Tick Spreads Nasty Allergy

20 Apr 2016

By Chris Clayton
DTN Ag Policy Editor

WALDRON, Ark. (DTN) -- Dan Wright hasn't been able to eat beef or pork for more than 18 months and may not be able to ever again without risking a severe allergic reaction to the meat.

"When I was diagnosed, I asked the doctor if I could have a steak every now and then because I love ribeyes," said the Arkansas poultry and hay farmer. "He said the next one had better be a good one, because it would probably be my last one. He said I could die if I had a full-blown anaphylactic episode."

Wright, 56, is one of an increasing number of people who have contracted an allergy to forms of a carbohydrate called galactose-alpha-1,3-galactose, more commonly called "alpha-gal." All non-primate mammals have alpha-gal carbohydrates. The alpha-gal allergy is the body's immune system trying to counteract the introduction of the alpha-gal carbohydrate.

It's a frightening allergy and good reason to protect yourself from tick bites. People get alpha-gal from the lone star tick. Lone star ticks are often identified by a single white spot on the back of an adult female that can look like a star or diamond. Tick saliva in general is known to be a chemical factory for disease. In the case of alpha-gal, lone star ticks either have bitten a mammal before biting a human, or the tick has a sugar in its saliva similar to alpha-gal, causing the human body to react. The lone star ticks are nasty little buggers that also can bite a person while in the larval form and are often confused with chigger bites.

People with alpha-gal can have a variety of symptoms ranging from mild rashes, itching or hives to severe, life-threatening anaphylactic shock.

The Centers for Disease Control (CDC) reports the northwestern range of the lone star tick ends around Nebraska, but the tick is prevalent from central Texas to Florida and in nearly every state along the East Coast, including Maine. The range of the tick is expanding farther north and west almost every year.

Erin McGintee, an allergy specialist in rural Long Island, New York, has more than 300 patients who suffer from alpha-gal. Tick diseases are so common in the area the Southampton Hospital has a tick-borne disease resource center.

"Our area is very rural, but we're on an island so the deer can't go anywhere," McGintee said. "Just this part of Long Island has a terrible tick problem. So not only do we deal with this allergy, but a lot of tick-borne diseases occur here."

Alpha-gal was formally reported in medical literature with 24 cases in 2009, but there were reports on a possible mammal-meat allergy going back decades. By 2012, thousands of cases were being reported. No federal agency tracks the prevalence of the disease.

Scott Commins, an associate professor at the University of North Carolina department of medicine, is one of the few research experts on alpha-gal. He and other researchers recently reported a survey showing more than 1,500 confirmed cases in Virginia and North Carolina alone. He notes there are no national numbers tracking positive cases, partially because the Food and Drug Administration (FDA) has not approved the lab test most doctors use to identify the meat allergy. That means there is no clearinghouse to show how many people have been infected. While the federal government hasn't approved a test, Commins said there are tests doctors feel comfortable ordering that determine whether a person is allergic to different animals. So far researchers have been unable to determine who is susceptible, because a lot of people are bitten by lone star ticks and do not get alpha-gal. Some people even test positive but never get an allergic reaction.

"There are so many people who get bitten by ticks," Commins said. "There is no reason to stop eating meat because you get a tick bite."

Alpha-gal has a lot of diagnosis challenges. One, the allergy may take years to develop symptoms. Additionally, alpha-gal reactions generally don't occur until somewhere around four to eight hours after someone ate an offending hamburger or pork chop. That time delay makes it harder to draw the link between the symptoms and the food. A lot of times people don't figure out that meat is the source of their allergic reaction.

"We see in allergies a lot that people end up getting labeled, 'Oh, you are having idiopathic hives or idiopathic anaphylaxis,' which means we don't know what's causing it, we just treat it. We see that a lot with allergies," McGintee explained.

The allergy can be life-altering for people because they quickly discover how much of their lives revolve around foods they can no longer eat. It's especially frustrating for livestock producers who can no longer eat beef or pork from the animals they raise. Family gatherings are disrupted, because such events often revolve around a well-cooked ham, prime rib or even venison.

"I never really comprehended how much of my social live revolved around food," said Carey Wagoner Robertson, a livestock producer from Bradford, Arkansas. She feels as if alpha-gal turned her life upside down. "Every family occasion -- Easter Sunday at my mother's house -- we still have a ham. Everything we do I have to pack some food to take, because I'm probably not going to be able to eat. Everything changes."

Robertson had been dealing with hives, asthma and a rush of anxiety for about seven years when she read about alpha-gal just prior to eating ham at a family gathering. She got sick later that night.

