Check out these 8 tips about ticks and AGS

Warmer days mean more time in the backyard or backcountry. It’s also time to learn how a tick bite can cause an allergy to red meat called alpha-gal syndrome.

Alpha-gal syndrome begins when a bite, usually from the Lone Star tick, triggers an immune reaction to a sugar called alpha-gal found in red meat. The allergic symptoms may include hives, belly ache, itching or life-threatening anaphylaxis.

The Centers for Disease Control and Prevention says that around 450,000 people in the U.S. have alpha-gal syndrome.

Dr. Scott Commins, the Dr. William J. Yount Distinguished Professor and vice chief of the UNC School of Medicine’s rheumatology, allergy and immunology division, offers the following advice on alpha-gal syndrome.

1. Prepare to be outdoors and do tick checks.

Sprays like Off! Deep Woods help. Treat your clothes, but never your skin, with permethrin. Once outside, stick to trails or paths. Don’t wander into high grass. On returning from outside, do a tick check. CDC data shows that tick checks are critical to stopping transmission of infectious diseases, but a tick bite may have already caused an alpha-gal allergy.

2. Recognize alpha-gal symptoms.

After a bite, it takes four to six weeks for the antibody response to form. Symptoms of anaphylaxis can include hives, swelling, itching, redness, loss of blood pressure and chest tightness. Other symptoms are nausea, vomiting, diarrhea or abdominal pain. Many people have itchy palms. Some patients report isolated gastrointestinal symptoms. They eat a hamburger and develop diarrhea, belly pain, nausea or heartburn, sometimes at night, four to six hours after eating meat. You can wake up with hives or terrible abdominal pain. That’s very different from most food allergies. It’s not unusual to have some cramps after a fatty hamburger, but if it happens again after eating pork tenderloin or a hot dog, that pattern is a clue.

3. Get a blood test.

Any healthcare provider can order an alpha-gal blood test, which — coupled with a supporting history of symptoms — can lead to a diagnosis.

4. After diagnosis, avoid red meat and consider medication.

We call it an “appropriate avoidance diet” because there can be individual differences. In addition to no mammalian meat, allergists may recommend avoiding dairy products. Generally, we try not to take away dairy unless folks are really having symptoms. Talk with your doctor about Xolair, a medication that can prevent accidental reactions. Not everybody qualifies for it, but it’s an FDA-approved option.

5. Alpha-gal can go away.

People should not lose hope. The allergy can absolutely resolve, and three to five years is an estimate. Data show that resolution happens in 20 to 30% of patients. Unfortunately, additional tick bites can prevent resolution by boosting the allergic immune response.

6. Alcohol and exercise can worsen the reaction.

Patients often report a link between reactions and eating a hamburger with a beer or a steak with wine. If they were exercising or intensely exerting themselves, their reactions may be more profound. By themselves, these cofactors don’t cause a reaction, but they can intensify it.

7. Reactions can occur irregularly.

The sporadic nature of reactions is a characteristic of AGS. It’s not like an allergy to peanuts or tree nuts, where you react every time. The fat content of meat is important. Some people don’t react to a lean cut, then they have a fattier cut and react again. That inconsistency makes diagnosis tricky.

8. Bite site reactions may predict alpha-gal.

If the tick bite spot is red, raised, itchy and slow to heal, that “allergic reaction” seems to be a clue to predicting who may develop AGS.