Alpha-Gal Syndrome (AGS): Tick-Bite Associated Red Meat Allergy
What Is Alpha-Gal Syndrome (AGS)?
Alpha-Gal Syndrome (AGS) is caused by an allergic reaction to the carbohydrate galactose-α-1,3-galactose (alpha-gal) found in tick saliva. Certain ticks carry alpha-gal in their saliva and transmit this carbohydrate through a tick bite. Humans do not make alpha-gal. Other non-primate mammals do. This syndrome occurs when the human immune system creates anti-alpha-gal IgE antibodies after exposure to mammalian meats that contain alpha-gal. It is also known as a mammalian meat allergy.
Prefer to watch instead of read? In this video, I explain alpha-gal syndrome, how it develops after tick exposure, and what to know if you suspect this condition.
👉 Alpha-Gal Syndrome 101 (Video)
Prefer to watch instead of read? In this video, I explain alpha-gal syndrome, how it develops after tick exposure, and what to know if you suspect this condition.
👉 Alpha-Gal Syndrome 101 (Video)
How Tick Bites Lead to Alpha-Gal Syndrome
Certain ticks—most notably the lone star tick (Amblyomma americanum) in the U.S.—can introduce alpha-gal into the bloodstream when they bite. This can lead the immune system to produce α-gal specific IgE antibodies. Later, when the sensitized individual consumes mammalian meat or other alpha-gal-containing products, the immune system mounts an allergic response.
Ticks that carry alpha-gal:
Only a small percentage of people bitten by these ticks develop AGS. However, the risk increases with the number of tick bites received.
Ticks that carry alpha-gal:
- Amblyomma americanum (lone star tick) in the US
- Amblyomma cajennense in Central America
- Haemaphysalis longicornis in Asia (this species in the US does not carry alpha-gal)
Only a small percentage of people bitten by these ticks develop AGS. However, the risk increases with the number of tick bites received.
Common Symptoms of Alpha-Gal Syndrome
Symptoms can vary widely and may develop 3–8 hours after eating mammalian products, especially red meat. This delayed timing is a unique feature of alpha-gal reactions and can make diagnosis challenging. Furthermore, the first reaction can happen weeks to months after the tick bite that transmitted the alpha-gal containing tick saliva.
After consuming mammalian meat/products, common reactions may include:
Alpha-gal syndrome is the leading cause of anaphylaxis in adults.
After consuming mammalian meat/products, common reactions may include:
- 90% of people experience skin symptoms like hives or flushing.
- Typical first symptom: itching of palms and soles of feet, may be with rash or swelling
- Itching or swelling in mouth, lips, face, tongue, or throat; throat closing
- Anaphylaxis is seen in 60% of cases (can be life-threatening)
- Cardiac symptoms: low blood pressure, lightheadedness, dizziness, fainting, rapid or weak pulse (30-40% of people)
- Respiratory symptoms: shortness of breath, wheezing, chest tightness, cough, hoarseness, trouble breathing
- Gastrointestinal symptoms: abdominal pain, diarrhea, nausea, vomiting, heartburn (20% of people have GI symptoms
alone) - Runny nose, sneezing, headaches
Alpha-gal syndrome is the leading cause of anaphylaxis in adults.
Diagnosis and Testing
Diagnosis typically involves:
Standard allergy skin testing is ineffective for alpha-gal due to the nature of the allergy. A diagnosis should be made in consultation with a health care provider familiar with alpha-gal syndrome.
- A blood test for alpha-gal IgE antibodies
- Clinical evaluation of symptoms and timing relative to meat or mammalian product ingestion
Standard allergy skin testing is ineffective for alpha-gal due to the nature of the allergy. A diagnosis should be made in consultation with a health care provider familiar with alpha-gal syndrome.
Managing and Avoiding Triggers
At this time, there is no FDA-approved treatment for alpha-gal syndrome. In some individuals, the allergy may lessen or resolve over time, particularly if further tick exposure is avoided.
