HJAR May/Jun 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2024 33 Jennifer Dillaha, MD Director Arkansas Department of Health indigestion; diarrhea, cough, shortness of breath, or difficulty breathing; low blood pressure; swelling of the lips, throat, tongue, or eye lids; dizziness or fainting; and severe stomach pain. These symptoms usually ap- pear two to six hours after eating red meat or dairy products or after taking pharma- ceuticals such as porcine-derived pancre- atic enzymes or gelatin capsules. Products containingmammalian ingredients can also cause more immediate reactions when in- jected (such as porcine-derived heparin) or when applied topically (such as makeup or lotions containing mammalian ingredients). Reactions can differ from person to per- son, range from mild to severe, and can be life-threatening. It may be necessary for those with severe reactions to keep an epi pen on hand. It is possible for some people to see their levels of antibodies decline over time, al- lowing them to eventually eat the foods that triggerAGS. However, the level of antibodies does not necessarily correlate with severity of symptoms. Anyone can contract AGS, but it is mostly found in adults. Not everyone will have an allergic reaction after an alpha-gal exposure. It is important forAGS to be diagnosed by a healthcare provider. The CDC says that AGS cases are rising. Between 2017 and 2021, the United States saw a 41% increase in cases, although this may be partly due to increased reporting. In a separate report, the CDC also found that 42% of healthcare providers didn’t know about AGS. Another 35% were “not confident” in diagnosing AGS. In 2023, Arkansas became the first state to make alpha-gal syndrome a reportable illness. ADH is currently assessing reports of AGS, which will, over time, allow the agency to better understand the increase of AGS in Arkansas and assist healthcare providers in our state with understanding how common AGS is. Themost important thing people can do to avoid contracting alpha-gal syndrome is to avoid being bitten by ticks. Experts recom- mend walking on trails instead of through grassy, wooded areas; treating clothing with permethrin and using EPA-approved insect repellants; checking clothing, gear, and pets for ticks; and showering and performing thorough tick checks after spending time outdoors. If you find a tick, remove it im- mediately and correctly. I would also encourage healthcare pro- fessionals to learn more about alpha-gal syndrome and become familiar with the symptoms of AGS. With increasing cases and warmer weather on the horizon, it’s crucial to become more aware of this aller- gic reaction. n REFERENCES 1 Hester, W.P. “Meet the Doc Who Discovered the Infamous Red Meat Allergy Spread by Ticks.” University of Virginia News, Feb. 8, 2019. https:// news.virginia.edu/content/meet-doc-who-dis- covered-infamous-red-meat-allergy-spread-ticks 2 Centers for Disease Control and Prevention. “Al- pha-Gal Syndrome.” Last reviewed Oct. 27, 2023. https://www.cdc.gov/ticks/alpha-gal/index.html 3 Mayo Clinic Staff. “Alpha-gal syndrome.” Mayo Clinic, Nov. 15, 2022. https://www.mayoclinic.org/ diseases-conditions/alpha-gal-syndrome/symp- toms-causes/syc-20428608 4 Yale Medicine. “Alpha-gal Syndrome (AGS).” Acccessed March 2024. https://www.yalemedi - cine.org/conditions/alpha-gal-syndrome-ags 5 Centers for Disease Control and Prevention. “Al- lergic Reactions to Red Meat Linked to Lone Star Tick Bites — United States, 2003–2017.” Morbidity and Mortality Weekly Report (MMWR) 67, no. 30 (Aug. 3, 2018): 819-824. 6 Centers for Disease Control and Prevention. “Health Care Provider Knowledge Regarding Al- pha-gal Syndrome — United States, March–May 2022.” Morbidity and Mortality Weekly Report (MMWR) 72, no. 30 (July 28, 2023): 809-814. https://www.cdc.gov/mmwr/volumes/72/wr/ mm7230a1.htm 7 Arkansas Department of Health. “Alpha-Gal Syndrome.” Accessed March 2024. https://www. healthy.arkansas.gov/programs-services/topics/ alpha-gal-allergy 8 Arkansas Department of Health. “Alpha-gal Syndrome Fact Sheet.” Fact sheet, Sept. 29, 2023. https://www.healthy.arkansas.gov/images/ uploads/pdf/Alpha-gal_Syndrome_Fact_Sheet. pdf THIS TICK has primarily been found in the southeastern and central U.S. According to the Mayo Clinic, though, AGS appears to be spreading farther north and west due to mi- grating deer who carry the tick. Additionally, the Centers for Disease Control and Preven- tion (CDC) says other kinds of ticks have not been ruled out as transmitters of AGS and that tick species in other countries have been linked to AGS cases as well. In 2007, while working with the cancer drug cetuximab, University of Virginia pro- fessor Thomas Platts-Mills, MD, found that the sugar alpha-gal (galactose- α -1, 3-galac- tose) was causing allergic reactions in cancer patients from the southeastern part of the United States. Curious, Platts-Mills expanded his research and found an unusual redmeat allergy occurring in people from the same area. Throughmore testing and research, he was able to establish that the redmeat allergy occurring in the southeastern United States was associated with a tick bite. AGS is transmitted through the saliva of the tick and triggers a reaction by the im- mune system, which causes the creation of antibodies against alpha-gal, leading to alpha-gal syndrome. The alpha-gal sugar molecule is found in many mammals but isn’t found in fish, birds, reptiles, or people. There is currently no treatment or cure for alpha-gal syndrome. Those who have contracted it should not eat dairy products or redmeat, which includes beef, pork, venison, rabbit, lamb, and organ meats; should care- fully check ingredient labels on store-bought foods; and refrain from eating things like gelatin (including gelatin-coatedmedicines), soup stock cubes, gravy packages, and some flavor packets. According to Yale Medicine, alpha-gal can also be found in snake anti- venoms and prosthetic heart valves from cows or pigs. Symptoms of AGS can include itchy rash or hives; nausea or vomiting; heartburn or