The Mysterious Case of Alpha Gal  🔗 **Source:** [The Mysterious Case of Alpha Gal](https://share.snipd.com/episode/71aad1fc-0942-4cfa-9297-eade8c018de6) ## Highlights - **Sudden Meat Allergy Sent Her To The ER** - Amy Pearl went from a lifelong meat lover to collapsing with hives and near-fainting hours after eating lamb and a cheeseburger. - After googling “sudden meat allergy,” she persuaded her doctor to test her and later required emergency epinephrine treatment. Transcript: Dan Pashman Years ago, before any of this happened to you, just tell me, what was your relationship with meat? Amy Pearl My relationship with meat? Yeah. Well, you know how when you're little and your mom is like, you can have any special dinner for your birthday? My dinner was meatballs. And she was like, except meatballs, they're so hard to make. So it was pot roast. And then Peter Lugers. Dan Pashman Famous steakhouse in Brooklyn. Yeah. Amy Pearl I used to go there quite often and I live there and I have a Peter Luger credit card. Dan Pashman Are those hard to get? Amy Pearl I, you know, I don't, I don't know how they give them out, but nobody seems to have one. I don't think they give them out anymore. But I mean, I was very into Peter Luger. I was living in Williamsburg, and it just opened at like 1 o'clock every day, and you could just walk in at 1. They had an amazing bar. There was no tablecloths on the table, these old German waiters. They bring out your porterhouse for three. They put a little plate upside down and then put the big platter on top of it so it's tilted and all the juice runs to the end. And then they like have this special double spoon thing that they somehow like scoop juice onto your steak and oh, so good. And also like the smell of burning fat from a hamburger. What about hot dogs? Oh my God. I love hot dogs so much. When you bite into them and they're like clack and have like a snap. And like having a weenie roast out in the open air is just, it's like the, oh God, it's so good. Anyway, I was always very into meat. What changed? Oh my God. It was terrible. It was, what happened was I was having this beautiful, it was springtime. I was having a beautiful leg of lamb with some neighbors, and we, like, put it on the grill, and it was just a delicious, beautiful dinner. And I had served with it some ramps that I foraged in my mom's yard. So we had this delicious meal, and then, you know, I went home, and I was going to sleep at like midnight, like a few hours later. And I just felt weird. I was like, God, something's wrong. I feel like really anxious, like something's wrong with me. And I went in the bathroom and I like look in the mirror and my face was like all weird looking. And I was like, I kept laying down and be like, I'll just sleep it off, whatever it is. But every time I lay down, I felt like I was going to faint. So I was like, prop myself up. And I was like, oh, God, I'm having terrible like stomach cramps and just like a weird feeling of impending doom, you know, but just like anybody, I'm just like, just get a good night's Sleep. This will pass. I like splash a little water on my face. I mean, I don't know what made me think this, but I thought like maybe a snail, a tiny snail was one of the ramps that I ate and it was like poisoning me somehow. You know, snails, I mean, they probably poison us. So I called my friends in the morning. I was like, hey, how you guys doing? How was dinner? And they were like, oh, so great. I was like, really? So great? Nothing weird? Dan Pashman No horrific panic attacks? Amy Pearl They were like, oh, that was so lovely. Thank you so much. Let's do it again. And I was like, wow, I really had a rough night. But I didn't think anything of it, and I went on with my life, you know, just like, whatever. And then about a week or two later I made some cheeseburgers and I ate a cheeseburger and I was watching um Goodbye Mr. Chips really tear-jerking movie and a good book too and um about a couple of hours after I ate I was like started to feel really weird again I was like feeling like I was like had to stand Up I was like I think I'm gonna faint I feel really lightheaded. I can't catch my breath. I feel really woozy. But if any time I lay down, I really felt like I was going to faint. So I was trying to stay sitting upright. And I was like, oh my God, this is very similar. I ran into the bathroom and I was looking in the mirror. And lo and behold, I had hives all over my stomach. And then they started coming out of my hands. And I was like, oh my God, something's happening. And at one point, I did get up and unlock my door because I did feel like I'm going to pass out, call an ambulance, and then they're not going to be able to get in. So, I mean, I was a little bit afraid of what was happening. And when I woke up in the morning, the first thing I did was Google sudden meat allergy because I was like, this seems like an allergy. And the only thing that was ([Time 0:03:12](https://share.snipd.com/snip/7597f49d-7731-4ff3-a48b-868044d39d3e)) - **Alpha Gal Sugar Linked To Red Meat