Management focuses on symptom prevention and safety. This often includes the use of antihistamines to help reduce allergic reactions. For individuals at risk of more severe reactions, emergency medications such as epinephrine (an EpiPen) may be recommended by a healthcare provider.
A central component of care is dietary and exposure modification. This involves avoiding alpha-gal–containing products, including mammalian meats and other products derived from mammals. In some cases, alpha-gal may also be present in medications, supplements, or personal care products that use animal-derived ingredients.
To help evaluate medications and supplements, resources such as PillClarity can be used to identify products that are free from animal-derived ingredients. This tool can be especially helpful in preventing inadvertent reactions and in assessing whether a medication or supplement may be contributing to symptoms. Always consult with your healthcare provider before stopping or changing any prescribed medications.
Management involves avoiding foods and products containing alpha-gal. Products to avoid may include:
Management focuses on symptom prevention and safety. This often includes the use of antihistamines to help reduce allergic reactions. For individuals at risk of more severe reactions, emergency medications such as epinephrine (an EpiPen) may be recommended by a healthcare provider.
A central component of care is dietary and exposure modification. This involves avoiding alpha-gal–containing products, including mammalian meats and other products derived from mammals. In some cases, alpha-gal may also be present in medications, supplements, or personal care products that use animal-derived ingredients.
To help evaluate medications and supplements, resources such as PillClarity can be used to identify products that are free from animal-derived ingredients. This tool can be especially helpful in preventing inadvertent reactions and in assessing whether a medication or supplement may be contributing to symptoms. Always consult with your healthcare provider before stopping or changing any prescribed medications.
Management involves avoiding foods and products containing alpha-gal. Products to avoid may include:
- Mammalian meats such as beef, pork, lamb, bison, venison, goat.
- Dairy products, gelatin, fats, lard, suet
- Foods with mammalian byproducts
- Carrageenan (from red algae, but containing alpha-gal epitope)
- Flounder eggs
- “Natural flavorings”
- Drugs, medical products, personal care, and household items with mammalian ingredients
Foods, Products, and Ingredients That May Contain Alpha-Gal
Alpha-gal is found in many mammalian-derived foods and products. The severity of reactions varies widely, and not every individual reacts to all items listed below. Avoidance recommendations are therefore individualized.
Mammalian meats may include:
Mammalian fats may include:
Mammalian organs and byproducts may include:
Dairy and food additives
Some individuals with alpha-gal syndrome also react to:
Medications and medical products
Alpha-gal may be present in certain medications or biologic products, including:
Personal care and skin products
Some cosmetics and skin care products may contain mammalian-derived ingredients such as:
Because sensitivity varies, individuals may tolerate some items while reacting to others. Careful observation and guidance from a healthcare professional are important when determining avoidance strategies.
For a comprehensive list of products to avoid and for more information, visit the invaluable resource Alpha-Gal Information.
Mammalian meats may include:
- Beef, pork, lamb
- Bison, buffalo, venison
- Goat, rabbit, squirrel
- Kangaroo, antelope, camel
- Guinea pig, bat, whale
Mammalian fats may include:
- Lard
- Tallow
- Suet
Mammalian organs and byproducts may include:
- Internal organs (such as liver or kidneys)
- Bones, gelatin, collagen
- Broth, bouillon, stock, gravy
- Blood-derived products (e.g., blood pudding)
Dairy and food additives
Some individuals with alpha-gal syndrome also react to:
- Dairy products
- Natural flavors
- Carrageenan
- Fish roe (such as flounder eggs)
Medications and medical products
Alpha-gal may be present in certain medications or biologic products, including:
- Cetuximab and other monoclonal antibodies
- Pancreatic enzyme replacements
- Some hormone replacement therapies
- Ingredients such as stearic acid or glycerin
- Vaccines that contain gelatin
Personal care and skin products
Some cosmetics and skin care products may contain mammalian-derived ingredients such as:
- Gelatin
- Lanolin
Because sensitivity varies, individuals may tolerate some items while reacting to others. Careful observation and guidance from a healthcare professional are important when determining avoidance strategies.
