Mammalian meat allergy emerges after tick bite: the alpha-gal syndrome

Ellery Altshuler; Jesse Krikpatrick; Mahmoud Aryan; Frank Miralles

doi:10.1136/bcr-2021-245488

Mammalian meat allergy emerges after tick bite: the alpha-gal syndrome

BMJ Case Rep. 2021 Nov 19;14(11):e245488. doi: 10.1136/bcr-2021-245488.

Authors

Ellery Altshuler¹, Jesse Krikpatrick², Mahmoud Aryan³, Frank Miralles⁴

Affiliations

¹ Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA ElleryAltshuler@gmail.com.
² Harvard Medical School, Boston, Massachusetts, USA.
³ Internal Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
⁴ University of Florida College of Medicine, Gainesville, Florida, USA.

Abstract

Alpha-gal syndrome (AGS) is a hypersensitivity reaction to mammalian meat that develops after tick bite exposure. AGS was first described in 2009 and testing for the allergy has become available in the last decade. We report the case of a 56-year-old farmer with a history of frequent lone star tick bites who presented with a 7-year history of diffuse urticaria occurring hours after eating red meat. AGS is likely underdiagnosed because of the unusual presentation of the allergy, historic lack of available testing, and deficiency of physician knowledge about the condition. Recognition of AGS is important both to help alleviate symptom burden and to avoid iatrogenesis. Patients with AGS should not receive products containing mammalian products, such as cat-gut suture, porcine-derived heart valves, and bovine-derived vaccines. Patients with AGS may present in a variety of clinical environments and physicians of all kinds should be able to recognise the symptoms.

Keywords: dermatology; general practice / family medicine; infectious diseases.

Publication types

Case Reports

MeSH terms

Animals
Cattle
Food Hypersensitivity* / diagnosis
Food Hypersensitivity* / etiology
Humans
Meat
Red Meat*
Tick Bites*
Urticaria*

Supplementary concepts

red meat allergy