Updated Nov. 19
Alpha-gal syndrome is so prevalent on the Island that restaurant menus often mark items that do not include meat or dairy with a simple “AG,” and just about everyone seems to know what that means.
Sadly, the whole Island, and definitely the local healthcare providers, are all too knowledgeable about alpha-gal, which is an allergy to mammalian products like meat and dairy. That’s evident in a surge of tests done in the emergency department at the hospital, in walk-in clinics, and in private practices over the past few years.
But off-Island, this tick-borne allergy is not as well-known or understood, or at least it wasn’t until last week, when a wave of national media stories hit about a 47-year-old man who was the first documented death in the U.S. of an alpha-gal-related allergic reaction from food exposure. The story led NBC News, and was covered on National Public Radio and by the Associated Press.
“He didn’t know alpha-gal syndrome existed. Awareness could have changed the trajectory. That is heartbreaking,” said Lea Hamner, contract epidemiologist for Dukes County. Hamner said she hears that there’s a lack of knowledge around alpha-gal when patients seek medical care off-Island. This lack of awareness is why the Martha’s Vineyard Tick Program is so focused on outreach, she added.
Alpha-gal is a molecule naturally found in most mammals besides humans; ticks transfer alpha-gal into a person’s blood through saliva, and trigger an allergic reaction because the body sees the molecule as a threat.
The study released last week by the University of Virginia School of Medicine states the man, an airline pilot who had no significant past medical issues, died in the summer of 2024; his death was initially listed as unexplained. The report doesn’t say where geographically the man was bitten, but the case has resonated locally, and highlights the continued need to educate the public on the potential severity of alpha-gal.
While this is the first documented alpha-gal death from food exposure in the U.S., including on Martha’s Vineyard, cases of alpha-gal have surged on the Island. And hospital officials have seen that firsthand in their emergency room.
“We’ve had people come in with very severe allergic reactions, I can confirm that,” Claire Seguin, chief nursing officer and vice president of operations at Martha’s Vineyard Hospital, said. “Thankfully, not death, but very scary.” She added that the hospital on-Island is “more in tune here” to test for alpha-gal should someone come in for an allergic reaction. In 2020, the emergency department performed nine tests for alpha-gal, which resulted in two positive cases; in 2024, 1,254 tests gave 523 positive results, about a 42 percent positive rate, which was higher than the year before, Seguin said.
The Centers for Disease Control doesn’t have a concrete number of people affected, but estimates that as many as 450,000 have alpha-gal across the country. However, knowledge of the syndrome isn’t as prevalent elsewhere as it is here. A study from 2023 said around 42 percent of surveyed healthcare providers had never even heard of alpha-gal.
As the Island is already flooded by Lyme cases and other diseases, the rapid infestation of lone star ticks has further burdened the community through tularemia and ehrlichiosis. Hospital officials recently released a preliminary version of the 2025 Community Health Needs Assessment, which is published every three years, and saw that tick-borne illness surfaced as a much higher issue than in the past. Based on thousands and thousands of tests, the Island has a rate 10 times higher than the rest of the state for tick-borne illness.
Hamner, who collects data for public health surveillance, said that a surge in tests at the hospital isn’t happening only because cases are more frequent. “[It] tells us that there is increasing patient and provider awareness of tick-borne conditions like Rocky Mountain spotted fever, tularemia, and alpha-gal,” Hamner said.
Based on five years of data collected, 2020 to 2024, Hamner said the Island’s highest burden comes from Lyme disease, babesiosis, and anaplasmosis, all of which are seen at rates from five to 11 times higher than the state rate. She is currently gathering more data to contextualize large-percentage increases in disease preliminarily reported in the assessment.
“Tick-borne illness is a challenge, and it uniquely affects us here on the Island, and I feel that the community, the hospital, everyone working together, is going to address this head-on,” Seguin said. The needs assessment requires an improvement plan that’s implemented over three years; the next plan cycle starts in January, once the report is finalized.
This isn’t the first fatality documented worldwide from an alpha-gal allergic reaction. There was a 2023 case in the Czech Republic about a man who suffered from anaphylactic shock after he ate spicy pork kidneys; hospital staff found a tick embedded in his skin upon arrival. Jiri Müller, an internist on the case, also said in his report that their hospital saw another alpha-gal patient die from severe anaphylactic shock.
And though not from food exposure, a monoclonal antibody drug called cetuximab, which was trialed in the late 2000s to treat colorectal cancer, is what led scientists to discover alpha-gal syndrome, after exposure to the medication caused severe allergic reactions, some of which were fatal.
