Alpha-Gal Syndrome and the Role of the Pharmacist

Alpha-gal syndrome (AGS), a growing allergy linked to tick bites and mammalian meat exposure, is a condition pharmacists can’t afford to overlook. This course discusses the pathophysiology of the syndrome, common triggers, and emerging case trends—while highlighting how pharmacists can play a critical role in helping patients navigate safe OTC and prescription therapies by screening for allergenic excipients. You will gain practical knowledge to support patient education, ensure safe medication use, and guide appropriate referrals.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

GUEST
Geoff Wall, PharmD, BCPS
Professor of Pharmacy Practice
Drake University

 
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CPE INFORMATION
 Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the pathophysiology, triggers, and clinical presentation of alpha‑gal syndrome.
2. Identify pharmacist‑led strategies for patient counseling, medication review, and referral when AGS is suspected or confirmed.

Rachel Maynard and Geoff Wall have no relevant financial relationships with ineligible companies to disclose.

0.05 CEU/0.5 Hr
UAN: 0107-0000-26-058-H01-P
Initial release date: 3/30/2026
Expiration date: 3/30/2027
Additional CPE details can be found here.

Transcript

Welcome And Topic Setup

SPEAKER_00 0:00

Hi Health Mart Pharmacist, from your education partner CE Impact, this is Game Changers. I'm your host, Jen Moulton, and each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.

SPEAKER_01 0:21

Welcome to the Game Changers Clinical Update Podcast. I'm your host, Rachel Maynard, and I'm really excited about our discussion

What Alpha Gal Syndrome Is

SPEAKER_01 0:27

today. We're going to be looking at a topic that's gotten some buzz recently, Alpha Gal syndrome or AGS. And you may or may not be familiar with Alpha Gal syndrome, partly depending on where you live. It's actually an allergy to red meat, but you can develop it after a tick bite. And in the US, the lone star tick is most often associated with Alpha Gal syndrome. And most reported cases in the US are in the south, east, and central states, the areas where most lone star ticks are found. Although we are starting to see more cases outside of these areas too. So today we're going to dive into Alpha Gal syndrome, sometimes called a red meat allergy or tick bite meat allergy, and what this is in more detail. And so to help us demystify this topic, I'm so pleased to introduce our guest today, a longtime guest and former host of this podcast, Dr. Jeff Wall. So welcome again, Jeff.

SPEAKER_03 1:12

Hello, how are you guys doing?

SPEAKER_01 1:13

Great to have you again. Thank you. And for our listeners who might not have heard you in the past, Jeff, if you could just give a little bit of background of who you are, where you are, where you're at, your practice setting, and why you're interested in this topic.

SPEAKER_03 1:26

Absolutely. Yeah. So yeah, so as you point out, I actually was the first uh host of Game Changers for several years. Um and I am a professor of pharmacy practice at Drake University here in Des Moines. I'm also an internal medicine clinical pharmacist at a Iowa Methodist Medical Center, which is the large tertiary hospital here in town. I've done a lot of research in the area of drug allergy. This is kind of adjacent to drug allergy, but I teach it at Drake. I've I've published a lot in this area. So yeah, drug allergy is always something that's fascinated me. And as I said, this is kind of an interesting, you know, intersection between drug allergy, food allergy, and an infectious and an infectious disease. So it's really, it's really kind of bizarre. You know, it is interesting.

SPEAKER_01 2:10

Yeah. And normally when you think about tick-borne illnesses, you think you think of infection, whereas this is more of a sensitivity, as you said, more adjacent to drug allergy, food allergy sort of situation. So excited to get into all that. Thank you again for your time and for joining us today. And so I shared a few little tidbits about what Alpha Gal syndrome is, but let's get more specific about this. So can you describe, you know, what Alpha Gal syndrome is and how do people get it and sort of that nuance between tick-borne and infection and sensitivity, those sorts of considerations.

