Tuesday, October 18, 2016

Alpha gal allergy (meat allergy) and lone star ticks


A 40-year-old patient developed a meat allergy after a tick bite.  This condition has been reported in association of lone star tick bites.  She previously lived in a rural part of South Eastern Virginia and actively engaged in gardening and she had two dogs. Over a period of years, she had numerous tick bites. On one occasion she developed a bull’s eye rash after a tick bite and was treated for Lyme disease. It was after this she noticed a reaction to dairy products, causing hives. She had acquired the tick-bite meat allergy syndrome.  She was a long time vegan. One would have thought “meat allergy” wouldn’t be a problem. It was. Dairy was surprisingly an issue. She found that she was sensitive to trace amounts of meat. For example, she reacted to vegan food prepared in restaurants that also served meat. She became sensitive to leather shoes and leather belts. She began to have hives daily. Nothing could control the reactions.  She became progressively sensitive to a wide array of inciting agents. Chemicals, other foods, environmental changes (change in temperature), non-specific scents would cause reactions. Hives were a daily affair, recurring several times. The hives were severe covering large swaths of skin, itching like mad. The hives were minimally controlled with high doses of antihistamines. She had several scary anaphylactic reactions and carried an epi-pen at all times. The illness was progressive and frightening. In addition to allergic manifestations she suffered with: chronic fatigue, migratory joint pain, numbness and tingling and brain fog.  
She tested positive for alpha gal antibodies.  Alpha gal is short of galactose-alpha-1,3 galactose. Alpha gal is a carbohydrate not found in our bodies but present in other mammals we ingest, i.e. cows and pigs.  A protein in lone star tick saliva promotes the production of antibodies against the foreign carbohydrate leading to the disorder.

Alpha gal allergy is not a benign disorder.  Despite claims to the contrary, patients may become sensitive to many other foods, including dairy, eggs and poultry.  In the case of this patient, she became reactive to foods high in histamine and histamine promoters (such as tomatoes, eggplants, strawberries etc.).  She developed a generalized, systemic mast cell disorder. To the best of my knowledge, this has not been described in literature.

When I first met her, several months ago, she had acquiesced to the notion that hives would always be with her.
But we got her better.  

Treatment has included: therapy for mast cell activation disorder and long-term antibiotics. The former daily hives now occur once monthly at most.
Mast cell programs have previously been described.  A low histamine or mastocytosis diet is required.  In addition, high doses of antihistamines: H1 and H2 blockers, Singulair (leukotriene blocker) and cromolyn (mast cell inhibitor) have effectively controlled her symptoms.

Long-term antibiotics have been very helpful, controlling fatigue, numbness and tingling, joint pain and brain fog.  We she came to see me she was only worried about alpha gal not realizing how much persistent Lyme was affected her.

This disorder is associated only with bites from lone star ticks (perhaps chiggers) but not deer ticks.

Yet another reason to avoid tick bites at all (reasonable) costs.

10 comments:

Jenny said...

Wish you were my doctor 😭 awesome!

borrismart121 said...

I have also been seeking suggestions for a professional doctor who can treat my allergic disease Urtikaria. I have often. Have tried various medicines, therapies and home remedies but nothing works for long.

Christian said...

When your patients are on long term antibiotic therapy, what antibiotics do you consider to support them for that I perceive as indefinitely?

Christian said...

Deer ticks convey alpha-gal allergy too. In Sweden a study has been following 50 patients with alpha-gal allergy after a tick bite. We only have deer-ticks in Sweden.

Silver said...

Vegan and vegetarian are different things - vegans do not consume or wear any animals products. Your patient was obviously NOT a vegan.

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crf said...

recent finding on alphagal and shingles/MMR vaccine
http://acsh.org/news/2016/12/29/ticks-may-cause-allergic-reaction-red-meat-shingles-vaccine-10654

and unexpected items that can cause sensitivity
http://www.treehugger.com/green-food/9-everyday-products-you-didnt-know-had-animal-ingredients.html

crf said...

article on alpha gal in Minnesota
http://www.scenicrangenewsforum.com/tick-triggered-allergy-surfaces-in-northern-minnesota-wiscon/