PT - JOURNAL ARTICLE AU - Ellery Altshuler AU - Jesse Kirkpatrick AU - Mahmoud Aryan AU - Frank Miralles TI - Mammalian meat allergy emerges after tick bite: the alpha-gal syndrome AID - 10.1136/bcr-2021-245488 DP - 2021 Nov 01 TA - BMJ Case Reports PG - e245488 VI - 14 IP - 11 4099 - http://casereports.bmj.com/content/14/11/e245488.short 4100 - http://casereports.bmj.com/content/14/11/e245488.full SO - BMJ Case Reports2021 Nov 01; 14 AB - 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.