Why It’s Unusual For Allergies

SPEAKER_03 2:40

Absolutely. Uh, you know, I'll be honest, I had heard of this. I had to do, you know, in in complete transparency, had had heard about this, had to do a lot of research myself. It is one of those things that was kind of floating around, you know, especially social media and things along those lines. Uh, it was first described actually in 2007. So it's not like this was a, you know, we've known about this for years and years and years. It actually was was first really delineated, you know, again, less than 20 years ago. Um, but again, it's gotten a lot of mainstream media attention for for good and for bad. I think that, you know, it's a very good thing that this is has made a lot of media and and and made a lot of people aware of it. I think it's kind of gotten a bad rap, if you will, among some practitioners and healthcare professionals, because you know, it tends to fall in the constellation of things like you know, Lyme disease and stuff like that, where there's this, there's this kind of thought process that, oh, you know, people are assigning all sorts of weird symptoms and stuff that really isn't associated with it. I don't think that's fair in the case of Lyme disease, and I certainly don't think it's it's it's fair in this case as well. As I said, and and as you mentioned, you know, it it it's this weird intersection between infectious diseases, food allergy, and drug allergy. But but basically what happens is you've got a chain reaction after a tick bite, usually the lone star tick, which is the most common one. It's more common in the southern U.S. But as climates change, so you could argue this is one of the another unintended consequence of climate change and the warming of the northern hemisphere that we're starting to see more and more spread of the of the lone star tick more north. And in Iowa, we actually do see quite a bit of these. So anyway, basically, as it's a result of of the lone star tick bite. Now, interestingly, you know, Lyme disease is also the result of a tick bite, but but what happens there is it's a vector. Basically, the saliva of of that tick delivers the organism to the the patient. In this case, it isn't a bug. So that it's not a it's not a vector, it's not like the the tick bite delivers another organism to you, but it's actually the tick bite itself and properties and the chemicals of the bite that lead to this sensitization. So again, extremely weird, you know. Um, so you know, and and you you wanted, you know, we talked a little bit about kind of what happens, right? You know, so yeah, alpha gal syndrome. And I have to admit, I had to keep practicing because I wanted to say alpha gel syndrome, but it's all alpha gal syndrome. And and and the reason it's called that is that it's it's the it's a an immune response to a specific sugar that is only found in mammalian

Symptoms And Delayed Reactions

SPEAKER_03 5:20

meat and only in mammals, and not even in all mammals, but but unfortunately in the mammals that I'd say most Westerners do consume. So, and that that sugar is galactose alpha-1-3 galactose, which is shortened to alpha gal. So that that's what where that comes from. Um, again, red meat allergy, as you pointed out, and it it it's an it's an experience where where patients develop an allergic reaction and it can have classic allergic symptoms like hives and rash and even anaphylaxis, but much more much more commonly gastrointestinal symptoms, including gastro-abdominal pain, diarrhea, things like that after eating a million meat. And it usually has a delayed onset. It again, unlike almost all IgE-mediated reactions, it doesn't occur instantaneously. And that's, I mean, in my world, in drug allergy, when you have an IgE-mediated drug allergy, the reaction usually occurs within minutes of of receiving the the allergen. That's not the case in this as well, again, again, something very unusual and and kind of strange. It is present. This this this sugar alpha gal is present in in all non-primate mammals. So uh again, I guess if you're fond of having orangutan for dinner sometime, I guess you're okay. Now, interestingly, the uh humans, while we don't have alpha gal, actually, if you are a have a B type blood type, if if you're blood type B, you uh there's a sugar in that blood type group that is nearly identical to alpha gal. So that's kind of interesting, right? But and has an additional fructose on on the residue. And so, as you might imagine, patients like that who already have kind of a tolerance because they have the sugar floating around in the bloodstream are are actually much less likely to develop alpha Gauss syndrome, and they're much less, and if they do develop, the symptoms are usually much less. So, I guess that's that's again another very fascinating piece of this disorder. So, again, humans and non-human primates don't express alpha gal, and they will develop all three or four immune globulins to it. But and again, almost all humans who have eaten red meat will probably develop immune globulin responses to alpha gal, including IgE, IgM, and IgA, they never have side effects, they never develop the allergic response. Only in the presence