"I quit eating red meat at that time for a month, and I knew I had it," Robertson said. "I went into my doctor and he had never heard of it. But he was a good sport and ordered the test."

Wright was told he could have been infected from a tick bite any time in the last decade. More to the point, as a hay and poultry producer, Wright notes he's always out the field so there is no telling when he may have been bitten. He somewhat jokingly adds, "Of course, we're here in western Arkansas and we grow ticks around here."

The allergy has become prevalent enough in Arkansas that at least two state lawmakers have contracted it. The state legislature now has a task force evaluating recommendations to educate the public, restaurants and medical professionals about alpha-gal, its symptoms, and how to spot the long list of products that contain ingredients from mammals.

Wright started showing symptoms of alpha-gal in the fall of 2014. He was visiting a son in Missouri and suddenly broke out in hives one evening, and his tongue started to swell. Like most people, Wright began taking over-the-counter Benadryl to deal with the allergy. But he had four more reactions over the next three weeks, and each one was more severe than the one before. That happened largely because he did not associate an allergy with his normal eating habits. Wright kept finding himself in an emergency room.

"The last reaction I had, my heart rate was dropping, my blood pressure was dropping, and my airways were closing off," Wright said. "It got pretty nasty."

Doctors at first were at a loss over what could have caused the allergic reactions. An allergist in Fort Smith, Arkansas, finally asked Wright if he had eaten pork or beef before the outbreak and had him tested for a meat allergy.

"He called me a week later and apologized," Wright said. "He said, 'I know you're a beef eater but you can't eat beef anymore.'"

Wright grows about 195,000 broiler chickens annually and has been president of the Scott County (Ark.) Farm Bureau for the past seven years. He calls production in his area of west-central Arkansas "king poultry." Wright is also on the Arkansas Farm Bureau state board. So during the American Farm Bureau Federation annual meeting earlier this year, he introduced a resolution that was adopted calling on officials to educate the food service industry about the allergy and risk it poses.

"Nobody's ever heard of it," he said. "I've gone on vacation as well. Every time you eat, you have got to explain this thing. The food service needs to know what this allergy is about, because they could serve somebody and that person could die in four or five hours. There is always that possibility"

It's not only the problem of directly consuming beef or pork, but the allergy also can come from cross contamination as well. Often, other foods may be cooked in bacon grease, for instance, or a baking pan could be lined with such grease.

"It's just totally changed the way I live now," Wright said. "It changed everything. When I go to a restaurant, I have to know exactly how they prepare the meal."

Vaccines and tetanus shots also can create reactions because of mammalian ingredients. People with the allergy even need to know the ingredients in their toothpaste, because a lot of them use glycerin or gelatin derived from beef or pork.

"There's a lot of stuff you take for granted that you just can't do," he said.

Wright and his wife, Belinda, could often spend as much as $300 a month eating out. That has dropped down to about $25. Wright said the one place he knows he can eat is Subway, because he can watch how the food is prepared.

"We just never go out to eat anymore because you can't chance it and you get tired of explaining it," he said.

The allergy has made him willing to try different seafood he had not eaten before. Still, he continues to search for an alternative to steak. He buys emu meat from time to time. "It's not a ribeye but it's the closest thing I could get," Wright said.

AVOID TICK BITES ON THE FARM

It may be hard for anyone who works on a farm to avoid the woods or tall grasses, but the Centers for Disease control recommends people use repellents with at least 20% DEET on exposed skin and, at the very least, in the areas around your boots and shoes. Tuck in your shirt tails as well.

If you live in an area with ticks, check your clothes and body as soon as you can when you come indoors. Check under your arms, around ears and behind knees.

If you find a tick on your body, gently pull it straight up and out with tweezers by getting the tweezers as close to the skin as possible. Then, disinfect the bite area with rubbing alcohol or soap and water.

ALPHA-GAL ALLERY SYMPTOMS

People often find the symptoms start with redness, itching and hives that occur late at night, hours after eating. Episodes can remain mild, but often become more severe over time. Cramping, diarrhea, shortness of breath, and swelling can occur. The reaction can be severe enough to cause death.

Doctors can diagnose the allergy through a test that specifically identifies alpha-gal immunoglobulin E (IgE). Treatment often means reducing or outright eliminating the consumption of mammal products.

Sources: Centers for Disease Control, Tick-Borne Disease Resource Center, Southampton Hospital. Southampton, N.Y.

Chris Clayton can be reached at chris.clayton@dtn.com

Follow him on Twitter @ChrisClaytonDTN

(CZ/SK)