Study says allergy to red meat is under-diagnosed, probably due to clinicians' limited knowledge of it, and Ky. is a national hotspot

Map from CDC research report, adapted by Kentucky Health News; click on it to enlarge.

Lone star ticks are the main source. (CDC photo)

Kentucky Health News

Thousands of Kentuckians are likely living with an allergy to red meat, and many of them probably don't know it because it hasn't been diagnosed in them, a new study suggests. Another study says most of the people who do the diagnoses -- health-care providers -- have little or no working knowledge of alpha-gal syndrome.

The studies were published Thursday by the Centers for Disease Control and Prevention. In the first one, scientists reviewed laboratory results of people who had been tested for antibodies that identify the syndrome since 2020. They found 110,000 suspected cases, but that figure is probably a significant underestimate," reports Emily Anthes of The New York Times. 

The second study, also done by CDC disease ecologist and veterinarian Dr. Johanna Salzer, "found that 78 percent of health-care providers who were surveyed had little or no knowledge of the condition, and many clinicians who had heard of the syndrome were not sure how to diagnose it," Anthes reports. "When the researchers factored in this knowledge gap, they estimated that the true toll of the syndrome might be closer to a half-million, although Dr. Salzer acknowledged that the figure was 'a crude estimate'."

Extrapolating the national estimate of 450,000, about 6,000 Kentuckians would have the syndrome if they reflected the estimated national prevalence, but a map with the study shows that Kentucky is one of the states with the highest prevalence of the allergy, based on the available antibody tests.

Anna Buckman of the Adair County Community Voice reported in 2019, "Dr. Kourtney Gentry Gardner, an allergist-immunologist in Bowling Green, diagnoses about five people a month with the alpha-gal allergy, and it’s becoming increasingly more common, she says."

Buckman noted that the syndrome "is relatively new to the allergy world," having been identified in scientific literature about 15 years ago. Anthes reports, "Until August 2021, a single commercial lab did nearly all of this antibody testing in the United States. In one of the new studies, researchers reviewed the results of the antibody tests performed at this lab from 2017 to 2022."

The allergy "takes its name from galactose-alpha-1,3-galactose, a sugar present in beef, pork, lamb and the meat of most other mammals. (It is not present in humans or other apes.) Lone star ticks, which scientists believe are the primary culprits of the disease in the United States, can transmit the sugar to people through a bite. Some people’s immune systems may then label this foreign sugar a threat and overreact to its presence the next time they eat meat," Anthes writes.

The more a person is bitten, the more at risk they are of developing the allergy, Buckman reported.

"The symptoms, which often take hours to appear, are wide-ranging, and may include hives, nausea, diarrhea or anaphylactic shock," Anthes reports. "Even patients who have the syndrome may not feel sick every time they eat meat."

Rural weekly reports on increasing tick-borne allergy to red meat

Map shows cases entered by site users and is not verified. For a larger version of the map, click on it.

A tick-borne allergy to red meat is becoming more common, the Adair County Community Voice reported Oct. 31, in a pair of front-page stories: one on the main front and the other leading its occasional Health and Wellness section.

The allergy is caused by a sugar molecule called alpha-gal. Anna Buckman writes, "Dr. Kourtney Gentry Gardner, an allergist-immunologist in Bowling Green, diagnoses about five people a month with the alpha-gal allergy, and it’s becoming increasingly more common, she says."

Close-up of the Lone Star tick, which
is much larger when it is full of blood.

People who are bitten by the Lone Star tick, especially those bitten repeatedly, are at risk of "having allergic reactions to the molecule, which is found in most mammalian or red meat," Buckman notes. "It is relatively new to the allergy world," having been identified in scientific literature only 10 years ago.

Buckman deals with the science but brings the story home by writing about some local victims, illustrating the varying manifestations of the allergy:

"Tiffany Bean can no longer hang out at summer gatherings where friends grill burgers because, following a tick bite, she developed a food allergy so severe that she even has reaction being around the fumes of cooked beef. . . . Rick Wilson is also allergic to red meat but can eat dairy products. He only had occasional reactions when he was still consuming red meat."

