One day, you’re enjoying a beautiful hike through the tall grass. A few months later, you find yourself in anaphylaxis from a post-hike hamburger. The culprit: a tick bite. In this much-requested episode, we take on alpha-gal syndrome, the red meat allergy triggered by the bite of a tick. Sometimes science is stranger than fiction. How exactly does an encounter with a tiny arachnid cause your throat to swell up and your skin break out into hives hours after eating red meat? Is it all red meat? Is it all ticks? How on earth did anyone even make this connection in the first place? Those are just a few of the questions we answer in this action-packed episode that has us venturing into surprising topics, like primate evolution, ancient epidemics, and cancer treatments. Tune in for all this and more.
| History | Biology |
| Anstee, David J. “The relationship between blood groups and disease.” Blood, The Journal of the American Society of Hematology 115.23 (2010): 4635-4643. | Moore, P., 2020. The meat-allergy mystery with a tick-bite link. Nature, 588, p.S17. (not peer reviewed) |
| Bishop, Joseph R., and Pascal Gagneux. “Evolution of carbohydrate antigens—microbial forces shaping host glycomes?.” Glycobiology 17.5 (2007): 23R-34R. | Nunen, S.A.V., O’Connor, K.S., Clarke, L.R., Boyle, R.X. and Fernando, S.L., 2009. An association between tick bite reactions and red meat allergy in humans. Medical journal of Australia, 190(9). |
| Cabezas-Cruz, Alejandro, et al. “Effect of blood type on anti-α-Gal immunity and the incidence of infectious diseases.” Experimental & molecular medicine 49.3 (2017): e301-e301. | Commins, S.P., Satinover, S.M., Hosen, J., Mozena, J., Borish, L., Lewis, B.D., Woodfolk, J.A. and Platts-Mills, T.A., 2009. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Journal of Allergy and Clinical Immunology, 123(2), pp.426-433. |
| Cabezas-Cruz, Alejandro, et al. “Environmental and molecular drivers of the α-Gal syndrome.” Frontiers in immunology 10 (2019): 1210. | Commins, S.P., James, H.R., Kelly, L.A., Pochan, S.L., Workman, L.J., Perzanowski, M.S., Kocan, K.M., Fahy, J.V., Nganga, L.W., Ronmark, E. and Cooper, P.J., 2011. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1, 3-galactose. Journal of Allergy and Clinical Immunology, 127(5), pp.1286-1293. |
| Cabezas-Cruz, Alejandro, et al. “Tick–human interactions: from allergic klendusity to the α-Gal syndrome.” Biochemical Journal 478.9 (2021): 1783-1794. | Steinke, J.W., Platts-Mills, T.A. and Commins, S.P., 2015. The alpha-gal story: lessons learned from connecting the dots. Journal of Allergy and Clinical Immunology, 135(3), pp.589-596. |
| Commins, Scott P., and Thomas AE Platts-Mills. “Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant.” Journal of allergy and clinical immunology 124.4 (2009): 652-657. | Commins, S. P. (2020). Diagnosis & management of Alpha-gal Syndrome: Lessons from 2,500 patients. Expert Review of Clinical Immunology. doi:10.1080/1744666x.2020.178 |
| Commins, Scott P., et al. “Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose.” Journal of Allergy and Clinical Immunology 123.2 (2009): 426-433. | van Nunen, S.A., 2018. Tick‐induced allergies: mammalian meat allergy and tick anaphylaxis. Medical Journal of Australia, 208(7), pp.316-321. |
| de la Fuente, José, et al. “The alpha-Gal syndrome: new insights into the tick-host conflict and cooperation.” Parasites & vectors 12 (2019): 1-5. | Koike, C., Uddin, M., Wildman, D.E., Gray, E.A., Trucco, M., Starzl, T.E. and Goodman, M., 2007. Functionally important glycosyltransferase gain and loss during catarrhine primate emergence. Proceedings of the National Academy of Sciences, 104(2), pp.559-564. |
| Gagneux, Pascal, and Ajit Varki. “Evolutionary considerations in relating oligosaccharide diversity to biological function.” Glycobiology 9.8 (1999): 747-755. | Crispell, G., Commins, S.P., Archer-Hartman, S.A., Choudhary, S., Dharmarajan, G., Azadi, P. and Karim, S., 2019. Discovery of alpha-gal-containing antigens in North American tick species believed to induce red meat allergy. Frontiers in immunology, 10, p.1056. |
| Galili, Uri. “Evolution and pathophysiology of the human natural anti-α-galactosyl IgG (anti-Gal) antibody.” Springer seminars in immunopathology. Vol. 15. Springer-Verlag, 1993. | Shah, R., Schwartz, R.A. Meat Allergy: A Ticking Time Bomb. Am J Clin Dermatol 23, 515–521 (2022). https://doi.org/10.1007/s40257-022-00696-x |