According to last week’s study, the American man who died had gone to a barbecue in New Jersey, where he ate a hamburger at around 3 pm. Afterward, at home, he mowed the lawn for an hour, and had no gastrointestinal symptoms when his wife left the house at 7 pm. But by 7:20 pm, he went to the bathroom, and within 10 minutes, his son called his mother to say his father was sick.
The son called 911 at 7:37 pm, and started resuscitation efforts after he found his father unconscious on the bathroom floor, surrounded by vomit. Paramedics continued resuscitation and transferred him to the hospital, but by 10:22 pm, he was declared dead.
This mirrored a similar event two weeks earlier, when the family was on a camping trip: Several hours after the man ate beefsteak for dinner, he awoke at 2 am with severe abdominal pain. His symptoms improved a few hours later, but he had told his son he thought he was “going to die.”
“The significance of this case is that a large and increasing population of the U.S. is being exposed to the lone star tick, both because the tick is moving north and because there are now large populations of deer in many states,” the report said.
Symptoms, which can manifest in ways from digestive to respiratory, can appear two to six hours after mammalian meat is consumed. Symptoms that clinicians watch for include abdominal pain, cramping, nausea, vomiting, diarrhea, hives, itching, flushing, swelling of the lips, eyes, or face, shortness of breath, dizziness, low blood pressure, and anaphylaxis.
Alpha-gal can often go undiagnosed because of delayed reactions, as evidenced by the man from New Jersey. The report comes almost a year after the man died, when his initial examination showed no abnormal indicators, and his autopsy report concluded that this was a “sudden unexplained death.” But his wife wanted a better explanation.
The Virginia researchers, who reviewed the autopsy, concluded the death was anaphylaxis related to alpha-gal; the severity of his anaphylaxis could have been exacerbated by alcohol consumed at the barbecue, exposure to ragweed pollen, and exercise in the afternoon, researchers said. His wife told the Virginia team that her husband had had tick bites in the past, but none in the last year. However, she said that earlier in the summer, he had had 12 or 13 what he believed were chigger bites around his ankles. The report notes that lone star larvae bites are often confused with bites from chiggers, microscopic red mites.
“This terrible incident illustrates why we often lean on coining alpha-gal syndrome as the ‘midnight allergy,’” Hamner said. “People can eat a perfectly normal dinner, feel fine for hours, go to sleep, and then wake up in the middle of the night or early morning with unexpected symptoms — sometimes with gastrointestinal symptoms like abdominal pain, nausea, or vomiting, sometimes with skin symptoms like hives or flushed hands and feet, sometimes with shortness of breath or dizziness, sometimes an impending sense of doom.”
Meat is also not the only common trigger for the allergy; gelatin products, such as candies, marshmallows, and some medications, as well as organ meats or high-fat dairy, can cause an allergic reaction.
“If someone suspects alpha-gal, they should avoid mammalian meat until they know more, and seek emergency care for any breathing problems, throat swelling, severe abdominal pain, or lightheadedness,” Dr. Karen Casper, emergency medical department director at Martha’s Vineyard Hospital, said. “If an epinephrine auto-injector has been prescribed, it should be always carried.” But Casper added, “The most effective way to reduce risk is to prevent tick bites through insect repellents, protective clothing, and careful tick checks after time outdoors.”
On the edge of holiday season, Kelley Ellsworth, physician assistant for Martha’s Vineyard Medical, added that caution is imperative when food is prepared by others, and suggests that those affected by alpha-gal read all food labels themselves. “Others may use substances such as beef broth or bacon to add a richness to their dishes. Custards, flans, and icing can contain gelatin or carrageenan,” Ellsworth said. She added that dairy-free items, fish, and poultry can include carrageenan, which can also trigger an alpha-gal reaction.
Editor’s note: This story was updated to include Island context and data as well as correct that lone star tick larvae bites are often mistaken as chigger bites.
I put in a correction to this article, but in case someone’s reading I will say it here as well. Chiggers are not lone star larvae. What the study reported is the patient thought his itchy bites on his ankles were chiggers. The researchers note that many people confuse the two, thinking lone star larvae bites are chiggers. They are not. And the researchers think the patient had lone star larvae bites on his ankles.
