Sunday, September 7, 2014

Lone Star tick bite causing meat allergies

There is a rare, newly diagnosed meat allergy resulting from tick bites, but a good one to know about because the symptoms can be so severe, even fatal. These reports come from the ISID (International Society for Infectious Diseases), not to be confused with the IDSA (Infectious Diseases Society of America).


A ProMED-mail post
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International Society for Infectious Diseases

In this posting:
[1] Pennsylvania
[2] Oklahoma

[1] Pennsylvania
Date: Mon 25 Aug 2014
Source: KDKA [edited]

It was just a small tick on her foot, just part of working in the
woods, the woman thought. "My husband took it off with a pair of
tweezers, didn't think anything else about it," she said. Then weeks
later, she woke up in the middle of the night swollen with hives and
unable to breathe. "They said I was probably 20 minutes from dying at
that point, so it was scary, one tick," she said.

Eventually, doctors figured out the woman had developed a severe food
allergy. That lone tick bite left her completely unable to eat red
meat. "It's actually called the unintentional diet," she said. "This
is to the point that if I didn't make those changes, I'd die."

Doctors are seeing more and more of this rare allergy, which is
actually not against the meat, but a sugar on red meat called alpha
gal. "It's very new. This disease is really first described in 2008,"
allergist Dr James DeAngelo said.

Alpha gal is also in the saliva of the biting tick, which is how the
allergy starts. All mammals carry the sugar, except primates. Humans
are primates, and therefore react against the sugar in other mammalian
meat. Steaks and burgers could cause a problem, but not chicken or

"It's also dose dependent. Unlike the peanut allergy, where even a
little drop can cause a reaction, in this case, it's very hard to
reproduce. In other words, the person has to consume enough beef to
produce an allergic reaction, and then you have to wait, [up to 8]
hours afterwards to confirm the reaction," Dr DeAngelo explains.

The Lone Star tick is seen mostly in the eastern and south eastern
USA. Its area is expanding and includes Pennsylvania. Dr  DeAngelo
says local tick analysis has not shown any in Allegheny County, though
residents have found the tick on themselves, but it's thought to be
brought from other areas.

The allergy can be confirmed with blood tests, though these aren't FDA
[Food and Drugs Administration] approved yet, and could be a big
out-of-pocket expense. There are no shots or tablets available for
densensitization. But the allergy can be self-limited. "Fortunately,
it does go away. In the majority of the cases, if the person avoids
future tick bites, it will gradually diminish over time," DeAngelo

[2] Oklahoma
Date: Tue 26 Aug 2014
Source: CBS News [edited]

If you've been spending a lot of time outdoors and have suddenly
developed an allergy to red meat, you may want to check yourself for
ticks. The Lone Star tick can set off a potentially life-threatening
red meat allergy. That's what happened to an outdoorsman and arborist
from Tulsa, Oklahoma. He told CBS Tulsa affiliate KOTV that he didn't
remember any ticks biting him, but a severe allergic reaction after
eating a taco last fall prompted him to seek medical attention.
"Itching, hives, sweating, couldn't breathe, throat closed up," he
recalled the terrifying reaction.

Doctors can be slow to recognize the problem, and the man's trip to
the ER failed to provide him with answers. After a 2nd reaction to
eating a cheeseburger a few days later, the avid carnivore went to an
allergy clinic for testing. "They said, oh, well, you're allergic to
red meat. And I asked, I said, Are you sure you're looking at the
right person? Because that's what I've lived on my whole life. And
they said, Yeah, this is you," he said.

The Lone Star tick, found in the south and the eastern half of the
USA, carries a sugar called alpha-gal that humans don't have. This
sugar is also found in red meat, beef, pork, venison, rabbit, and some
dairy products. When the tick bites, it can trigger a person's immune
system to create antibodies to the sugar that, in turn, cause their
body to reject red meat, setting off a serious allergic reaction.

And, because the slightest cross contamination could be fatal, dining
out can become a matter of life and death for those affected. The man
is now restricting his diet to "fins" and "feathers," just fish and
poultry. "Seafood's not bad, but there's only so many ways you can
cook chicken and turkey," he said laughing.

