Alpha-gal Syndrome has emerged as the latest rising threat among tick-borne diseases in the area since its discovery in 2009. The allergy to meat sourced from mammals has begun to make its presence known as it continues to plague local residents.
Alpha-gal Syndrome is a tick-borne allergy to red meat, like beef, pork and venison, and dairy products caused by Lone Star tick bites. But much like Lyme disease, symptoms vary among patients, and the condition presents many uncertainties amid the medical community, often leading to misdiagnosis.
The allergy is still unknown to some, leaving many patients baffled when they experience an allergic reaction without having had a history of any food allergies.
“Certainly, in this area I think it’s becoming more prevalent,” said Rappahannock resident Patricia Burke, who learned about Alpha-gal Syndrome after being diagnosed a year ago.
Burke experienced hives and uncontrollable itching four hours after eating beef on multiple occasions. She wasn’t aware of the Alpha-gal allergy at the time but heard about it from a friend after explaining her outbreaks. Eventually, Burke was diagnosed with Alpha-gal Syndrome through a blood test.
Symptoms range from anaphylaxis, a life-threatening allergic reaction involving hives, swelling, a drop in blood pressure and sometimes shock, to no reaction at all. A tell-tale sign of Alpha-gal Syndrome is a Lone Star tick bite that is particularly itchy.
Rappahannock resident Merrill Carrington sought medical guidance after a tick bite which she described as “extremely itchy.” The blood test results were positive for Alpha-gal Syndrome, and she is now limited to a diet absent of red meat.
However, treatment is not always as simple as just avoiding meat and dairy. Carrington’s first allergic reaction included nausea, lethargy and stomach pain after eating French fries at a restaurant, not knowing the fries were cooked in pork fat.
Burke also noted concerns of cross contamination when eating at restaurants and said Alpha-gal Syndrome has had a huge impact on her life. Many restaurants have become accustomed to catering to food allergies, but an allergy to Alpha-gal is new to the category.
Galactose-alpha-1,3-galactose, or Alpha-gal for short, is a sugar molecule found in mammals, aside from humans and certain primates. Anyone who has contracted Alpha-gal Syndrome is likely to have an allergic reaction when consuming this sugar molecule with symptoms occurring several hours after ingestion.
“It turned out that the target was this sugar,” said Dr. Thomas Platts-Mills, the director of the Division of Allergy and Clinical Immunology at the University of Virginia. Platt-Mills is credited with discovering the Alpha-gal allergy and its connection to tick bites. “This sugar, which is the primary blood group substance of the mammals, explains why these patients are allergic to mammals. And they’re allergic to all mammals.”
Platts-Mills discovered the medical phenomenon after he and his research team were tasked with investigating allergic reactions to the cancer drug Cetuximab, used to treat colon cancer patients. He traced the allergic reactions to a specific component of the drug – Alpha-gal. After treating patients at his clinic who suffered from Alpha-gal allergies, a correlation was made between the allergy and Lone Star tick bites. The conclusion, said Platts-Mills, was unusual to medical science.
“If you told me that there was a form of allergy where people got bitten by ticks, they become allergic to a sugar, not a protein; their reactions are delayed – I’d have said ‘you’re just dreaming, it’s not possible,’” he said. “And then we began to see it. And once you see it, you realize it.”
Alpha-gal Syndrome is an abnormality among allergies and continues to puzzle doctors.
“It’s often misdiagnosed still,” said Platts-Mills. “Many doctors don’t have a clue about it.”
While this dreaded meat allergy is a clear threat to anyone who enjoys the outdoors in the Piedmont, the Centers for Disease Control and Prevention (CDC) does not yet document cases of Alpha-gal Syndrome.
“It is a disease that is in the process of being defined. It is not well defined, so we don’t have a good idea of the numbers of cases in Virginia,” said Dr. David Gaines, Public Health Entomologist for the Virginia Department of Health. “We don’t want to make it reportable until we understand it better.”
“[The CDC] is very interested in tick-borne infectious diseases,” added Platts-Mills. “We’re convinced this is not an infectious disease; this is a straight allergic disease.”
Thus, Alpha-gal Syndrome is still in its defining stages and, so far, the only known treatment is avoiding all foods containing the Alpha-gal sugar. Experts advise anyone spending time in tick-infested areas to practice preventative methods, like treating clothing with tick repellent and tucking pants into socks, and to see a doctor after experiencing a concerning tick bite.
Though cases may not be easy to document, local awareness of Alpha-gal is relatively high. Former Rappahannock News publisher Walter Nicklin wrote an editorial in 2014 on the arrival of Alpha-gal Syndrome and the threat it poses.
Dr. John McCue of Mountainside Medicine near Washington said he has seen several confirmed cases from patients since blood testing for Alpha-gal Syndrome has become more common.
Fortunately, Platts-Mills’ UVA allergy and immunology clinic – located in nearby Charlottesville – has one of the nation’s leading research teams for the Alpha-gal allergy, but that might not be a coincidence.
“Central Virginia is one of the hotspots in the country,” said Platts-Mills.
The Lone Star tick inhabits the entire southeast and thrives in any habitat with an abundance of deer, the known breeding grounds for the species.
“Deer is where male and female Lone Star ticks get together and where female Lone Star ticks get a large blood meal that they use for egg production,” said Gaines.
The Lone Star ticks feed on deer in the late winter and early spring season, said Gaines. Eventually the female tick falls to the forest floor and hatches as many as 5,000 eggs.
This nightmare-inducing image might be enough to keep anyone out of the woods, but Gaines noted that a Lone Star tick bite is often harmless.
“I’ve been bitten by plenty of Lone Star ticks in my lifetime. More than I can count, and I don’t have any Alpha-gal problems,” he said. “But some people, after being bitten by Lone Star ticks, will develop an allergy to foods that contain Alpha-gal.”
While the Lone Star tick is the confirmed carrier of Alpha-gal Syndrome, the CDC has not ruled out other tick species.
Another uncertainty surrounding the alpha-gal allergy is the various severities of symptoms that patients experience, with some patients being asymptomatic.
“There’s at least as many patients who’ve got the antibody and don’t get reactions,” said Platts-Mills. “And we honestly don’t know quite why that is. Either they don’t react enough for us to notice, or for them to notice, or the digestive system is very effective at getting rid of this sugar.
“The tick bites that cause Alpha-gal itch, and they often itch for two weeks or more,” said Platts-Mills.
Experts are still uncertain on the length of time a tick requires to transmit the allergy. While Lyme disease typically requires a tick bite attachment time of at least 30 hours, according to the CDC, epidemiologists believe Alpha-gal Syndrome can be transmitted far more quickly. A Lone Star tick, Platt-Mills said, might only need a couple of hours to transmit the allergy.
Anyone concerned about Alpha-gal Syndrome or experiencing symptoms after eating foods containing alpha-gal, should contact their local doctor or allergy clinic.
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