Amblyomma americanum
The lone star tick (Amblyomma americanum.) Photos by Chris Fowler.

This story first appeared in issue #57 (fall 2015) of our Gravy quarterly. 

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Fear the Tick

Alpha-gal is the scariest allergy you’ve never heard of

by Chris Fowler

I was in the dirt underneath my girlfriend’s car in Durham, North Carolina, trying to pull a dead alternator off an engine that had been installed sideways. When it became too dark outside for me to continue cursing the engineer who signed off on this configuration, I retreated indoors for supper, took off my shoes, and discovered, to my horror, a single tick attached to the top of my foot. It hadn’t been there long, perhaps a couple of hours. I easily picked it off. When I inspected the small female lone star tick with that telltale white dot on her back, in the nymph stage of her short life, paranoia kicked in. I was not afraid that I had contracted Lyme disease or Rocky Mountain spotted fever, two rather well-known tick-borne illnesses. I know what symptoms to look for with those, the bull’s-eye rash or fever, fatigue, and joint pain that follow in the days after a bite. This lone star tick (Amblyomma americanum) could unleash a far worse fate: It could rob me of my ability to eat mammals.

A few friends of mine have developed an allergy to red meat: pork, beef, lamb, goat, venison, rabbit, bison, and the like—no more barbecue, no more cabbage smothered with neckbones. More specifically, the allergy is to a sugar inside that meat, the carbohydrate Galactose-alpha-1,3-galactose. It’s called “Alpha-gal” colloquially and is found in non-primate mammals. The only mammals whose bodies do not contain Alpha-gal are primates like humans and old-world monkeys—but I don’t plan to acquire a taste for those types of meat. The Alpha-gal allergy develops for certain people after pathogenic lone star tick bite, and researchers are unsure whether it’s transmitted through tick blood or saliva.

The time from infecting bite to an allergic reaction varies by patient. Some of the people I know with this allergy can remember the exact tick that did them in. Others say it’s been years since they remember having been bitten. During the interval between tick bite and the development of histamines to Alpha-gal, life may go on as usual—until the day that a BLT sends them to the emergency room.

The reactions often occur three to eight hours after ingesting red meat. At that point, many Alpha-gal sufferers feel an upset stomach. They might begin to itch, sometimes in conjunction with hives. Others go into full-blown anaphylaxis. For the uninitiated, anaphylaxis is a reaction that includes a number of alarming physical effects, from the unsettling (swelling of the lips and tongue) to the seriously dangerous (difficulty in breathing, low blood pressure, swelling of the throat). Death sometimes follows.

Researchers studying Alpha-gal at the University of Virginia observed severe gastrointestinal distress in some of their subjects, reporting that “it is not uncommon for a patient who has anaphylaxis to lose consciousness while moving their bowels.”

Scared yet?

I am terrified.

Dr. Thomas Platts-Mills, an allergist at UVA, discovered the lone star tick connection to Alpha-gal back in 2006. He was trying to determine why certain cancer patients, most of whom lived in the South, suffered serious allergic reactions to the cancer drug Cetuximab—which happens to contain Alpha-gal. Eventually, Dr. Platts-Mills linked the lone star tick and the Alpha-gal allergy.

The next summer, he went for a hike in the Blue Ridge Mountains. After he took off his hiking boots and socks, his ankles were covered in lone star tick larvae. A few months later, Dr. Platts-Mills awoke in the middle of the night, covered in hives. He’d eaten lamb for supper that evening. Now he is afflicted with the very same Alpha-gal allergy that he researched and helped identify.

Because of Alpha-gal’s delayed reaction, the allergy is often misdiagnosed or not diagnosed at all. Like Dr. Platts-Mills, people who suffer from the Alpha-gal allergy frequently experience reactions in the middle of the night after they eat red meat for supper. It can take multiple attacks to make the connection.

An engorged female lone star tick. Photo by Lyle Buss.
An engorged female lone star tick. Photo by Lyle Buss.

I probably eat more red meat than is good for me. I grew up in rural, southeastern North Carolina, where livestock is big business and whole-hog barbecue reigns supreme. Dinnertime often meant barbecue sandwiches (more precisely: finely chopped, whole-hog flesh including the crispy skin, dressed in peppery-red vinegar sauce), and suppertime centered around things like gnaw-the-bone-good fried pork chops.

After moving away for college and work, I discovered different ways to enjoy plated mammals. When I was working in London, lamb vindaloo became a dietary staple, and I developed a taste for pork bulgogi when I lived in Massachusetts. Red meat is the subtitle of my food autobiography.