| Galili, Uri. “Anti‐G al: an abundant human natural antibody of multiple pathogeneses and clinical benefits.” Immunology 140.1 (2013): 1-11. | Kay, A.B., 2001. Allergy and allergic diseases. New England Journal of Medicine, 344(1), pp.30-37. |
| Galili, Uri. “Significance of the evolutionary α1, 3-galactosyltransferase (GGTA1) gene inactivation in preventing extinction of apes and old world monkeys.” Journal of Molecular Evolution 80 (2015): 1-9. | Rindsjö, E. and Scheynius, A., 2010. Mechanisms of IgE-mediated allergy. Experimental cell research, 316(8), pp.1384-1389. |
| Galili, Uri. “Evolution in primates by “Catastrophic‐selection” interplay between enveloped virus epidemics, mutated genes of enzymes synthesizing carbohydrate antigens, and natural anti‐carbohydrate antibodies.” American Journal of Physical Anthropology 168.2 (2019): 352-363. | Anvari, S., Miller, J., Yeh, C.Y. and Davis, C.M., 2019. IgE-mediated food allergy. Clinical reviews in allergy & immunology, 57, pp.244-260. |
| Hodžić, Adnan, et al. “Tick bites induce anti-α-Gal antibodies in dogs.” Vaccines 7.3 (2019): 114. | Binder, A.M., Cherry‐Brown, D., Biggerstaff, B.J., Jones, E.S., Amelio, C.L., Beard, C.B., Petersen, L.R., Kersh, G.J., Commins, S.P. and Armstrong, P.A., 2023. Clinical and laboratory features of patients diagnosed with alpha‐gal syndrome—2010–2019. Allergy, 78(2), pp.477-487. |
| Rodriguez, Idalia A., and Raymond M. Welsh. “Possible role of a cell surface carbohydrate in evolution of resistance to viral infections in old world primates.” Journal of Virology 87.15 (2013): 8317-8326. | Hilger, C., Fischer, J., Wölbing, F. and Biedermann, T., 2019. Role and mechanism of galactose-alpha-1, 3-galactose in the elicitation of delayed anaphylactic reactions to red meat. Current allergy and asthma reports, 19, pp.1-11. |
| Sharma, Surendra Raj, and Shahid Karim. “Tick saliva and the alpha-gal syndrome: finding a needle in a haystack.” Frontiers in cellular and infection microbiology 11 (2021): 680264. | Ferreira, BR., and Silva, JS, 1999. Successive tick infestations selectively promote a T‐helper 2 cytokine profile in mice. Immunology, 96(3), pp.434-439. |
| Singh, Sumnima, et al. “Loss of α-gal during primate evolution enhanced antibody-effector function and resistance to bacterial sepsis.” Cell host & microbe 29.3 (2021): 347-361. | Carpenter, A., 2023. Health care provider knowledge regarding alpha-gal syndrome—United States, March–May 2022. MMWR. Morbidity and Mortality Weekly Report, 72. |
| Soares, Miguel P., and Bahtiyar Yilmaz. “Microbiota control of malaria transmission.” Trends in parasitology 32.2 (2016): 120-130. | Thompson, J.M., 2023. Geographic distribution of suspected alpha-gal syndrome cases—United States, January 2017–December 2022. MMWR. Morbidity and mortality weekly report, 72. |
| Steinke, John W., Thomas AE Platts-Mills, and Scott P. Commins. “The alpha-gal story: lessons learned from connecting the dots.” Journal of Allergy and Clinical Immunology 135.3 (2015): 589-596. | Neergaard, L. July 21, 2024. Associated Press. Pig transplant research yields a surprise: Bacon safe for some people allergic to red meat. https://apnews.com/article/meat-allergy-lone-star-tick-pig-alphagal-edf82b6c1928450da1373ea61e6a3a44 |
| van Nunen, Sheryl. “Tick-induced allergies: mammalian meat allergy, tick anaphylaxis and their significance.” Asia Pacific Allergy 5.1 (2015): 3-16. | Vaz-Rodrigues, R., Mazuecos, L. and de la Fuente, J., 2022. Current and future strategies for the diagnosis and treatment of the alpha-gal syndrome (AGS). Journal of asthma and allergy, pp.957-970. |
| Nunen, Sheryl A. Van, et al. “An association between tick bite reactions and red meat allergy in humans.” Medical journal of Australia 190.9 (2009). | |
| Xi, Jiahui, et al. “Genetically engineered pigs for xenotransplantation: hopes and challenges.” Frontiers in Cell and Developmental Biology 10 (2023): 1093534. |
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6 thoughts on “Episode 153 Alpha-Gal Syndrome: A tick bite gone bad”
Thanks for covering this! My Dad has this and unfortunately was already allergic to sea food as well as eggs.