Prevalence And Underdiagnosis

SPEAKER_03 7:47

of the development of IgE antibodies do people develop alpha gal syndrome. So, again, again, very interesting. Yeah. If if you are listening to this and you were like me and you were kind of vaguely aware that it existed but didn't know much about it, don't feel bad. A 2200 survey of 1500 physicians revealed that half of them weren't even aware of it. They know what it was. And of those, at least a third of them said, Yeah, I don't know how to diagnose or manage or anything along those lines. So don't particularly feel bad. That, of course, always leads to delay in diagnosis. And one study actually found that that patients, the average number of years people will wait before diagnosis is five years, sometimes they over 10 years. And as you might imagine, they do they undergo, you know, especially with the abdominal symptoms, all sorts of of you know, CT scans, colonoscopies, all this other stuff. So again, you know, kind of interesting. And it's you know, not super common, but it ain't rare either. Uh, CDC estimates that there are 400,000 cases that have been reported since uh 2010. So kind of interesting. Um, it is unusual in allergic reactions that also as far as age is concerned, kids can get this at about the same rate as adults. So again, it you know, it it it happens in both children and adults. And I'm sure, you know, that kids who have a complaint of stomach problems often will undergo the same amount of testing that adults will. So again, you know, very, very interesting stuff.

SPEAKER_01 9:26

Yeah. You you you called it a lot of great points there. So just to sort of summarize a few things, I think the key distinction, one key distinction with other, again, tick-borne illnesses, you made the good comparison to Lyme, is that this is not a bug, not an infection that's being transmitted from a human. It is, as you say, alpha gal is this sugar that mammals, most mammals have. And this sugar can also be found in the saliva of some ticks. And so when the tick bites a human, it's not that an infection is being passed, it's that the human who has not who has not been exposed to this potentially in the past develops a sensitivity to the alpha gal. And that's where these symptoms come from. So that's a really important distinction, I think. I think also, you know, you described sort of the range of symptoms and that people can have any, you know, you can have sort of the hives, rash all the way up to anaphylaxis. So it can be a serious, life-threatening allergic reaction, but it can also present

Testing Limits And Clinical Clues

SPEAKER_01 10:25

as these GI symptoms, nausea, vomiting. And then again, another really important point you made is this delayed onset of symptoms. So I think that also contributes to the underdiagnosis because people may not, as you say, usually sort of an allergic type response. You you think about it as a quick sort of response, whereas this can be over two to six hours later, you might start having symptoms and you may not associate it with food that you've eaten that could potentially be at risk. The other thing I think that complicates is that after the tick bite, those symptoms may not even start occurring until weeks or months later, I think. And so there's also that associated with association with the tick bite itself, and then the actual symptoms upon the you know, put onset of food intake. So lots of complicating factors there. And as you said, you know, the the 400 plus thousand people as reported by CDC, but it's not a notifiable sort of condition, and so it's not something that we have necessarily good data on, again, for all the reasons you said too about this, it's difficult to diagnose. And then, you know, the other thing I thought was really interesting when looking into this was that it's it's something that even if you are exposed from a tick bite, not all people will develop Alpha Gauss syndrome. As you said, you know, maybe there's a blood type consideration there. So whether or not it doesn't mean if you get bit, you're going to develop this, not that's not the case. And then also, again, that sort of spectrum of symptoms that people have, and also that people some people can respond to red meat, some people can also respond to dairy, but they may not. And and so that gets into sort of the med side and the pharmacist role and helping with inactive ingredients and medications. But I just split, like you said, there's a lot of really interesting sort of facets of this condition that are important to tease out because it is it is quite a bit different than than some other drug or food sort of related allergies, I think we're used to seeing.

SPEAKER_03 12:20

Yeah, absolutely. Uh, you know, and again, yeah, it it it is so different than IgE mediated drug allergies or or food allergies for that, for that matter, that it just I'm I'm sure that that there are allergists and and immunologists out there who are doing tons and tons of research on this because it's such it's such a unique entity, you know. You know, and you know, to your point, you know, that I think that's the key piece for an IgE-mediated reaction. Most people don't develop symptoms as soon as they have a bite of a hamburger, right? It's usually hours after the event that they start developing GI symptoms. And I actually found a couple of case reports where people were were would be would be taking Benadryl at night, you know, to help them sleep. And that actually masked the symptoms of of Alpha Gal, right? And if they if they didn't take the the diphenhydramine to help them sleep, they developed real bad gastrointestinal problems. I mean, it's just yeah, really weird, you know.