Reactions** - Researchers identified a sugar called galactose alpha-1,3-galactose (alpha-gal) in the cancer drug cetuximab that triggered severe allergic reactions. - Alpha-gal also exists in the tissues of non-primate mammals, explaining why reactions appear after eating beef, lamb, pork, and similar meats. Transcript: Robert Krulwich And he tests two groups of blood, a control sample, and then people that have this allergy. And he quickly zeroed in on a particular molecule, a sugar, that was part of the drug. Latif Nasser This sugar, galactose alpha-1 galactose, or alpha-gal. Alpha-gal? Yeah. As in a particularly great lady? Robert Krulwich Yeah. Better than the beta or gamma gal? Dr. Thomas Platts Mills It's like alpha male, but alpha female didn't quite have a ring to it. It's the alpha gal. Robert Krulwich Anyway, it seemed like alpha gal was the culprit. Latif Nasser Yeah. And if you told me four years earlier that there's a whole lot of people out there who are allergic to this sugar, I'd have thought you were smoking, you know, vaping again. Robert Krulwich Because not only does this sugar alpha-gal show up in the cancer drug, and this is where we get back to Amy, it also shows up in the blood of mammals. Latif Nasser All non-primate mammals. ([Time 0:11:38](https://share.snipd.com/snip/68ca53e2-4458-4425-9e68-21ea3ab78cee)) - **Maps Pointed From Cancer Drug To Ticks** - Geographic clustering of reactions matched regions with Lone Star ticks and Rocky Mountain spotted fever maps. - That spatial overlap suggested a vector rather than a dietary cause, redirecting investigators to ticks. Transcript: Robert Krulwich Worm or a fungus. But then he looked again and noticed that all the people who had had bad reactions to the cancer drug, they were in a particular area of the country. Latif Nasser It was Virginia, North Carolina, Southern Missouri, Tennessee, Arkansas. No cases in Salt Lake no cases in Denver, just smatterings down the west. So he turned to his technician, Jake, and he said, I said, you've got to Google every map you can find and say what matches that area. Robert Krulwich Creatures or diseases that appear wherever the allergy appears. So Jake starts Googling. Googling and Googling and Googling. And eventually he comes across a map that matches where the cases are very beautifully. Latif Nasser The maximum area for Rocky Mountain spotted fever. Dan Pashman So he made this little map and it's like the shaded dark areas of the country are places with Rocky Mountain spotted fever. And then there's like some stars where, you know, this allergy had appeared. Latif Nasser Yeah. Dan Pashman And they overlap. Latif Nasser Ah, very interesting. And then all of a sudden, it clicks. Rocky Mountain Spotted Fever is a tick-borne disease. Robert Krulwich This is the distribution of the Lone Star tick. ([Time 0:17:20](https://share.snipd.com/snip/6263b394-ddd3-4775-9332-03b98def87fe)) - **Lead Researcher Got Bitten To Test The Theory** - Dr. Thomas Platts Mills intentionally exposed himself to ticks while walking and later ate lamb, then developed hives and a red meat allergy. - His self-experiment provided a dramatic proof-of-concept linking tick bites to alpha-gal sensitization. Transcript: Robert Krulwich He does what? He decides to test it on himself. Latif Nasser Oh, my God. He sort of, like, denies that he did it intentionally. I know I had no intention. I mean, I think he also likes to walk and amble and think about things. Right. So he goes for a long walk along the Blue Ridge Mountains. And I knew I wanted to be off trail because I'm actually rather allergic to humans. So he's walking and walking and walking and along the way, he bumps into a whole bunch of ticks. And if you walk into a nest of those things... Oh, my God. This sounds like a nightmare. Yeah, absolutely. I got 200 seed ticks. Oh, boy. And then in November of that year, I was taken out to dinner. And the lamb chops were particularly delicious. And the French wine was delicious. And six hours later, I woke up covered in hives. He's got an allergy to red meat. ([Time 0:19:26](https://share.snipd.com/snip/7b06f017-a21e-43d2-bd7f-7597e9edc0fc)) - **Tick Bite Likely Reprograms Immune Response** - The hypothesized mechanism: ticks inject alpha-gal in saliva through skin, priming the immune system to label alpha-gal as harmful. - Later ingestion of alpha-gal in mammal meat triggers delayed, severe allergic responses driven by those antibodies. Transcript: Robert Krulwich Normally, when you eat a piece of meat, you put alpha-gal in your stomach, and your stomach digests it, and it's in your body, and it's no big deal. But the tick cunningly... Dr. Thomas Platts Mills Will drill into you, poke into you... And injects... Its saliva. We'll call that tick spit. Tick spit into its victims. Straight into its victim' largest organ. Robert Krulwich The skin. Dr. Thomas Platts Mills And tick spit has an anti-clotting factor, an anesthetic, anti-inflammatory compounds. And we think the alpha-gal. Robert Krulwich Now, Peter says the thing about the skin is... The