This is a terrible tragedy yet the report is instructive. I recommend all read the source article.
https://www.sciencedirect.com/science/article/pii/S2213219825009535
Seriously. Permethrin. All the feel good natural alternatives don’t kill ticks. That’s a fact. Save your life and spray with permethrin.
https://wwwnc.cdc.gov/eid/syn/en/article/30/1/23-0813.htm
The cdc conducted an entire study on essential oils and other natural alternatives and simply put. They don’t work. Use permethrin.
Alpha Gal is a serious issue. it’s increased frequency on the island recently is well documented. If there is a silver lining to this tragic death may it be that it raises awareness that if you have a serious medical issue that you don’t know the reason for , don’t hesitate to seek medical care. This unfortunate individual, for whatever reason did not when he had the first issue. Of course, every time you get a stomach ache you may not want to go to the doctor. But this person thought he “was going to die” 2 weeks earlier. If I had something that severe, I would talk to my doctor about it. I wonder why he didn’t . Of course, we know nothing about his medical insurance or lack of it. But, Let me take this opportunity to put in a plug for universal health care. Maybe, just maybe, this man would have sought medical advice and had testing done if we had free universal heath care, as do most developed countries. Perhaps his son would not be mourning the death of his father today.
I understand your concern, but it relies on assumptions not supported by the article. Nothing in the reporting indicates this man avoided medical care, lacked insurance, or hesitated to seek help.
After his earlier episode, he underwent an examination that showed “no abnormal indicators,” which means he did seek evaluation and was trying to understand what happened. Suggesting he ignored a life-threatening event isn’t grounded in the facts provided, and it risks assigning motives we cannot know.
More importantly, alpha-gal syndrome is unpredictable. Symptoms can appear many hours after eating, and researchers noted that factors like exercise, alcohol, and ragweed pollen can intensify a delayed reaction. Even individuals under active medical care can experience anaphylaxis with little warning, and this delayed pattern is consistent with known presentations of alpha-gal.
Assuming that universal healthcare would have prevented this tragedy goes beyond what the medical findings support.
The researchers’ message is about awareness: the Lone Star tick’s range is expanding, cases are rising nationwide, and delayed anaphylaxis can become deadly without warning.
Turning an unpredictable medical event into speculation about why the victim “didn’t” do something — something we don’t know he avoided — doesn’t honor the facts or the family’s loss.
The examination that resulted in the “no abnormal indicators” diagnosis was the autopsy after the death which resulted from the second incident, not after the “earlier episode”. No indication the man sought medical attention after the first episode and as Mr. Keller states clearly there is no information in the article about the man’s insurance status…but we know he wasn’t covered by “free universal health care” as there is none available in the good ol’ USA….pity.
Excellent and helpful comment, Murray. Politics, assumptions without facts, and victim blaming for the unpredictability of alpha gal syndrome are inappropriate and disrespectful. I’m sorry for everyone going through this.
We’re taking the wrong look at this. Sure it’s a tragic death but alpha-gal is really a blessing. Less meat eaters = happier planet!
Dude what is wrong with you. Somebody died.
Murray–Thank you for your response to my comment. I take your reasonable and articulate points seriously. As I said, the point of my comment was to plug for universal health care. I agree –The article is short on details and we don’t know if he actually sought medical care or had insurance . The article states “The man’s examination showed no abnormal indicators in the cardiac, respiratory, neurological, or abdominal systems, and his autopsy report concluded that this was a “sudden unexplained death.” We don’t know if the examination was post partum or not. The sentence is ambiguous enough to remain, well, ambiguous– I also didn’t say he ignored it. We simply don’t know– I agree with you that unpredictable medical conditions happen all the time– I am in no way disparaging the person who died. This is an anecdotal case– I am vicariously speculating / advocating for the millions of people who do not have access to adequate and/or affordable medical care.
I am curious what, if any, concerted Island effort to reduce the tick population is being implemented? Not seeing much, if any?
None. Everyone is too worried about the possible harm to cats and bees so we’re stuck using essential oils and fairy dust to curb the tick population.
I also have alpha- gal, but luckily , not a severe case. After a year of acupuncture, I can tolerate dairy again with no reactions. However, today at lunch ( not MV, Key West,) that had shrimp on it, obviously cooked in bacon fat, as I had an immediate reaction. However, since it was not severe, instead of immediately going to one of the epi pens that I always carry with me, I took two Benadryl instead , and after a half hour, my symptoms subsided. Good idea for folks to carry both. And of course, the epi pen will be with me at all times in case the symptoms return or get worse, but folks should carry both, I think, the Benadryl could save you a trip to the hospital, maybe.
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