A few years ago, I caught up with a friend over dinner in Hillsborough, North Carolina. When I asked why he was passing over a very fetching swine entrée for a Buffalo shrimp wrap, Adam Rosemond told me his story. For a barbecue lover, it sounded like the plot of a sci-fi horror film.

This is what more than a year of Adam’s life looked like after receiving multiple lone star tick bites: When he ate a pork chop or a cheeseburger for supper, he would wake up in the middle of the night, perhaps six hours after his evening meal, covered in a layer of hives that resembled bubble wrap. Next came the debilitating stomachaches. The reactions eventually got worse, and Adam would struggle to catch his breath. For months he slept with a bottle of Benadryl on his nightstand, popping a couple whenever he would wake up, in a panicked effort to head off the reactions. He couldn’t figure out what was wrong, These reactions were absolutely terrorizing him.

Finally, after stumping a series of doctors, Adam identified the pattern on his own. When he stopped eating red meat, he stopped having reactions. Almost a year and a half after his symptoms appeared, he received a formal diagnosis at Duke University’s Asthma, Allergy, and Airway center.

As I tucked into the mammalian smorgasbord before me, I contemplated how different life would be if I were similarly afflicted. Since learning about Adam’s experiences, I’ve met others who suffer from the Alpha-gal allergy, and I’ve developed a macabre obsession. In my nightmares, I live a life without sausage biscuits, mark joyless birthdays without pig pickings, and sit down to Sunday lunches with no roast beef. My cardiac health might be better, but I’d be heartbroken. Many of the afflicted I know are hunters, farmers, or work in the food industry. Adam works in the grocery department at Weaver Street Market, a cooperative grocery store in Hillsborough. The implications of this allergy go beyond an altered diet. They demand lifestyle changes.

Mary Beth Miller with the cows she raises but cannot eat.
Mary Beth Miller with the cows she raises but cannot eat.

I met Mary Beth Miller last spring when I was taking photos for an article about Coon Rock Farm, where she works. Coon Rock is a sustainable organic farm in Hillsborough, NC, that grows vegetables and raises cattle, sheep, and heritage-breed hogs. Mary Beth and her husband, Brock Phillips, met when they were both serving as as interns there after college. Mary Beth plants, weeds, harvests vegetables, and takes care of the animals. Growing up in nearby Wake and Chatham counties, she says, “I am not a stranger to a tick. We would pull them off of us all the time, pull them off the dogs—I have no idea when I was bitten. It might’ve been when I was seven years old, or it might’ve been when I was twenty.”

Things took a turn for the worse one night after a meat-centric supper on the farm. “My first reaction, I had no idea what was going on,” says Mary Beth. “I’d had hives before, just not that intense. I kept having these reactions for about a year and a half.” Her primary care doctor misdiagnosed Mary Beth’s symptoms. Eventually, like Adam, she went to the Duke Asthma, Allergy, and Airway Center, where a doctor confirmed her Alpha-gal allergy with a simple test.

“It’s been interesting, still being a part of raising the meat animals I can’t partake in eating,” says Mary Beth. “We take care of the animals so well and make sure they have a good life. We watch them being born on the farm, and then we raise them, and we take them to the processor. Then we get to enjoy the meal that we’ve worked so hard for—except now, that part has been taken away from me. I don’t see the animals as a dinner in the future. I think I look at them more in the moment as these very sentient beings that are here, and it’s my job to take care of them.”

Even though her work with livestock no longer manifests as a meal, she is still deeply connected to these foods. “I miss a good steak. It’s funny, because since my diagnosis I’ve been to a butchering class, and I’ve been to the Women in Meat conference—I learned how to break down a pig and break down a cow. It’s still part of my job. I have no problem touching it. It still interests me a lot. I still go to the farmers market every Saturday and sell meat—I just can’t eat it. It’s all right. I think the universe works in very funny ways.”

Like Adam and Mary Beth, the other Alpha-gal sufferers I know have been able to adjust to life without red meat. Adam has substituted ground turkey for ground beef—turkey burgers feature regularly at his house. Even so, I catch myself checking the clock and counting the hours since my last torta de carnitas from my favorite Mexican spot, Fiesta Grill. I keep Benadryl in my truck now. My paranoia is palpable.

Alphagal-Chris Boots

Chris Fowler is an omnivore who no longer leaves the house without his pants tucked into his socks. He lives (in fear of ticks) in Hillsborough, NC.