For a comprehensive list of products to avoid and for more information, visit the invaluable resource Alpha-Gal Information.
Prevention: Reducing Tick Bites and Sensitization
Preventing tick bites is currently the most effective strategy for reducing the risk of alpha-gal syndrome. Alpha-gal syndrome begins with a tick bite, so preventing future tick exposure is an important part of reducing the risk of developing alpha-gal sensitization or worsening existing reactions. In some individuals, repeated tick bites may prolong immune activation related to alpha-gal.
Practical tick-bite prevention strategies include:
Awareness of tick seasonality and regional risk is also helpful. Even brief or unnoticed tick attachments may be relevant, as sensitization can occur without a recalled tick bite.
Reducing tick exposure not only plays a role in alpha-gal prevention, but also helps lower the risk of other tick-borne diseases. Education, preparation, and consistent prevention practices are key components of long-term risk reduction.
Practical tick-bite prevention strategies include:
- Wearing permethrin-treated clothing, including long sleeves and long pants tucked into socks
- Performing thorough tick checks after outdoor activities
- Promptly and properly removing attached ticks
- Managing outdoor environments by reducing tall grasses, leaf litter, and tick habitat around the home
- Using tick tubes in your yard
Awareness of tick seasonality and regional risk is also helpful. Even brief or unnoticed tick attachments may be relevant, as sensitization can occur without a recalled tick bite.
Reducing tick exposure not only plays a role in alpha-gal prevention, but also helps lower the risk of other tick-borne diseases. Education, preparation, and consistent prevention practices are key components of long-term risk reduction.
Working Together / Next Steps
One therapeutic option that some individuals with alpha-gal syndrome choose to explore is Soliman Auricular Allergy Treatment (SAAT). SAAT is an acupuncture-based protocol that involves placing a small needle at a specific point on the ear, which remains in place for approximately three weeks.
Soliman Auricular Allergy Treatment (SAAT) in Savannah, GA
SAAT has been reported to provide symptom remission in approximately 96% of patients for at least nine months. I am trained and certified in SAAT by Nader Soliman, who developed this protocol. To learn more about SAAT and its application in alpha-gal syndrome, visit:
👉 https://saatallergy.com/alpha-gal/
If you are interested in scheduling the Soliman Auricular Allergy Treatment (SAAT) protocol for alpha-gal syndrome, please submit your information using the contact form on this page or schedule a “45-Minute Pre-SAAT Telehealth Consultation." This consultation is the first step in the two-step process. During the telehealth visit, we will determine whether you are a candidate for SAAT. If so, we will then schedule your in-person appointment in Savannah, GA for the needle placement.
As with any therapeutic approach, individual responses to SAAT vary, and outcomes depend on factors such as overall health, immune reactivity, and ongoing tick exposure.
👉 https://saatallergy.com/alpha-gal/
If you are interested in scheduling the Soliman Auricular Allergy Treatment (SAAT) protocol for alpha-gal syndrome, please submit your information using the contact form on this page or schedule a “45-Minute Pre-SAAT Telehealth Consultation." This consultation is the first step in the two-step process. During the telehealth visit, we will determine whether you are a candidate for SAAT. If so, we will then schedule your in-person appointment in Savannah, GA for the needle placement.
As with any therapeutic approach, individual responses to SAAT vary, and outcomes depend on factors such as overall health, immune reactivity, and ongoing tick exposure.
References
1. Commins SP. Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients. Expert Rev Clin Immunol. 2020 Jul;16(7):667-677. doi: 10.1080/1744666X.2020.1782745.
2. Bernal M, Huecker M, Shreffler J, Mittel O, Mittel J, Soliman N. Successful Treatment for Alpha Gal Mammal Product Allergy Using Auricular Acupuncture: A Case Series. Med Acupunct. 2021;33(5):343-348. doi:10.1089/acu.2021.0010
This information is crucial for managing Alpha-Gal Syndrome effectively. If you have any further questions or need additional guidance, please consult your healthcare provider.