Joshua Wethington (Adair Co. Community Voice photo)

"Five-year-old Joshua Wethington doesn’t like dairy-free pizza, but that’s the only kind he can have. Because of a tick bite at some point in his short life, he is so allergic to red meat that allergists recommended removing dairy from his diet because it is a byproduct of cows." Joshua’s mom, Dana Wethington, told Buckman, “I’m having a hard time getting him to eat things because it doesn’t taste the same to him.”

Other differences: "Bean went from just having an itchy tick bite to having a stomach illness for hours or breaking out into a rash if she consumed anything with alpha-gal. She has lost 40 pounds due to the allergy," Buckman reports. "Joshua got hives all over his body every day that he consumed red meat. Wilson experienced severe itching and nearly passed out during one of his few reactions. Speak to three people with alpha-gal and you’ll discover one thing is certain: it’s complicated. The only similar experiences that Bean, Wilson and the Wethingtons have are the difficulty of living with the allergy and dealing with its affects when they go out publicly."

Bean told Buckman, “People don’t seem to take it seriously. You tell people that you have it and that you could die from it, and people are like, ‘Oh no, you can’t die from eating a hamburger or bacon.’ Well, yeah, you can.”

Alpha-gal victims use technology to help each other, including a smartphone app ("Is it Vegan?"), a Facebook groups (“The AlphaGal Kitchen” and “Alpha-Gal Support Kentucky”) and an interactive map that locates cases (above).

"Recommended by a member on a Facebook support group, the Munfordville Pool Hall and Grill is a relief to alpha-gal sufferers and also sets a great example for other restaurants for being allergy-friendly in general," Buckman writes. "The pool hall has designated one fryer where no red meat or cheese is prepared. They have designated skillets to cook foods for separate consumption because people with alpha-gal allergy can have a negative reaction from even the residue from a mammal product.

Pool-hall employee Justin Minton told Buckman that employees acted after notiing that several people in the community have the allergy. “Speaking from experience, going to Subway is pretty much the only place my grandpa can go,” Minton told Buckman.

Even though "people with alpha-gal are helping one another with useful information, Kandace Webster, an advance-practice registered nurse at T.J. Health Columbia Primary Care, "urges sufferers to seek professional guidance," Buckman reports.

Spring fever: If over-the-counter medicines don't quell your allergies, it's a good time to see an allergist

By Ann Blackford
University of Kentucky

The beauty of spring is upon us, but as lovely as it may be to look at, it can wreak havoc in your nose, throat and eyes. The higher the pollen count, the greater the misery.

Seasonal allergies are the result of a chain reaction that starts in your nose. If you are allergic to pollen, the immune system will overreact by producing allergic antibodies. The antibodies attach cells in your airway and cause release of chemicals, causing an allergic reaction.

Many people find relief in some very effective over-the-counter medications. If OTC medications don't provide relief, or cause significant side effects, this is a good time to visit an allergist. An allergist/immunologist is a pediatrician or internist who has spent an additional two to three years of training specifically in this field.

Allergists will discuss treatment options: typically allergy avoidance, followed by medical management, and lastly allergy injections.

Allergy shots are the only known cure to date for allergic rhinitis (nasal allergies). The concept behind allergy shots — allergy immunotherapy — is that the immune system can be desensitized to specific allergens that trigger allergy symptoms, thereby building up resistance or tolerance to the allergens.

Allergy shots generally work in two phases. The buildup phase can last from three to six months and involves receiving injections in increasing amounts of the allergen and are taken once or twice a week.

The maintenance phase begins when the most effective dose is reached. The dose can be different for each person, depending on how allergic you are and your response to the build-up injections. Once the maintenance dose is reached, there are longer periods of time between injections, typically two to four weeks.

Some people will experience relief of their symptoms during the build-up phase, but for others, it may take as long as 12 months on the maintenance dose. If there is no improvement after a year, your allergist may discuss other treatment options.

Allergy shots are a good option for people with allergic rhinitis (hay fever), allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy. Shots can be given to children as young as four to five years old.

Shots are not recommended for food allergies, but can help in patients with oral allergy syndrome. This syndrome occurs in patients highly allergic to pollens; the body reacts to cross-reacting foods, and causes itching of the mouth and tongue. Allergy shots are not started on pregnant women but can be continued on patients who become pregnant while on shots.

