your doctor learns of recent tick exposure.”

As with other food allergies, your doctor can work with you on appropriate dietary changes to manage the risk for severe reactions if you are diagnosed with AGS.

What should you know about the lone star tick and other ticks?

The majority of known cases of AGS are reported in the south and southeastern U.S. where the lone star tick itself is most prevalent. Andrew Rosendale, PhD, a molecular physiologist, and vector biologist at Mount St. Joseph University, says that while they are traditionally a southern species, their habitat is technically east of the Rocky Mountains. “I haven’t personally encountered them as much in the Cincinnati area as I have in more forested parts of southern Ohio,” he says.

Dr. Rosendale says the lone star tick population is growing in our region, along with the other two most common species of ticks in our area – the black legged tick, also known as the deer tick, and the American dog tick.

“One of the reasons we’ve seen an increase is the changes to the habitat of some of the more common hosts,” he says. “Ohio has actually seen a decrease in farmland and an increase in forest areas, which means a higher population of deer to sustain the tick population.” He adds that the growing deer population cohabitates with humans in areas with forested communities and parks where people tend to be more active outdoors, further exposing people to ticks.

The three prevalent tick species in our region share some common traits, according to Dr. Rosendale. For example:

• They all reside low to the ground among vegetation such as tall grasses, shrubs and leaves, where they await a passing host to attach to for feeding.

• They all require a blood meal to move between the three life stages of larva, nymph and adult.

• Feedings can take a few days, up to a week for adults, and the longer the feeding, the more chance of transmitting their respective diseases.

One of the major differences between the species is the diseases they can carry and transmit.

The lone star tick, for example, is the only tick known to transmit the Alpha-gal molecule that can lead to AGS, but does not transmit the more commonly experienced Lyme disease, which Dr. Lamarre cites as one of the three most common and concerning bacterial diseases spread via ticks. Those are:

• Lyme disease, which can cause headaches, fever, fatigue and rash, and if not treated can harmful to the joints, the heart and the nervous system. Dr. Lamarre says one of the dangers of Lyme disease is that you can develop potentially fatal cardiovascular complications even after symptoms clear, so it’s important to receive medical treatment if symptoms are present and you have known exposure to ticks. It is most often spread in this region by the deer tick.

• Ehrlichiosis, which is spread by lone star ticks and deer ticks and causes headaches and rash and can prove fatal, especially to those with a compromised immune system.

• Rocky Mountain spotted fever, which is less common in Ohio, but can cause severe illness including headaches, and high fever. It is spread by the American dog tick.

Both experts agree that the best way to lower your risk for tick-borne illness is to avoid exposure, and in instances of possible exposure, such as spending a long amount of time in or near highly vegetated areas, to be sure to thoroughly check all parts of the body for ticks.

“Ticks need to be attached for a long period of time to feed,” Dr. Lamarre says, “So you’re not going to get sick if you find a tick attached to you shortly after being exposed.”

Dr. Rosendale reiterates the importance of checking all over for ticks after you’ve been outdoors. “They can feed anywhere on the body,” he says. “But they’re especially drawn to warm, moist areas that aren’t always out in the open. That includes areas that aren’t easy to check such as the scalp.”

If you find a tick on your body, Dr. Rosendale recommends staying away from some of the old wives tales associated with removing and them and simply using a pair of tweezers to pull the tick off, making sure to remove all parts of the tick. He also suggests these tips for limiting the risk for tick exposure if you plan in spending any amount of time outdoors among vegetation:

• Stay on the trail, as ticks don’t tend to like short grass or bare patches

• Wear light-colored clothing, as ticks are dark in color and the contrast will make it easier to spot them before they can attach to feed
  

• Wear long pants, and tuck them into your socks, if possible. “It’s not very fashionable, but that can keep them from getting up your pant leg without being detected,” he says.
  

• Use a repellent on your clothing such as DEET or Permethrin, that latter of which can actually prove effective through a few washings of your clothing​
  

Dr. Rosendale also adds this advice for those who like to enjoy the outdoors with their best friend. “Don’t forget to check your dogs for ticks when they’ve been outdoors around thick vegetation,” he says. “Ticks can be harmful to them, and they can also jump from them onto humans to feed.”