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Tick-Induced Alpha Gal Allergy

Not unlike generations of boys who have gone before them, my seven-year-old twins, Ben and Nathan, spent summer afternoons exploring the thick, lush woods surrounding their self-appointed fort on the shores of Beaver lake. Aside from the occasional swim break to cool off, the hours unearthing treasures and cultivating adventure along the shoreline formed the framework for their summer memories. Despite working our way through countless bottles of bug spray, evening tick checks often resulted in the discovery of at least one or two tiny little pests hidden on their skin.

Months later, long past the scorching heat of summer, our family found ourselves dealing with the unexpected aftermath of those camping adventures in the woods. On a blistery cold Monday afternoon, my youngest wasn’t feeling well, and I planned to pick her siblings up from school before heading to her 3:15PM doctor’s appointment. As my turn approached in the car line, two of my three bounded to the car, while Ben walked slowly, and looked like he had also started feeling ill. I assumed he had the same virus as his sister, and felt thankful we were already headed in to the doctor’s office.

During the fifteen minute drive to the office, Ben’s breathing became unusually loud and labored. Assuming this was caused by the virus, I wasn’t overly concerned, and asked him to take slow, deep breaths. We arrived at the clinic and were taken to a room where our nurse started taking Ben’s vitals. Dr. Fankhauser popped his head in to say hello and to let us know that he would be back in a few minutes to see us. However, he immediately noticed Ben’s breathing and quickly entered the room to listen to his chest. The pulse oximeter on Ben’s finger read 84% and I noticed his lips were turning an alarming shade of blue. Panic registered in Ben’s eyes, while my heart raced and I looked to Dr. Fankhauser for reassurance that this was somehow normal.

Of course, this was not normal. In fact, Ben was having an anaphylactic reaction.

Dr. Fankhauser had already alerted a nurse to call 9-1-1, had epinephrine and steroids ready, and was administering oxygen when the paramedics arrived. Meanwhile, I called my husband, who happened to be a few minutes away from the clinic. He raced over to pick up the other three kids while I rode with Ben in the ambulance to Mercy Hospital.

For the next 24 hours, steroids and breathing treatments were administered and multiple tests were run, all attempting to uncover the cause of Ben’s respiratory distress. Because he had no prior history of allergies, presented no other obvious symptoms, such as hives, and hadn’t eaten anything since lunch at 10:45AM, a full five hours prior to the incident, the hospital attending physician released us with a tentative and shaky diagnosis of croup, rather than anaphylaxis.

Thankfully, Dr. Fankhauser refused to accept the croup diagnosis and set up an appointment for Ben to see Dr. Hedberg for allergy testing. Once more, I quizzed Ben, pleading with him to remember anything else he could have possibly eaten that afternoon, eager to find the missing piece of this scary medical puzzle. He had only eaten yogurt for breakfast and a beef taco with refried beans and rice for lunch, still insisting that he had not eaten anything just before school pick-up.

After reviewing everything he had eaten that day and completing initial skin allergy testing, Dr. Hedberg and Dr. Fankhauser agreed we needed to run blood work for pork, beef and dairy allergens.

Ben’s blood work proved the theory our doctors had been working off of. Ben had an alpha-gal allergy. Alpha-gal is a carbohydrate molecule present in the meat of mammals, thus causing Ben to be allergic to red meat. Unlike most food allergies, symptoms typically set in three to six hours after eating beef, pork or lamb – explaining the five hour lapse between eating the beef taco at lunch and his reaction after school.

The question remained: why did he suddenly develop an allergy to foods he had eaten all of his life? Dr. Fankhauser explained that this particular allergy is spread by the bite of a Lone Star tick. Our summer camping trips and the sporadic tick bites Ben received had caused concern for Lyme or Rocky Mountain Spotted Fever, but never a food allergy.

Our hope in sharing Ben’s story is to educate other families of yet another reason to fervently avoid ticks and to raise awareness of this fairly unfamiliar food allergy.

Dr. Joel Fankhauser, M.D. of Direct Care Clinic of Northwest Arkansas

Alpha-gal allergies are, fortunately, uncommon but seem to be increasing in prevalence in the southeast United States.  Developing meat allergies after tick bites was first described about 10 years ago in Australia, At approximately the same time, it was discovered in the United States that there was a chemotherapy drug which led to allergic reactions more in the Southeast than elsewhere, which was ultimately tracked to alpha-gal antibodies as well.  There are several unusual things about tick-induced food allergies.  The allergic reaction tends to be delayed, sometimes by up to 6 hours after exposure, whereas traditional anaphylactic reactions to foods like peanuts are more likely to occur within seconds or minutes of exposure.   The allergic reaction tends to be influenced by events unrelated to the actual food, such as exercise, other illnesses, even certain medications and alcohol use.  Alpha gal allergies also tend to wane with time, but may persist (or even return after they have totally resolved) with persistent tick exposure.  Right now, our best treatment plan is tick avoidance through 10-30% DEET, or, in children over the age of 3, lemon eucalyptus oil.   

For more information visit

www.healthy.arkansas.gov/programs-services/topics/alpha-gal-allergy

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