Alpha-gal: A lasting, growing hot topic around ticks

Lone star ticks imparting "red-meat allergy" to more and more Oklahomans

A male lone star tick. Adult females have a characteristic white spot (star) in the center of the posterior portion of the shield. (KJBOutdoors photo)

Another treatment, another spring day, another friend with a puzzling health issue caused by the common lone star tick.

A particular smell of springtime is in the air on my back porch as write. It’s a moist mix of earthy spring rain, recently mowed lawn and insecticide.

Springtime is tick time and a set of clothing is hanging on my typical temporary clothesline of faded red 7/16- inch stay line (it used to hang from a tree stand) that comes out every time I renew an application of permethrin on a set of outdoor clothing.

And springtime is tick time because yet another friend reported they had a short encounter with a lone star tick, “it wasn’t even attached for long.” A simple bite and now they have an allergy to red-meat products, are taking medications to get rid of uncomfortable hives and swelling and will carry an epinephrine injector, an Epipen, from now on.

Six years, I’ve been writing about this stuff and every year it seems more commonplace.

In 2015 the big news around ticks focused on rare but fatal cases that involved the Bourbon and Heartland viruses. Those viruses remain rare. (thankfully)

The Centers for Disease Control and Prevention cites only “limited” numbers of Bourbon and “more than 50 cases of Heartland from North Carolina to Colorado as of June 2020.

But that spring of 2015 I also wrote a story about a burger-and-steak loving 19-year-old in Skiatook that found out he was allergic to red meat after a couple of middle-of-the-night trips to the emergency room due to an inability to breathe. He was in a steak for dinner, epinephrine for a lifesaving middle-of-the-night boost, routine until his doctors zeroed in on what was then a mostly unheard-of allergy.

The allergy is growing and fascinating but the standard tick-borne illnesses still demand attention. I need to include those before I ramble on.

Oklahoma still ranks among the top states for Rocky Mountain spotted fever, ehrlichiosis and tularemia—and the highest risk comes when ticks are most active between May and August, according to the Oklahoma Department of Health.

The presence of Lyme disease in Oklahoma remains relatively rare although black-legged deer ticks that carried the bacteria have been documented in the state. Expansion of the similar Southern Tick Associate Rash Illness, or STARI, has compounded some debate around Lyme disease here.

While alpha-gal has become more common you won’t find a mention of it in Health Department tick-borne disease info. It’s not “reportable” because it’s not like getting a viral or bacterial disease like Lyme Disease or Rocky Mountain Spotted Fever.

The CDC labels it “Alpha-gal Syndrome” or AGS—or “red meat allergy” or “tick bite meat allergy”—which makes me wonder if whoever wrote it up for the CDC just felt like they really had to have a third title for it.

Apparently it takes very little to get this reaction and not much is known about why some people get it after being bitten year after year with no issues and why it impacts different people in different ways or levels of severity.

While the natural focus on the allergy is the need to stop eating red meat, alpha-gal is an ingredient in some medications, cosmetics, vaccines, milk products and gelatin.

Alpha-gal is the name for a sugar molecule found in most mammals but not primates or humans. It’s also not found in fish, reptiles or birds. The problem in Oklahoma is with lone star ticks that have this molecule in their saliva.

The tick bites and your body develops an immune response to introduction of that molecule. Then, at some point, you digest meat that contains that molecule and your immune system goes haywire, with rash, hives, dizziness, nausea, severe stomach pain, or difficulty breathing.

The reaction sometimes comes hours after a meal because the reaction comes with digestion of the sugar molecule that causes the reaction. While the natural focus on the allergy is the need to stop eating red meat, alpha-gal is an ingredient in some medications, cosmetics, vaccines, milk products and gelatin. My most recent friend with the malady has to take calcium supplements for another condition but the best effective supplement is made from beef bones and now causes problems.

I’ve talked to about people with scary lung issues and nausea caused just by breathing near a fast-food grill. I’ve heard about stomach issues you really would rather not hear about, tongues swelling up like tennis balls and hives and swelling that lasts for days. I’ve also heard about people with pretty mild issues of itching or redness that fades, and from those who see their symptoms lessening over time, as long as another tick does not bite them.

I caught up with Garrett Massey, that 19-year-old I wrote about in 2015, and he texted this update: “I am actually able to eat more and more as time has gone by. I have not been bitten again so the allergists are having me try more every day.”

“Slowly making progress,” is how he put it. He also noted, “I use bug spray like crazy.”
That’s a good idea for all of us, especially this time of year.

An adult female lone start tick with signature white “star.” (Photo Courtesy David John).

Keeping ticks at bay: My permethrin/DEET combo

Use permethrin to treat clothing/tents/chairs/hammocks: Permethrin is a common insecticide used by the U.S. military and ranchers (sheep dip) for decades. I guess I can claim the same now as I started treating my clothes with it as an off-label use of the produce in the early 1990s. It works, and it seems much healthier than spraying 98-percent DEET all over your body.

Several times a year I use Sawyer Permethrin Insect Repellent for Clothing to treat socks, hats, pants and shirts I regularly wear outdoors—especially my turkey hunting vest and clothes and my deer hunting clothes. It is available at Bass Pro, Walmart and other sporting good stores. I commonly wear knee boots with neoprene uppers and I treat those boots, too. I’ll typically wear an over-the-calf lightweight sock, also treated. I like to wear a loose shirt in summer, but now I wear a thin T-shirt under that loose shirt (also treated) that is tucked in.

Do it yourself, or have others do it: Repel and other companies make a permethrin treatment for clothing and camping gear you can use to treat but several brands of insect-repellent clothing can be purchased. Look for a label that notes “Insect Shield” treatment or other applications—but check to make sure it specifically lists ticks as a target of the treatment. Insect Shield also offers to treat clothing. You send off your stuff and they send it back with a treatment that lasts much longer than do-it-yourself sprays.

Fill in the gaps with DEET 100: I don’t apply too much DEET, but what I do apply is either 98% DEET or a 3M product called Ultrathon (which is 20%). I’ve found the Ultrathon cream lasts well even when I’m sweaty or getting wet and muddy. The downside is it’s a little greasy and smelly.

DEET 100 (actually 98%) will repel ticks and mosquitoes and last longer than the 20 or 40 percent versions. The downside to it is, again, smell, but also that DEET melts plastic. That includes the sunglass or eyeglass rests behind your ears, camera parts, rubberized grips on tools, fishing gear, you name it. It’s best to spray it on your hands, rub it where you need it and then wash your hands.

NOTE FOR PARTENTS: The American Academy of Pediatrics does not recommend DEET products for children younger than 2 months old and cautions against using any repellent with more than 30 percent DEET on children of any age. For children the safest bet is to stick with 10 percent DEET and try (I know, “try”) to use permethrin-treated clothing to keep them covered.

Just careful with DEET, use it sparingly, and it will fill in the gaps where permethrin-treated clothing doesn’t have you covered.

That’s the permethrin/DEET combo that has kept me (mostly) tick bite free.