[at-l] New Tick bite concern
Carla & Dave Hicks
carla_dave_hicks at verizon.net
Sat Jul 17 06:58:05 CDT 2010
The mystery of the tick and the allergy
Bedford's Emily Masters developed a sudden allergy to meat. So have many
adults throughout the Southeast. Doctors set out to find the reason.
By Sarah Bruyn Jones | sarah.jones at roanoke.com | 981-3264
During the past two years more than 200 people at a regional allergy practice
have been diagnosed with a newly identified red meat allergy that is related
to tick bites.
This allergy may be responsible for up to half of recurrent anaphylaxis cases
without known causes, researchers say.
In many ways the allergy doesn't behave like traditional food allergies, but
it is causing people to feel sick to their stomachs, break out in hives and in
some cases go into anaphylactic shock.
For Emily Masters of Bedford, the allergy seemed to come on without warning.
"I'm curious why all of a sudden this happened," Masters said. "I'm 28, so why
have I been OK eating meat for so many years and then this happened?"
Masters was diagnosed after she had a severe reaction following last year's
July Fourth cookout at her father's house.
During the party she ate some couscous, potato salad, hummus, a hamburger and
a sausage. With a known wheat allergy, she said she was careful to avoid
wheat, eating the burger without a bun for instance.
Several hours later her stomach started to hurt.
"I thought I must have eaten wheat that was hidden in something," she said.
But the reaction began to get worse than any reaction she had ever had to
Soon her arm began to itch just inside her elbow. She asked her husband to run
to a nearby gas station to pick up some Benadryl.
He suggested she come along so she could take the medicine faster. By the time
they were leaving she had hives on her legs. In the car, she began to swell
and it became hard for her to breathe.
They called 911.
"By the time I got to the ambulance, I was a red lobster and looked like a
blimp," she said.
Masters spent the night at Bedford Memorial Hospital being treated for
After she was discharged, she made up her mind to find out what caused the
reaction. She asked her friends for the list of ingredients in the foods she
ate. And she made an appointment at the Asthma and Allergy Center in Roanoke,
where she had previously been treated for her wheat allergy.
"I freaked out and I'm assuming its some mystery food and I've never had this
before," she said. "The last thing I imagined was it was beef."
While being examined, Dr. Luis Matos was brought in to consult. Matos has been
among the chief specialists diagnosing patients with this new allergy. Matos
and his partners in Roanoke and Lynchburg have diagnosed more than 200 cases
since a researcher at the University of Virginia first discovered the allergy.
In many cases, the patients don't have any other allergies, Matos said.
"It's so new that we don't know exactly the full story of how people develop
this reaction and the history of the allergy," Matos said.
But as Matos has learned the symptoms of the allergy, he has quickly been able
to identify patients.
"Just because we are looking for it, it is giving us an option that we didn't
have before," Matos said. "It's similar to other new allergies -- once you
know it is there, you find it."
The Asthma and Allergy Center also has identified patients who have had milder
symptoms, such as chronic itching or vague intestinal problems, who test
positive for the allergy. In some instances patients had gone decades without
knowing the cause of their discomfort.
"They thought they were crazy," Matos said. "In some cases, they were told
they were crazy."
Dr. Scott Commins of UVa is credited with discovering the allergy.
"In the world of food allergy, the notion that an adult could have a new onset
food allergy is unheard of," Commins said during a recent interview.
Last week he was in Roanoke presenting his research to physicians at Carilion
Roanoke Memorial Hospital. The hope is to alert more doctors to the research
and the new diagnosis and how patients can be helped.
"I think you are seeing these patients and you may not know it," he told the
doctors gathered for the presentation.
Since publishing his research in 2009, Commins said he has heard from patients
and allergists throughout the Southeast. He gets multiple e-mails a day from
patients looking for help.
Making the discovery
The home economics queen Martha Stewart has a small role in this story.
Researchers discovered some patients had a bad reaction after taking Erbritux,
the anti-cancer drug at the center of the insider trading allegations against
Stewart. Some of these patients would have anaphylaxis.
Researchers, who included Commins' boss Dr. Thomas Platts-Mills, ultimately
showed the negative reactions to the drug were associated with an allergic
reaction to a sugar called galactose-alpha-1,3-galactose, or alpha-gal for
A study about it was published in 2008 in the New England Journal of Medicine.
Ultimately the drug manufacture changed the way Erbritux was made to stop the
But because nearly all common allergies are reactions to proteins, not sugars,
Commins said he was extremely interested in the discovery.
Areas in the Southeast appeared to be unusually hard-hit by the severe
reactions to Erbritux, so Commins decided to investigate how common the
alpha-gal reaction was among anaphylaxis patients where the cause was unknown.
About 20 percent of anaphylaxis patients don't know the cause.
Alpha-gal is a sugar that is found in all mammals, such as pigs, deer and
cows. Those who have an allergy to alpha-gal produce an antibody that binds to
the alpha-gal sugar causing the body to produce hives or go into anaphylaxis,
A simple blood test will show if a person produces the antibody to alpha-gal.
Masters' blood test, which Matos sent to be tested by Commins, came back
The connection to ticks
Figuring out why patients had suddenly developed a severe allergy to meats in
which alpha-gal was present was the next step.
Commins quickly realized that the geographic range of the Lone Star tick
matched the geographic location of people who had developed this allergy. Both
were in the Southeast.
"It just fits perfectly," he said.
Commins started asking his patients about their exposure to tick bites and
"A lot of science can be serendipity," he said. "My boss [Platts-Mills] goes
out in the woods a lot. He got chigger bites or seed ticks. He developed this
allergy. So we started to make the connection."
Masters too has had a lot of tick bites and chigger bites. Last year, prior to
her July 4, 2009, reaction, she said she was bitten by about a dozen ticks and
hundreds of chiggers.
Commins said outdoor enthusiasts, including hunters and hikers, are often the
type of people diagnosed with the allergy. He strongly believes it is related
to the seed tick bites that people get by the hundreds. These are the bites
from the newly hatched tick larva, as opposed to a mature adult tick. Often,
he said, people in this area call these tiny ticks chiggers.
It's unclear what in the seed ticks is causing people to develop the allergy.
"My honest gut feeling is it is something in the saliva," Commins said.
He said that unlike Lyme disease and Rocky Mountain spotted fever, he doesn't
think it is an infectious disease carried by the seed tick. Instead he thinks
something in the saliva triggers the antigens in the alpha-gal sugar.
He is developing new research to focus on the relationship to the insect.
Finding a cure
Masters said she misses eating a hamburger on occasion. Others, especially
hunters, are more adamant about their desire to eat meat again, Commins said.
But for now, the only solution to treating the allergy is avoiding meat
products. For Masters and many others, this includes avoiding foods made with
"It's the hidden stuff that I worry about," Masters said.
Commins is planning a study to try to create a tolerance in patients. He's
waiting on approval from an institutional review board that monitors studies
"Even though I don't really miss a big steak, a cure would be great, that way
I wouldn't have to always worry when I get a twinge in my stomach or a little
itch," Masters said. "I am always on edge wondering, 'What if it had beef or
pork in it?' "
She always carries an epi-pen -- containing a dose of epinephrine to counter
anaphylaxis -- just in case.
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