a red lone star tick with a white dot on its back on a green leaf — The red meat allergy people develop after a tick bite is becoming more common in Oklahoma. The latest CDC data poses many questions about why lone star ticks are most often to blame and why some people are less susceptible to an allergic reaction. (Photo by Shutterstock)

Don’t skip the bug spray: Alpha-gal cases are climbing

Monday, October 30, 2023

Media Contact: Gail Ellis | Editorial Communications Coordinator | 405-744-9152 | gail.ellis@okstate.edu

Oklahoma State University Extension specialists say residents should remain diligent in preventing tick bites as the alpha-gal allergy emerges as a serious health in Oklahoma and the southeastern U.S.

Tick bites are rare during the cooler months, but the pests are considered a year-round threat in states with mild winter temperatures.

12 years of mysterious illness

Sand Springs, Oklahoma, resident Stephanie McAllister developed a mysterious cough in 2008 that baffled medical specialists. She coughed constantly, but every X-ray was clear and every test declared normal. The pulmonologist she visited mentioned a chronic cough is usually an indicator of some kind of allergy, but no diagnosis was determined. Doctors suggested several serious medical ailments as the probable cause, including bulimia or anxiety. McAllister felt like she was going crazy, but deep down she knew none of these were the problem.

“I started having brain fogginess and joint pain in my arms and legs, but all of the tests ran for arthritis came back normal,” she said.

In 2019, while hiking around Keystone Lake near her home, McAllister was bit by a tick and began vomiting five or six times a day. Again, every test doctors administered came back normal.

“I started Googling symptoms and reading articles,” she said. “I went to three different doctors and asked them to do an alpha-gal test, and they all said it was too rare, that there was no way I had it.”

Frustrated with 12 exhausting years of unexplained illness, McAllister started eating a vegan diet. Her symptoms disappeared, and she suspected alpha-gal was the culprit. In 2020, she found an urgent care that reluctantly ran the simple alpha-gal blood test, and the result was positive.

“It was a relief to know,” McAllister said. “I had it for so long, and I was just thankful I knew what to do to feel better.”

Today, she consumes chicken and seafood, but her avoidance of red meat is more complicated than it sounds.

“I have to be really careful with anything that’s processed because beef and pork aren’t listed on allergy labels,” she said. “Any box, can or bag that lists natural flavors as an ingredient could have beef or pork in it. I know if I eat it, I’m going to feel terrible for the next three days.”

High risk in northeast Oklahoma

A report from the Centers for Disease Control in July 2023 illustrates the geographic distribution of suspected alpha-gal syndrome cases from 2017-22. The northeast and central regions of Oklahoma report some of the highest rates of alpha-gal in the country.

“Mammals have the alpha-gal compound, but humans don’t,” said Janice Hermann, OSU Extension nutrition specialist. “When a tick feeds on a mammal and bites a human, it can cause the human to have an allergic reaction to alpha-gal.”

Meat from beef, pork and venison contain the compound and can enact a severe allergic reaction. In some cases, even milk, gelatin or beef broth can heighten alpha-gal syndrome.

Hermann explained the allergy is difficult to identify because of its delayed reaction.

“Food allergy symptoms usually occur rapidly whereas alpha-gal syndrome may not show symptoms until 2 to 6 hours after consuming the product,” Hermann said. A lot of times, people don’t associate it with the fact they consumed meat.”

The CDC lists the following symptoms of an alpha-gal allergic reaction:

Hives, itchy skin or rashes
Nausea or vomiting
Heartburn or indigestion
Diarrhea
Cough, shortness of breath or difficulty breathing
Drop in blood pressure
Swelling of the lips, throat, tongue or eyelids
Dizziness or faintness
Severe stomach pain

Health issues had consumed Stillwater resident Ryane Draper’s life for two years,

“I had extreme fatigue. I felt like someone was drugging me every day,” Draper said. “I had terrible joint inflammation, constant digestive issues, stomach pains bloating, and I was also reactive to dairy.”

After a significant reaction to a meal with pork, she visited a doctor who had diagnosed a previous patient with alpha-gal. The doctor ran the same blood test on Draper, confirming the allergy in 2020.

“I’m able to consume a little bit of milk and ice cream here and there, but if I eat too much, I can feel it almost immediately,” Draper said. “If cutting out certain foods works, that’s what I’m going to do.”

For those who have alpha-gal syndrome, some can trace the allergy to a specific tick bite. Others were never aware of a tick on their body. Bruce Noden, associate professor of medical/veterinary entomology in the OSU Department of Entomology and Plant Pathology, has personal experience with the health condition. His son was diagnosed shortly after high school.

“He got into a bunch of seed ticks out at Lake McMurtry and wound up in the hospital with anaphylaxis,” Noden said. “He calls me at 11:30 at night and says, ‘Dad, I can’t breathe.’”

His son is one of the lucky alpha-gal victims whose symptoms eventually faded.

“We ate fish and chicken for two years in our house, and when he tried to reintroduce red meat, he came out of it,” Noden said.

Alpha-gal goes global

The lone star tick variety is the most common carrier of the alpha-gal compound, inoculating a salivary protein.

“We’re recognizing it more and seeing it in areas where lone star ticks are prevalent,” Noden said. “The lone star tick is invading New England, and we’re seeing alpha-gal cases rise there. Wherever the lone star tick is present, we have a problem.”

He described the lone star tick as ubiquitous; while most other varieties feed on different hosts during different stages of their development, the lone star tick will feed on anything regardless of its stage.

Another confusing characteristic of the alpha-gal compound is human variability. Noden’s international veterinary medicine colleagues in other areas of the world, such as Spain, have discovered people can show high levels of the alpha-gal antibody in their system but not exhibit allergic reactions to red meat.

“It seems there’s something else going on here,” he said. “We’ve simplified the allergy to a tick bite, but what else in the bite causes the reaction, and why is the reaction coming from lone star ticks?”

As an emerging illness, physicians are more aware of the possibility of alpha-gal when a patient shows symptoms. Dr. Lora Cotton, a primary care physician at OSU Family Medicine – Health Care Center, said the unusual symptoms are not typically associated with an allergy and can change every time a reaction occurs.

“It’s probably underdiagnosed because of the variability in presentation of symptoms,” Cotton said. “We’re not able to pinpoint a cause right away. We mark off the common things, and when we don’t find a diagnosis, that’s when we should consider testing for the alpha-gal allergy.”

Cotton said the blood test that reports antibodies to the alpha-gal sugar molecule is readily available. Patients can ask for the test if they suspect a tick bite.

There is no direct treatment for the allergy, and those who experience serious anaphylactic reactions should carry an EpiPen. Cotton said that although symptoms can fade over time, alpha-gal can be reactivated if a person is re-exposed to tick bites.

OSU Extension’s nutrition and entomology specialists say the most effective way to prevent tick bites in tall grass or wooded areas is to spray skin with an insect repellant that contains DEET. Wear pants, tall socks and boots that impede pests from crawling onto bare skin, and always complete frequent and thorough tick checks.

Alpha-gal awareness

For residents such as McAllister in Sand Springs, the long journey of suffering from and finally receiving an alpha-gal diagnosis has changed the way she prepares for any time spent in the great outdoors.

“Now I do not go out in the woods without bug spray, and our two dogs and three cats have flea and tick medicine at all times,” she said.

A native Oklahoman, McAllister was never afraid of ticks, but her experience has uncovered the scary, life-threatening side effects of an encounter.

“If I get another bite, it could make my symptoms worse,” she said. “Some people still don’t think it’s a real thing. I believe there are a lot of people walking around with the symptoms who have no idea they have it.”