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Mammalian meat allergy emerges after tick bite: the alpha-gal syndrome
  1. Ellery Altshuler1,
  2. Jesse Kirkpatrick2,
  3. Mahmoud Aryan3 and
  4. Frank Miralles4
  1. 1Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Internal Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
  4. 4University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Ellery Altshuler; ElleryAltshuler{at}


Alpha-gal syndrome (AGS) is a hypersensitivity reaction to mammalian meat that develops after tick bite exposure. AGS was first described in 2009 and testing for the allergy has become available in the last decade. We report the case of a 56-year-old farmer with a history of frequent lone star tick bites who presented with a 7-year history of diffuse urticaria occurring hours after eating red meat. AGS is likely underdiagnosed because of the unusual presentation of the allergy, historic lack of available testing, and deficiency of physician knowledge about the condition. Recognition of AGS is important both to help alleviate symptom burden and to avoid iatrogenesis. Patients with AGS should not receive products containing mammalian products, such as cat-gut suture, porcine-derived heart valves, and bovine-derived vaccines. Patients with AGS may present in a variety of clinical environments and physicians of all kinds should be able to recognise the symptoms.

  • dermatology
  • general practice / family medicine
  • infectious diseases

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  • Correction notice The article has been corrected since it has been published online. The author's name has been corrected from "Jesse Krikpatrick" to "Jesse Kirkpatrick".

  • Contributors EA conceived of the idea for the case reports and was primarily responsible for writing the manuscript. EA also helped with background research. JK assisted with writing the manuscript and helped design the manuscript. MA helped with background research and assisted in the writing of the manuscript. FM also helped with background research and helped write the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.