By Michelle Brusio, MSN, RN, CCM
I was on my way home from Dallas after last year’s conference, and at the airport, there was a man waiting for his flight. He was calling several friends and/or family members to tell them he had contracted Alpha-gal syndrome and could no longer eat red meat. He also talked about how expensive epinephrine pens are and said he wasn’t going to get them filled at the pharmacy. But his wife insisted he fill it. No, he didn’t have one with him. After I heard him make a few calls, I said, “Excuse me, sir, but I am a case manager, and I heard you talking about how expensive epinephrine pens are.” We talked for about 10 minutes about EpiPen affordability and its importance. After our conversation, I began researching Alpha-gal syndrome and recently added it to my food allergy presentations as it found it intriguing.
Alpha-gal syndrome is also known as the red meat allergy. It begins with a tick bite, usually from the lone star tick and possibly other arthropods, in which the alpha-gal molecule is transmitted through their saliva after feeding on mammalian blood. Unlike food allergies, which trigger an immediate reaction, Alpha-gal reactions occur hours after eating beef, pork, or lamb. Most food allergies are protein-based, but alpha-gal is a carbohydrate, hence the delayed reaction time of about 3-8 hours.
It is important to note that an allergic reaction can occur in the middle of the night due to a delayed reaction. Symptoms of an allergic reaction are the same as those of food allergies. They include swelling of the face and lips, hives, shortness of breath, wheezing, abdominal pain, and nausea and vomiting. Anaphylaxis, which can include many of these symptoms, may also occur, and immediate administration of epinephrine is needed.
It is important to see an allergist if you have been bitten by a tick and have experienced any of the listed symptoms. Skin testing can be performed to determine whether you are allergic to beef, pork, or lamb. Blood work may be conducted to measure Immunoglobulin E (IgE) levels to confirm alpha-gal. If confirmed, you must keep antihistamines and epinephrine with you in case of accidental ingestion. Epinephrine is the drug of choice for anaphylaxis.
In conclusion, alpha-gal should be treated like any other food allergy. Epinephrine should be carried in a pack of two, as most people need two doses. Avoiding allergens is the most important step to prevent an allergic reaction. Be mindful that alpha-gal reactions are delayed. If you hike, hunt, or spend time outdoors, wear long clothing and check yourself for ticks. If you find a tick attached, remove it and clean the site. See your provider as appropriate. More research is underway on who carries alpha-gal and whether other foods, such as dairy, can also cause an allergic reaction. With tick season upon us, it is important to be aware.
It's not too late to earn more than 60 CE's - the CMSA Annual conference and expo wrapped up last week in Las Vegas, but the digital sessions are available through July 31st. Register here: https://cmsa.societyconference.com/v2/
Bio: Michelle Brusio, MSN, RN, CCM, has been an RN for 26 years and in case management for 20 years. She is currently the Clinical Manager for Population Health, Care Transformation Organization, and Primary Care at University of Maryland Upper Chesapeake Health. Michelle has experience in acute care, payer, primary care, and outpatient case management, as well as value-based programs. Michelle serves on several local boards in Harford County, Maryland. Michelle also serves on several CMSA national committees. On a personal note, Michelle is a fierce allergy mom and advocate. Michelle is also a current DNP student.