Recently the Food and Drug Admimistration approved allergy drops or sublingual immunotherapy for grass and ragweed allergy. However, most patients have many confounding allergens (i.e. trees, molds, mites, animal danders), which can be included in allergy shots, thus making shots much more effective.

Scott County schools will have a smartphone app to let parents see cafeteria menus, look up nutritional content

For parents who have children with food allergies, it can be stressful not to know what will be served in the cafeteria. Scott County Nutrition Director Mitzi Marshall is researching two smart-phone apps that inform users of what will be served for breakfast and lunch each day at school, Dan Adkins reports for the Georgetown News-Graphic.

"Parents are on the go," Marshall told the school board. "If you're working, it's here at your fingertips." The app will also let parents single out certain food allergies and determine which dishes their children should not eat, Adkins writes. Marshall said the one app, NutriSlice, will also let parents look up nutritional content for each meal.

"Nutritionals automatically pop up, so this will help the nurses with carb counts, families . . . There are the sugars for diabetics, the carbs," Marshall said. She did not yet specify when a decision will be made about which app to implement.

Crittenden County Elementary School is latest school in area to restrict nuts to protect the health of those with nut allergies

This story has been updated to include information about other Western Kentucky schools with nut restrictions.

Peanut butter and jelly sandwiches are a lunchbox staple for many American children, but they can also pose a serious health risk to those with peanut and tree-nut allergies, especially in the young. The risk has prompted the Crittenden County school district to become the latest in the area to restrict the use of nuts at the Crittenden County Elementary School in Marion.

"Peanut and tree nut allergies plague an estimated 19 million Americans and the number of children with peanut allergies in the U.S. has nearly doubled in just over a decade," The Crittenden Press noted.

After researching the issue and how other schools have dealt with it, the school's parent-teacher council and wellness committee created a policy that restricts but doesn't ban nuts, the Press reports.

The policy asks everyone to be aware that nut products are dangerous to some of the students and asks them to not send those products to school, Principal Melissa Tabor told the Press. She said at least five students have proven nut allergies.

Several other Western Kentucky schools have peanut restrictions,Genevieve Postlethwait reports for The Paducah Sun, including Carlisle County and Fulton County schools, with Paducah and Hickman County schools having restricted peanuts for varying periods of time in the past. (Story is behind a pay wall.)

"We do it on a case-by-case, year-by-year basis," Penny Holt,the district's nutrition director, told Postlethwait of Paducah schools' approach to restricting peanuts and other allergens. "If a child has an allergy that is that serious, we're not going to risk it," she said, noting that they are seeing an increase in all kinds of food allergies.

Another school, Heath Elementary, has a child with an airborne peanut allergy so the school does not serve any peanut products or cook with any peanut products, Sara Jane Hedges, food services director for McCracken County schools. told Postlethwait. Students are still allowed to bring peanut butter products, but " "It's just taken care of very carefully," Hedges said.

Crittenden County Elementary school's policy does not require school personnel to check backpacks or lunchboxes for nut-containing products, but if they see children have one of these products, they ask them to sit at a designated table for that day, where they can ask a friend to join them.

The school sent home a list of nut-free snacks, including safe name brands that do not contain peanut oil, to help parents re-think what to pack in their child's lunch or to send for school snacks or for school parties.

So far, the principal said, parents have been receptive to the policy, and one parent told her that they had successfully switched to a soy butter that tastes like peanut butter because their child wants peanut-butter sandwiches for lunch.

The policy states that those with severe allergies to peanuts or nut products may be at great risk of anaphylactic shock, "an allergic reaction causing swelling, difficulty breathing, itching, unconsciousness, circulatory collapse and sometimes death," if they ingest or are exposed to these products.

"Because of the possibility of cross-contamination, a campus-wide, comprehensive avoidance of foods containing nuts was deemed to be the best solution to reduce the health risks to students with allergens," Tabor told the Press.

Crittenden County School Supt. Vince Clark told the weekly newspaper that he supports the school's policy, despite the argument that it creates a burden to parents of students who love peanut butter.

“There are valid points on each side of the issue,” he told the Press. “Ultimately, we have to support efforts to offer a safer learning environment for the children.” (Read more)

Prevention and preparation is the key to a productive year at school for kids with asthma (and that's 1 in 10 students)

By Melissa Patrick
Kentucky Health News

As the beginning of a new school year approaches, parents of children with asthma and allergies need to make sure that not only does their child recognize what triggers their symptoms and how to treat a flare-up, but also that their school knows what to do.

