Beef broth changed the trajectory of Amy Bonnette’s life.
The Lynchburg native never had issues with red meat until 2020, when almost four hours after eating, she broke out in hives.
Her worry grew when her throat started to close up and swell. From experience treating the allergic reactions of her kids, Bonnette took a Benadryl and called her allergist.
She took a blood test. The result: She had alpha-gal syndrome, a tick bite-associated condition that causes a red meat allergy.
“It was really scary at first,” she said. “My thoughts were, ‘Oh God, what can I eat, where can I go? How allergic am I going to be?’”
Bonnette is not alone in this diagnosis.
A recent study conducted by the Centers for Disease Control and Prevention found that the number of confirmed cases of alpha-gal syndrome has surged to nearly 450,000 in the U.S. From 2017-2021, cases increased by around 15,000 per year.
Among the hotspots: Bedford County, which has the second-highest number of alpha-gal cases in the U.S., according to the CDC.
The way to prevent alpha-gal is to prevent tick bites. The best way to avoid ticks is to keep out of grassy and wooded areas, keep to the center of trails and treat clothes with permethrin or DEET.
The Centers for Disease Control and Prevention recommends checking clothing, gear, pets and children for ticks when coming inside. Checking for ticks before showering can help stop the spread.
Lone star ticks can cause alpha-gal no matter their size. Larval, nymphs and adult lone star ticks have been known to feed on humans and cause alpha-gal allergies.
If you find a tick, remove it immediately using tweezers, pulling upward and making sure every piece of the tick is removed from the skin. Ticks should be drowned in alcohol and never crushed with fingers.
Self-monitor after exposure and inform a doctor of exposure to a tick if symptoms develop.
The region’s geographic and ecological characteristics provide an ideal habitat for the lone star tick (Amblyomma americanum), the species found to cause alpha-gal allergies. With its abundant woodlands and diverse wildlife population, Bedford County offers an environment where ticks can thrive and encounters between ticks and humans are more likely.
Bedford had 1,511 reports of positive alpha-gal tests results as of December 2022; this number does not include those that have not been tested properly through antibody testing. Almost 2% of the county’s population is suspected to have alpha-gal syndrome.
It’s second only to Suffolk, New York, recorded around 3,700 cases; 3% of Suffolk’s population is suspected to have alpha-gal.
Alpha-gal — or alpha-1,3-galactose — is a carbohydrate molecule found in the tissues of mammals, but not in humans. Lone star ticks transmit alpha-gal when they bite.
When exposed to alpha-gal, some people’s immune systems produce an antibody called IgE, setting off a cascade of allergic reactions when they eat red meat, such as beef, pork or lamb. Reactions can range from mild discomfort to severe anaphylaxis; symptoms generally kick in within three to six hours after eating meat.
Thomas Platts-Mills, the head of the University of Virginia Health System’s Division of Allergy and Clinical Immunology and a pioneer in discovering alpha-gal syndrome, said the allergy was linked to the lone star tick through the geographic pattern of the allergy, which followed that of Rocky Mountain spotted fever, a disease spread by the lone star ticks.
“Once I lined up the map of where the positives were, it was exactly the same as ours,” Platts-Mills said.
The discovery of alpha-gal syndrome from a tick bite led to many late diagnoses through antibody testing. Suddenly, cases of patients with high levels of IgE made sense, he said.
Christina Abraham, an allergy specialist at Allergy & Asthma Clinic in Roanoke, said alpha-gal allergies have been in Southwest Virginia for longer than people realize. Many patients would come into her practice with questions about their allergic reactions, and Abraham wouldn’t have answers, she recalled.
“I didn’t realize why my patient was having idiopathic urticaria, or hives,” she said. “Since we’ve realized what alpha-gal is, and more doctors are aware of it, it’s very common in our area.”
Abraham has seen reactions ranging from gastrointestinal issues to anaphylaxis, a condition that needs urgent emergency room care. In her practice, she sees a lot of alpha-gal allergies and said it is more prevalent than it was in past years.
Platts-Mills said the largest population of lone star ticks is currently east of the Mississippi River and mainly in the Mid-Atlantic area. However, the tick is slowly traveling east and north as temperatures increase. The more warmer months there are in the year, the more time the tick has to travel and grow, he said.
In Southwest Virginia, cases are most prevalent in Roanoke and Bedford County, he said.
“You come to Roanoke, there are plenty of cases and then Lynchburg, Bedford County has got lots of cases now,” Platts-Mills said.
Matthew Miller, a doctor of Chinese medicine and acupuncturist in Lynchburg, has been offering acupuncture therapy for alpha-gal allergies for almost 10 years. Now, cases are pretty high, he said.
“In the last five years, we’ve seen an explosion of alpha-gal here,” Miller said.
His procedures and knowledge of helping treat other allergies helped him use acupuncture to treat alpha-gal allergies as the need in Central Virginia and Lynchburg increased, Miller said.
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Navigating her alpha-gal allergy brought unexpected challenges for Bonnette. No longer eating red meat wasn’t too difficult, but the presence of animal products hidden in other products added complexity to her life.
“Marshmallows, Jell-O, I mean anything that might have lard I can’t have,” Bonnette said. “Even … shots have animal products.”
A study done in 2021 by the Technical University Munich studied the effect of gelatin in vaccines on patients with alpha-gal allergies. It found that all patients with an alpha-gal allergy exhibited allergy-like responses to vaccines with gelatin: measles, mumps and rubella, varicella and a V-zoster vaccine.
“You just don’t know what people put in things,” Bonnette said. “But now that more people have it, I feel like I can go to a restaurant and be less worried about it.”
Rachel Blankenship-Tucker has had her alpha-gal allergy since 2020. Before her diagnosis, she ate meat and enjoyed spending time outside around her home near Ferrum. But her initial allergic reaction has greatly impacted her life.
“I really couldn’t breathe. I started getting hives and I couldn’t sit down. And I just couldn’t find any relief,” she said. “I called a telehealth doctor and she didn’t know anything about alpha-gal. She just told me to take a Benadryl. She didn’t know what I was talking about.”
Blankenship-Tucker was diagnosed with an alpha-gal allergy a few weeks later. Her wife is vegetarian so the diet switch wasn’t too severe, she said.
“I do have a fear of ticks now,” she said. “That’s hard because I’m a forager and I love to spend time in the woods. But I now have this fear of, what if I get a tick bite and this gets worse or I get something else? I don’t have the freedom to walk out and feel like I’m going to be OK.”
Blankenship-Tucker said it has been spreading in her community.
“There are many people I know who have this. So I’m glad awareness is happening, we need to start adapting,” she said.
Some patients recover naturally as their IgE levels decrease, but another tick bite can reactivate alpha-gal allergies, according to the CDC’s alpha-gal website.
“I tried to get acupuncture but I got another tick bite before I was able to even see if it worked,” Bonnette said. “So I hope it gets better but for now, I’m just going to continue to eat my diet.”
These ticks are often hard to spot and many people don’t know what they’re looking for, Platts-Mills said.
“The essence of their life is being able to latch on to someone’s skin and sit there for five or six days to really get fat,” Platts-Mills said. “They’re very small, all you can really see is a little black dot on your skin.”