The Asian Longhorned Tick (Haemaphysalis longicornis), recently introduced in the U.S., is known to trigger AGS in Asia ( 19). As of yet, it has not been tied to any cases in the U.S.In the United States, the Lone Star Tick ( Amblyomma americanum) is thought to be the primary cause of AGS ( 16), based geographical range and tick salivary factors ( 57).
Alpha-gal syndrome is associated with the bite of certain species of ticks. In different parts of the world, different tick species are implicated ( 15). AGS is the leading cause of adult-onset allergy and anaphylaxis throughout the South and much of the eastern U.S. People in rural areas and others in frequent contact with ticks, including foresters, hunters ( 57, 59), loggers, and people with outdoor hobbies ( 15) are especially at risk. The vast majority are undiagnosed or misdiagnosed with other illnesses. In some areas, including much of the southeastern U.S., up to 3% of the population is estimated to have clinical AGS with anaphylactic reactions ( 57, 61). Even for people without the clinical symptoms of AGS, alpha-gal sensitization could be a risk factor for coronary artery disease ( 79, 80). In populations with high exposure to ticks, 15-35% of individuals can be sensitized to alpha-gal ( 57). lab testing for alpha-gal IgE, ViraCor Eurofins, reported over 14,500 positive test results in a recent twelve-month period (81). ( 11), where the number of diagnosed cases has risen from 12 in 2009 to over 34,000 in 2019 ( 63). AGS is already a common allergy in some regions of the world, including the U.S. Models suggest that this will continue ( 10, 15). Conditions tentatively linked to the alpha-gal immune response include some autoimmune diseases ( 7), arthritis ( 60), and atherosclerosis ( 79, 80).Īs tick populations swell and their ranges expand ( 3, 9, 10, 15) the number of people being diagnosed with alpha-gal syndrome is rising ( 8). The allergy component of AGS is only one dimension of a complex immune response that may have other health implications ( 7). In some regions, twenty times as many people living in rural areas may be sensitized than people living in nearby urban areas ( 98). 
Hunters, foresters, and other populations with high exposure to ticks are more at risk of developing AGS ( 57, 59, 69, 98).AGS is associated more with adults than children, and onset in adults and older children who previously tolerated red meat is common ( 57).Prior to diagnosis, many patients are misdiagnosed with IBS or other GI conditions ( 57). In 3-20% of cases, patients report gastrointestinal symptoms alone, without other symptoms.Co-factors such as alcohol consumption and exercise can dramatically impact the severity of reactions or whether they occur at all ( 22, 23, 57).This lack of consistency has been described as “almost a diagnostic hallmark” by experts ( 57). Reactions do not occur after every exposure or follow an obvious pattern.Its presentation is atypical and includes delayed-onset reactions that can occur 2-10 hours or more after exposure, often in the middle of the night ( 1, 5, 6).Lipids, in addition to proteins, are an important source of the allergen ( 100).It is one of only two carbohydrate allergies that cause life-threatening reactions ( 4).AGS is associated with tick bites ( 3).Products containing carrageenan, which isn’t from a mammal, but which contains the alpha-gal epitope ( 54, 57)ĪGS differs from typical allergies in significant ways:.Drugs, medical products, personal care, household and other products with mammalian ingredients ( 57).Foods that contain mammalian byproducts ( 57).
Dairy products, gelatin, and other foods derived from mammals ( 57). Mammalian meats, organs, and blood ( 57). Delayed-onset reactions often occur in the middle of the night ( 1).Īlpha-gal allergic reactions can occur after exposure to: They can be immediate, as with hypersensitivity reactions to injected drugs, or delayed by 2 to 10 hours, as is typical after consumption of mammalian meat ( 1). It is poorly understood within the medical community because of its recent discovery and its varied and atypical presentation. Reactions to alpha-gal are often severe and sometimes fatal. The onset of AGS is associated with tick bites ( 3).Īlpha-gal syndrome was first described in 2009 ( 1). This sugar, commonly known as alpha-gal, is found in all mammals except for Old World monkeys, apes, and humans ( 99), as well as some other organisms. Medications and Other Medical Products–coming soonĪlso known as mammalian meat allergy, is an allergy involving an IgE antibody response to galactose-α-1,3-galactose ( 1). Reactions to Airborne Alpha-gal–coming soon.
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