On Monday, May 4, boards of health from across Martha’s Vineyard organized a meeting about best practices for creating an alpha-gal-friendly kitchen. The discussion brought together public health officials, scientists, and members of the Island’s food industry to address a condition that is becoming increasingly relevant to daily life on the Vineyard.
The conversation was led by epidemiologist Lea Hamner, who specializes in tick-borne diseases, and included Josh Levy from Vineyard Nutrition; Patrick Roden-Reynolds, a wildlife biologist who surveys ticks on Martha’s Vineyard; and local chefs Charles Granquist (Slough Farm), Everett Whiting (Fish House), and Hal Ryerson (Sweet Life). Board of health agents Alexa Arieta and Fred Hehre were also present.
“The goal today is to get business owners, restaurant owners, people who work in the kitchens, to kind of come together in a roundtable discussion,” said Arieta to start the meeting. “To make sure that everybody understands just how serious this actually could be in your restaurant. I’ve worked in many kitchens in my life where you’ll hear somebody say, ‘Oh sure, you’re allergic to dairy, you just don’t like it,’ but this could be really serious for someone.”
It is unusual for all boards of health to organize a meeting for the food industry. The initiative reflects the growing seriousness of the risk alpha-gal syndrome (AGS) poses. Until officials figure out what to do with the growing deer-tick-spreading party, we have to assume the lone star tick will continue to affect Martha’s Vineyard’s residents and visitors.
On an island where outdoor work, farming, landscaping, and recreation are central to daily life, exposure to ticks is hard to avoid. As a result, alpha-gal is no longer a rare condition — it’s part of the lived experience for the year-round population, especially service industry staff and guests.
Jamie Hamlin, Vineyard caterer, raised a concern about working and dining outdoors. “We do a lot of work in open fields, so we are particularly susceptible,” she said. “Do any of the organic sprays work on alpha-gal? What would you recommend for treating us and the property? What are guests supposed to do?”
Roden-Reynolds emphasized the first step should be treating your clothing with permethrin and making sure your clothes are properly tucked in. “That’s what I do when I go out on my surveys. Been here five years, only have had two bites. Even if you treat the property, it’s not going to eradicate the problem. And as soon as you venture out, you’re exposed again.”
Hamner added that permethrin has been studied for more than 30 years, and is not toxic to humans.
Levy explained the intricacies of AGS, describing it as a potentially life-threatening allergy primarily triggered by consuming — or sometimes even inhaling the fumes of — cooked beef, pork, lamb, venison, or goat. Dairy and other mammalian-derived products, such as broths, gelatin, stocks, and even refined white sugar (filtered through animal-bone charcoal) are lower-risk allergens. Certain non-mammalian products, like fish roe, red algae, or carrageenan, can also ignite a reaction.
Unlike typical food allergies, symptoms can take up to two to six hours to show up. Some common reactions include hives, itching, swelling of the lips and/or throat, severe stomach pain, diarrhea, and vomiting. Consuming alcohol or fatty foods may worsen the reaction. Levy recommended using the FIG (Food Is Good) app to search for foods with alpha-gal. Since there is no cure, the only recommended treatments are to avoid mammalian products, cook your own food, and avoid getting more tick bites.
As the number of affected Islanders grows, the food industry cannot ignore this dangerous allergy. For local restaurants, creating AGS-friendly menu items is quickly becoming part of the baseline expectation for doing business on the Island, and a sign of care for the safety of our community.
Treating allergy alerts in restaurants is challenging, to say the least. Guests tend to overuse the term to force the kitchen to accommodate their preference, and chefs often have a difficult time believing that their patron is allergic to parsley. Chef Granquist acknowledged he’d had a somewhat loose approach to AGS until he saw his wife go into anaphylaxis within 20 minutes of eating a burger. Her reaction made him realize just how serious this allergy can be, and since then Granquist has implemented very rigorous protocols to avoid cross-contamination in his kitchen at Slough Farm. With AGS, even trace exposure can be problematic. The seasoning of a cast iron pan or grill can transfer allergens onto alpha-gal-friendly food, rendering it unsafe.
Hamlin, who has five close friends with alpha-gal, recommends recipes from the Mediterranean region, where olive oil replaces butter as the primary fat. Both her son and I (also a chef) mentioned Asian cuisines as good options, relying less on dairy and more on umami-boosting ingredients. (I have found that silken tofu is perfect for making creamy chocolate mousse, and serves as a dairy-free thickener.) Chef Ryerson used to use only veal bones as a base for his sauces. Since the alpha-gal outbreak, he’s pivoted to chicken carcasses and feet, which contain a lot of gelatin, and dried mushrooms for depth.
The alga carrageenan — a potential AGS trigger — is frequently used in vegan substitutions. Levy noted that fortunately, a lot of imitation products are labeled “carrageenan-free,” making them easier to identify.
At Sweet Life, Chef Ryerson makes sure that each section on the menu has one alpha-gal-friendly dish, and maintains detailed allergen documentation. Chef Whiting has stopped using butter, and created more offerings that avoid mammalian products altogether. At the Maker Cafe, many dishes can be adapted by substituting olive oil for butter and omitting Parmesan, and are prepared in separate pans to prevent cross-contact. At MV Salads, allergy orders are handled directly by the manager.
Efforts like these reflect a growing awareness across the Island’s food industry. Yet it is apparent that even though the room was full today, there are a lot of folks who are unaware of the problem, or do not take it seriously. Hamlin shared a recent experience to illustrate the problem. “My alpha-gal friend and I went out for lunch the other day to the Atlantic,” she said. “She stopped at the front desk to ask if they are aware of alpha-gal. They just said, ‘What?’”
Board of health agents addressed questions: Are you going to do any outreach to restaurants? How are you planning to educate the food industry?
Arieta responded that the meeting itself was intended to serve that purpose.
As a chef in attendance, I noted that not all restaurant owners were there, and that the information about the meeting had been limited. The only public notice I was able to find was a single Instagram post on the M.V. Chamber of Commerce account, and the event wasn’t listed on the Inter-Island Public Health calendar.
Hehre noted that the issue is discussed at every inspection, but no policy has been implemented. The boards of health suggest that kitchens put together an “allergy kit” that contains extra-clean and sanitized utensils, cutting boards, etc. By law, food establishments are required to provide reasonable accommodation to customers with food allergies. At the same time, chefs must be honest about what they can and cannot do in their kitchens, to help their patrons make an informed decision about their health.
Since there is no official policy, AGS has not made it to allergen-awareness training. It’s surprising, considering that about 500,000 Americans are battling this.
Hamner called upon the attendees to advocate for the proposed “Alpha-Gal Allergen Inclusion Act,” which would require clear product labeling and make navigating this problem a lot easier for all of us. She also invited suggestions and input on how to keep educating Martha’s Vineyard’s food industry.
For chefs, the issue extends beyond managing workflow. As a chef myself, my hope is that this situation will prompt a consideration of sourcing away from heavily processed foods with long ingredient lists toward more transparent, wholesome, and seasonal cooking.
Hehre followed up after the meeting: “A key takeaway from today’s discussion is the need for increased education and awareness about alpha-gal syndrome. To all readers: you can help spread awareness by continuing this conversation with residents and visitors; consider posting public health education materials in your business, and share the link to the Inter-Island Public Health Collaborative webpage on this topic, bit.ly/IPH_alpha-gal-info.”
Krem Miskevich Combra has been a private chef on Martha’s Vineyard since 2021. Seasonal, local, and safe cooking is their priority.