skin is like this enormous surveillance system. It's always on the lookout for invaders. So when the alpha gal comes through your skin, covered by all that bad, bad tick spit stuff. That's going to really like set off your immune system. The immune system freaks out. Like, oh, uh-uh. And the alpha gal covered now in bad spit, almost sort of by mistake, gets labeled bad. And now it's on the bad guy watch list. So therefore, the next time you eat meat, the meat comes in, and then, the body unleashes wave upon wave upon wave of chemical attacks to do battle against this alpha guy. And this reaction gets way out of hand. ([Time 0:29:02](https://share.snipd.com/snip/26dbb86f-2eb9-49d7-a0ad-a84e3214d8fb)) - **Get Tested If You Have Delayed Meat Reactions** - Check with an allergist and get an alpha-gal blood test if you have unexplained delayed reactions after eating mammal meat. - Expect delays between exposure and symptoms and insist on testing even if clinicians are unfamiliar with alpha-gal. Transcript: Amy Pearl Yeah. But I am going to my allergist tomorrow because I did, you know, I was reading about this allergy a lot when I first got it. And I read that for some people, the allergy can fade away. So I'm going to get a blood test to see what my blood level of alpha-gal is. Dan Pashman So I'm a little— So what are you hoping for tomorrow? Amy Pearl I want to be normal. Again. Dan Pashman Coming up, Amy gets the results of her test. Stick around. Amy Pearl Hope you're hungry because it's time for some ads. Dan Pashman Hey everyone, it's me, Morgan Stewart, and I have a new podcast called The Morgan Stewart Show. Join me each week as I talk about pop culture, fashion, my personal life, and just a warning, I'm going to be giving my opinion on everything. I'll also have some really fun guests to join in on the fun. The Morgan Stewart Show is out now. Listen and follow wherever you get your podcasts or watch full video on YouTube. Latif Nasser Why have we asked our contractor we found on Angie.com ([Time 0:31:39](https://share.snipd.com/snip/066463af-d6b7-4271-8f05-8cdc3c661227)) - **Allergy Changed Her Relationship To Meat And Ethics** - Some patients reframed alpha-gal as morally or environmentally positive, reducing red meat consumption involuntarily. - Amy observed she now avoids meat for ethical reasons and feels a kind of moral superiority. Transcript: Amy Pearl And then also, I think it's great. It's like we're all evolving to be on this planet, which is getting harder to be on. And we know that meat takes a lot of resources. And like, now I don't, now I'm not doing that. So like the tick is helping me evolve into a better human being. ([Time 0:36:57](https://share.snipd.com/snip/807ee237-6f79-4304-986b-a339d2631c76)) - **Antibody Levels Can Fall But Tick Bites Raise Them** - After initial high levels in the 40s, Amy's alpha-gal antibody fell to about 3.1 but remained positive; a later tick bite raised it back to 11. - Repeat tick exposures can boost antibody levels and reduce chances of the allergy fading. Transcript: Amy Pearl Order is important. Dan Pashman You got the results. Before we play them, just remind us what your numbers were. Like, after your first huge incident when you were rushed to the hospital and almost died, what was your alpha gal number? Amy Pearl I think after the first incident, my number was like in the 40s or something. Okay. Dan Pashman And then last year, a year ago, you had it tested. And what was it? 3.1. What is normal? How low would it have to be for you to be able to go back to eating meat? I think.3. So at your worst, you were in the 40s. You got down to 3-something, but to be able to eat meat again, you have to get down to.3. Amy Pearl Yeah. All right. Dan Pashman Can I play the voicemail? Amy Pearl Okay. It's Dr. Dr. Thomas Platts Mills Korn. Just calling to let you know that the Alpha Gal actually came back at 11. So it's still positive. That's the bottom line. And I wouldn't worry about the fact that it went up. The bottom line is it's still positive. And that's what we are really looking for, if it's positive or negative. Okay. I will actually put it in the mail and send it to you. Amy Pearl Thanks. Bye-bye. ([Time 0:40:40](https://share.snipd.com/snip/8e095997-8cb1-41aa-bc84-534f85469ace)) - **Reduce Tick Exposure To Help Antibody Decline** - Avoid repeated tick exposures to increase the chance alpha-gal antibodies will decline over time. - Realistically balance outdoor activities and tick prevention because total avoidance is often impractical. Transcript: Dan Pashman Amy, one option for you would be, you could say, I'm not going to go to the outdoors. I'm not going to go camping. I'm not going to go into tall grass for five years. And I'm going to see if the number goes down. And then I will eat hot dogs and steaks at Peter Luger again. Amy Pearl I mean, I don't know. I love I love being outside. I would never be terrible. Like, I don't want to think that No, I would never stop going out. ([Time 0:42:41](https://share.snipd.com/snip/9e907a9f-d655-4f5c-832a-77be6dbeb3f8))