So he can only eat chicken/turkey meat now.
We used to have steak or beef stew a lot when I was a kid so this was a big change for him.
I’m also allergic to eggs and before we knew about the tick induced side of the allergy I was convinced I’d eventually not be able to eat red meat as well.
I’m so glad you all did this episode, great time as there is a bill in congress to get the FDA to require food and medicine labels to finally protect use Alpha Gal people!
Hi Erins,
I am creator of the Alpha-gal Information website, the most extensive resource on alpha-gal syndrome, founder of the Alpha-gal Alliance, which promotes the health and well-being of people with alpha-gal syndrome (AGS), and cofounder of the Alpha-gal Alliance Action Fund, which works to to advance policy solutions that improve the lives of people affected by alpha-gal syndrome (AGS).
Just hear to say thanks for this great podcast. You *totally slayed* it, ladies! And I never say this. I am persnickety. I usually whine about all the inaccuracies in podcasts about AGS. I am going to promote the heck out of this episode.
I also want to make you aware of a new bill, HR 9382, the Alpha-gal Allergen Inclusion Act. This bill, which was introduced by Rep. Jeff Van Drew in August, would codify alpha-gal as a major food allergen. Doing so would help people with AGS more easily identify food that is unsafe for them by requiring labeling in plain language on packaged food sold in the U.S. in the same way that the other top allergens – milk, eggs, peanuts, tree nuts, wheat, soy, shellfish, fish, and sesame – are already labeled. Maybe you can work this into a future episode on AGS? There are so many cool possibilities for stuff about alpha-gal that you could cover, and I hope you do. You’ve just scratched the surface!
Again, thank you!
Sharon
Dear Sharon,
I wanted to make you aware of a virtual community engagement session I helped organize for our client, the HHS Office of the Assistant Secretary for Health, Office of Infectious Diseases and HIV/AIDS Policy. It’s related to the Mental Health and Neruological Effects of Tick-Borne Diseases and Associated Illnesses, including conditions such as Alpha-gal Syndrome. It take place on October 24th and will feature a talk by Dr. Scott Commins entitled: “It’s not just about avoiding red meat: giving voice to the untold implications of alpha-gal syndrome.” (The agenda will be updated with this title in the next day or so.) If you’d like to share your email address with me, I can add you to our outreach list. I hope you’ll share the event information with your colleagues and community as well! Thank you for all you do for the AGS community.
https://www.hhs.gov/oidp/initiatives/tick-borne-diseases-associated-illnesses-national-community-engagement-initiative/index.html
Anyone interested in receiving communications about this 2-year community engagement initiative or the October session can find information here: https://www.hhs.gov/oidp/initiatives/tick-borne-diseases-associated-illnesses-national-community-engagement-initiative/index.html
And email me to be added to our outreach list here: tb***********@ro**************.com
I’ve been aware of alpha-gal syndrome for probably 5 years now, but largely because I’m an optometrist, so in the health care field and I’ve had a few patients diagnosed with it (I had no part in their dx) and have to be careful about gelatin-containing products that I recommend. My neighbor was also diagnosed with it a couple years ago. He had a severe anaphylactic response overnight.
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