This man, and others affected by the allergy, have reason to hope for
a time when they can reintroduce red meat into their diets. Doctors
have yet to confirm whether the allergy is permanent, and there is a
chance some people will grow out of it. But, be warned, if you get
another tick bite, the allergy will return along with the severe

Though this patient's reaction occurred almost immediately, the
symptoms can take up to 8 hours to show after ingesting red meat in
some cases. Allergic reactions can be treated with antihistamines to
ease itching. In case of an extreme reaction, the patient carries a
medicine kit with an epinephrine shot.

communicated by:

[It seems that in some tick-endemic areas, this association is being
increasingly recognized. One relevant study was published in 2011
[Commins SP, James HR, Kelly LA, et al. The relevance of tick bites to
the production of IgE antibodies to the mammalian oligosaccharide
galactose-alpha-1,3-galactose. J Allerg Clin Immunol. 2011;127:
1286-1293.] The abstract can be found in ProMED-mail: Lone star tick -
USA: link to meat allergy 20120623.1178567.

It has been known for several decades that an immunological reaction
occurs to tick salivary antigens in animals fed on by the tick.
Indeed, a large amount of research has been published regarding the
protection of humans and animals from tickborne diseases by
immunization with tick antigens which may block the ability of the
tick to transmit infection (for a review, see: Lee R, Opdebeeck JP.
Arthropod vaccines [in: New vaccines and new vaccine technologies,
Lutwick LI (editor)]. Infect Dis N Am. 1999;13: 209-226).

This study came about related to the monoclonal antibody cetuximab,
which is specific for epidermal growth factor receptor and was
approved for use in treating cancer in 2005. Subsequently, it became
clear that a significant number of treated patients were experiencing
severe hypersensitivity reactions during their 1st infusion of this
monoclonal antibody. Those reports appeared to be restricted to an
area of the southeastern USA, including Tennessee, North Carolina,
Arkansas, Virginia, and the southern half of Missouri. In 2007, a
detailed investigation of serum antibodies established that these
reactions were occurring in patients who had preexisting IgE
antibodies specific for the glycosylation on the Fab fragment of the
monoclonal antibody. The relevant oligosaccharide was found to be
galactose-alpha-1,3-galactose (alpha-gal), which is a blood group
substance of non-primate mammals.

Of note, the known distribution of the immediate reactions to
cetuximab was similar to the areas with high prevalence of Rocky
Mountain spotted fever and human ehrlichiosis. The authors of the
paper became aware of patients who thought that reactions to red meat
started after receiving multiple tick bites and were informed that
several allergists had reported to their local allergy meetings about
patients who had become allergic to meat after experiencing multiple
tick bites.

Diseases linked to _A. americanum_ include erlichiosis, tularemia and
STARI (Southern Tick-Associated Rash Illness,
<>). Pictures of the lone star tick,
including one of engorging female _A. americanum_ ticks, can be found
at: <>.

It is increasingly clear that the same delayed (3-6 hours) IgE
mediated hypersensitivity from meat can be associated with other ticks
such as _Ixodes holocyclus_ in Australia (1) and _I. ricinus_ in
Sweden (2) and Spain (3); and not only can beef be an issue, but also
lamb, pork and game (1). Additionally, alpha-gal has been identified
in the gastrointestinal tract of ticks (2). The curious delayed nature
of a usually rapid onset immune reaction may be explained by the
slower absorption of the alpha-gal expressing glycoproteins
transported with dietary triglycerides (4).

1. Van Nunen SA, O'Connor KS, Clarke LR, Boyle RX, Fernando SL. An
association between tick bite reactions and red meat allergy in
humans. Med J Aust. 2009;190: 510-511.
2. Hamsten C, Starkhammar M, Tran TAT, et al: Identification of
galactose-alpha-1,3-galactose in the gastrointestinal tract of the
tick _Ixodes ricinus_: possible relationship with red meat allergy.
Allergy 2013;68: 549-552.
3. Nunez R, Carballada F, Gonzalez-Quintela, et al. Delayed mammalian
meat-induced anaphylasis due to galactose-alpha-1,3-galactose in 5
European patients. J Allergy Clin Immunol. 2011;128: 1122-1124.
4. Saleh H, Embry S, Nauli A, Atyla S, Krishnaswamy G. Anaphylactic
reactions to oligosaccharides in red meat: a syndrome in evolution.
Clin Mol Allergy. 2012; 10(1):5.
- Mod.LL]

[See Also:
Lone star tick - USA: link to meat allergy 20130614.1773380
Lone star tick - USA: link to meat allergy 20120623.1178567
Lone star tick - USA: New England 20060724.2038]

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