One of every 10 school-aged children in Kentucky has asthma, and these students miss an average of four school days each year, according to the Cabinet for Health and Family Services. Kentucky has one of the highest rates of asthma in the United States.

Nationally, more than 10 million kids under age 18 have asthma, 11 percent have respiratory allergies and about six percent have food allergies, according to according to the American College of Allergy, Asthma and Immunology. And on any given day, more than 10,000 kids miss school due to asthma.

Preventative care and avoiding triggers will help children miss fewer days in the classroom and will also allow them to be more productive in all of their activities, the college said in a news release.

“Parents need to be advocates for their kids, to help ensure they’re breathing well with clear minds and able to navigate the triggers that sometimes stand in their way,” Michael Foggs, president of the college. “If kids are having difficulty breathing, are sneezing, have runny noses and itchy eyes, and haven’t slept well the night before, they won’t perform at their best.”

Here are some tips to help with symptom-free days in the classroom and outdoors:

• Create an action plan with your allergist specific to your child's needs. Include medications, doses, triggers, early symptoms of flare-up and what to do if there is a flare up.&

• Share your child’s action plan with your child's teacher and whoever else might come into contact with your child every day. Discuss how independently your child is able to deal with their asthma, give them contact numbers for you and your child's doctor and be sure your child and school staff knows how to work the peak flow meter and how to administer medications, especially if your child needs assistance.

• Assess any triggers for your child at school: mold, dust mites, cockroaches, chalk dust, perfumes, cleaning products or other chemicals, animal dander, saliva or urine. Work on a plan to minimize these triggers.

• Discuss how to handle emergencies. Children who are at risk for a life-threatening allergic reaction (anaphylaxis) also should have epinephrine to use. Be sure your child and school staff know how to use emergency medications.

• If your child has food allergies, send a bagged lunch to school every day and instruct your child to not share foods, napkins or utensils.

• Make sure you have a plan for recess and sports activities. The American College of Allergy, Asthma, Asthma and Immunology says in the release that "asthma symptoms during exercise may indicate poorly-controlled medications."

• Pay attention to the pollen counts if your child is allergic to pollen; it is suggested to start medications two weeks prior to when the levels are at their worst.

Proper asthma control helps kids sleep better at night, spend more time in the classroom, experience less anxiety about their condition and fully participate in all school activities, according to kidshealth.org.

Bill encouraging schools to stock EpiPens to stop deadly allergic reactions will become law

A bill encouraging Kentucky schools to stock EpiPens, or epinephrine auto-injectors, to stop anaphylaxis, a life-threatening allergic reaction, has passed will soon be signed into law by Gov. Steve Beshear.

When someone has anaphylaxis, the sooner you use an EpiPen, the better the outcome can be, said Thomas Sternberg, an allergist at Graves-Gilbert Clinic in Bowling Green, told Alyssa Harvey of the Daily News.

Under House Bill 172, schools could keep at least two EpiPens in case of emergency, and school boards would develop and approve policies and procedures for managing a student’s life-threatening allergic reaction, reports Harvey.

The bill also helps schools receive or buy the auto-injectors through local health departments and directs the state Department for Public Health to develop clinical protocols for using the auto-injectors in schools. Harvey reports that EpiPens can be donated to schools, and the EpiPens for Schools Program will provide up to four free auto-injectors per school year; if more are needed, they can be purchased at a discounted rate.

"You don’t know when someone could have an anaphylactic reaction,” Rep. Addia Wuchner, R-Florence, who sponsored the bill, told the Daily News. She alluded to an incident in Virginia, where a 7-year-old student died last year after an anaphylactic reaction, and no medications were available at the school to treat her. "There could be a hero in the school who was able to reach for that epinephrine pen and save a child’s life and not a tragedy like in Virginia,” Wuchner said. She filed the bill late in the 2012 session, but the language has been revised for this year's session to encourage rather than mandate schools to stock EpiPens.

Amy Wallace, treasurer and former president of the Bowling Green area's Food Education Allergy Support Team, told Harvey she was disappointed schools will not be required to make necessary provisions, but said advocates of the bill are happy to see that the problem is being addressed. (Read more)