Existing Food Allergies Can Increase Alpha-gal Risks (AGS)

What is Alpha-Gal (galactose-α-1,3-galactose allergy) and how can it be made worse. Repost from Precision Point Newsletter

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Existing Food Allergies Can Increase Alpha-gal Risks

(PP Newsletter repost)

Alpha-gal Syndrome (AGS) is transmitted by tick bites and causes an allergy to galactose-α-1,3-galactose (commonly known as Alpha-gal), a carbohydrate that is found in all non-primate mammals. The allergy has been most strongly associated with the Lone Star Tick, but is thought to possibly be associated with other ticks as well. The allergy can be mild or very severe, even life-threatening, and is potentially triggered by consuming any meat from mammals after a tick bite. It’s often called the “red meat allergy” since many people find the allergy triggered by beef, but any mammalian meat, including lamb, pork, and non-fowl game, can also cause the allergy to set in.

The CDC believes that over 100,000 patients may be affected by Alpha-gal stemming from previous tick bites. That number appears to be increasing rapidly as the Lone Star Tick’s range has increased greatly in recent years. What used to be a condition confined to the Southeastern United States can now be found farther afield, up the East Coast as far as Canada, and as far Northwest as Illinois. In many Southern states, they are the most common ticks found on a person, partly because they are so aggressive. Their rapid spread is predicted to continue, and aside from AGS, they can also trigger the rarer Heartland Disease, which can be fatal. It was thought that Lone Star Ticks spread Lyme Disease as well, but the best data suggests they are not doing so. That doesn’t mean that patients who have Lyme Disease can’t also have AGS. Tick bites often go undiscovered, and someone bitten by one tick can be bitten by others, including ticks of other species. Anyone who is active outdoors, especially hunters, anyone with pets, or even people who just stay in their own backyards, can receive tick bites, especially if deer or other game (including wild turkeys) are present.

Only some people bitten by ticks will develop AGS. Alpha-gal Syndrome is a true allergy, meaning that an IgE immunological response develops in some individuals after consuming mammalian meat, which can be severe or even life-threatening. One unusual feature of an AGS meat reaction is that it can be more delayed than usual for an IgE reaction, up to 6 hours. Delayed reactions make it more difficult to trace what the trigger to the reaction is. If you have a hamburger for lunch, and fish for dinner, and react right after having the fish, you (and your doctor) may presume it was the fish that was the trigger, when it may have been the red meat.

The question of which individuals develop AGS and why has been recently studied, and an emerging body of research is coming to the conclusion that immunological damage, particularly that resulting from food allergies and some environmental allergens, is a major contributing factor. A case-control study published in Annals of Allergy, Asthma & Immunology in June of 2024, conducted among adults diagnosed with AGS at an allergy clinic in North Carolina from 2019 to 2020, found that case patients were more likely to report significant reactions to insect stings and a history of food allergies. They were also approximately eight times more likely to report family members with AGS. The study also noted that AGS was more likely in certain blood types, and so, possible genetic factors were involved as well:

“Case patients were more likely than controls to report particularly large marks or welts and/or longer healing times when stung or bitten by an insect (irrespective of tick bite reactions) (OR, 3.14; 95% CI, 1.81-5.47), experiencing allergies in childhood that they no longer had as an adult (OR, 1.99; 95% CI, 1.02-3.89), having food allergies other than red meat and associated products (OR, 1.88; 95% CI, 0.99-3.56), having an allergic reaction (independent of AGS reactions) that required medical care (urgent care, emergency department, or hospital) (OR, 1.93; 95% CI, 0.97-3.82), and having experienced anaphylaxis (independent of AGS reactions) (OR, 1.87; 95% CI, 0.96-3.64)”

These results suggest that a history of unrelated food or insect sting allergies and severe reactions to these allergies specifically were contributing factors in the development of AGS. This is very interesting because it leans into the idea that the immune system, when exposed to many allergens, becomes hyper-primed to become susceptible to new allergies, and perhaps more severe allergies as well.

Another study published in J Allergy Clin Immunol Pract. In 2019 studied 261 children and adults with AGS and searched for correlations that could explain why that group was positive. The study concluded both that an earlier meat and/or pet allergy in childhood could have primed the immune system for AGS, and that:

“sIgE to nonmammalian food allergens was more prevalent (wheat), or trended toward being more prevalent (egg, peanut, and shrimp), in subjects who were sensitized to α-Gal.”

“Thus, differences in cutaneous immunity, as described in the dual-allergen exposure hypothesis, could be a risk modifier for sensitization not only to some food allergens, but also to α-Gal and insect venom.”

Whether or not the second part of the quote is true or just speculation, it is food for thought. The first part of the quote demonstrates that, again, there was a concurrent allergy to foods not related to beef, and that this was more likely to be true in those with AGS than those who were not positive. To be fair, there are some other studies in Europe that did not find the food allergen correlation, but did find the same correlations to stinging insects. In either case, the theory that alterations to the immune system caused by persistent allergies seem to make one susceptible to AGS has merit.

We’ve written extensively about how allergens can alter the immune system, and about how this immune modulation can set the stage for cross-reactivity, inflammation, intestinal permeability, systemic effects, and oxidative stress. It should come as no surprise that the susceptibility to AGS can stem from previous allergies, even though food allergies stem from a protein reaction and AGS stems from a reaction to a sugar. Monitoring a patient’s level of immunological response to foods with the P88 dietary antigen test from Precision Point Diagnostics can be an excellent way to examine risk factors for reactions to alpha-gal.

What are the effects of AGS? Alpha-gal levels subside over time, so there is a real chance that in a few years after developing AGS, an individual may be able to eat red meat again. One problem is that those who have milder responses may not recognize the conditions as AGS, and continue to eat red meat as well as to avoid tick protection. Not only do allergies that are ignored tend to perpetuate themselves, but they are also apt to worsen. Over time, continued red meat consumption, and potentially additional tick bites that transmit more alpha-gal can occur, worsening reactions, and causing other dangers as well:

“Clinical manifestations of AGS vary among patients, and the onset of AGS may not show clinical signs in sensitized patients. However, α-gal sensitization has been reported as a significant risk factor for coronary heart disease, even in people lacking clinical symptoms.” (Wilson et al., 2019).” (Surendra Raj Sharma, Shahid Karim, Front Cell Infect Microbiol. 2021 Jul 20;11:680264. doi: 10.3389/fcimb.2021.680264)

So what is to be done? To start with, if a patient experiences any symptoms of food allergies or sensitivities, which can also include things like brain fog, skin conditions, gastrointestinal pain, and general inflammation, you should consider our dietary antigen test to evaluate both IgE allergic reactions and IgG sensitivities. This might identify triggers you weren’t aware of that can be further narrowed down through a targeted elimination diet so that the offending foods can be removed from the diet. If they have Alpha-gal syndrome (AGS), certain medications might trigger an allergic reaction due to the presence of alpha-gal or other mammalian-derived ingredients. Treatments include avoiding all substances that could trigger a reaction. Remember, this is important. AGS usually fades over time, as long as a reaction isn’t being retriggered. Cross-reactivities are also important here, so any meat product allergens or persistent allergens of other types should be closely monitored.