SPEAKER_01 13:20

Yeah. I I saw one case report where it was actually, I think, one of the first reported deaths attributed to Alpha Gal syndrome, where it was a similar situation. They were camping, he had had dinner, and hours later it was, you know, the sort of worst pain of his life, GI, and then later was exposed and ended up dying from

Management Through Allergen Avoidance

SPEAKER_01 13:38

it. So it is yeah, it can be life-threatening, as we said.

SPEAKER_02 13:41

Absolutely.

SPEAKER_01 13:42

And in so, in terms of a diagnosis, we said it can take weeks to months after that take bite for people to start potentially presenting with symptoms if they do. What other kinds of diagnostic tests are done to help identify this outside of that trying to link it to symptoms, which we we identified some of the challenges there.

SPEAKER_03 14:02

That you know, that that's a good question. Unfortunately, so so again, there's there's no easy diagnostic test. You can look for the the immune globulins to alpha alpha gal, but unfortunately, because almost everybody expresses you know the these these antibodies to some degree, it it's not super specific or sensitive. Obviously, the the the one you want to look for the more is is IgE. And while there are no while there's no firm you know diagnostic guidance, everybody is everything that I've read says that if your alpha gal IgE is greater than 0.1 IUs per mil, that is at least laboratory support. Again, it's not gonna diagnose because it's a it's a clinic, it's a clinical diagnosis.

SPEAKER_02 14:52

Right, right.

SPEAKER_03 14:53

You know, so it you know it yeah, unfortunately, we don't have a super duper great sensitive and specific test for this. And so if you have you know a patient who's presenting with unexplained gastrointestinal symptoms or paritis or arthralges, unfortunately, a lot of people are not gonna even remember they got bit by a tick. Right, right, you know, so like unfortunately, you can't even just say, well, gee, have you gotten a recent tick bite?

SPEAKER_01 15:16

You know, some of them some people will say yes, but a significant number of people like no, all right, right, or or didn't recognize it or didn't aren't thinking back to several months ago when they did. And that was actually the case with the the patient I talked about who who did end up dying from this because there was uh upon further investigation was when the tick bite was identified. But yeah, it took a little bit of digging to figure that out. So now, in terms of management, if if you have a patient who has confirmed or suspected alpha gal syndrome, what are the key steps of managing that? So we talked about how exposure to mammalian mammal sort of red meat is sort of that classic characteristic that's associated with it. But what what kind of management strategies are there? Do they have to avoid red meat altogether? Are there other things they have to avoid? I sort of alluded to dairy and some other things. So let's get into that a little bit more.

SPEAKER_03 16:07

Absolutely. So uh yes, quite like a celiac disease where you've got, again, kind of an allergic reaction to gluten in that case, allergen avoidance is the cornerstone of management, right? So once you've made the diagnosis of Alpha Gal syndrome and and you've got at least gotten some supporting evidence from from the Alpha Gal IgE, uh, you know, they should not have any pork, beef, venison, or any other mammalian products.

Medications, Gelatin, And Biologics Risk

SPEAKER_03 16:36

So basically, you know, if if it's a mammal that walks on four legs.

SPEAKER_01 16:40

That's exactly what I was gonna say. That's what I've heard is anything that walks on four legs is what you need to think about. Whereas poultry, like chicken, turkey, exactly, that's not a problem. Yep, exactly.

SPEAKER_03 16:49

Yeah, so yeah, so exactly right. So poultry and fish are perfectly fine. But yeah, if it walks on four legs and it's and it's and it and it's a mammal, unfortunately not. So unfortunately, steaks are out, pork tenderloins are out, kind of sucks, you know. Uh, you mentioned dairy. Um, dairy products also contain alpha gal, but the vast majority of people with confirmed alpha gal syndrome actually tolerate dairy fine. So that, you know, so most patients will be able to have dairy okay. Now, uh many adults, in fact, the majority of adults can't tolerate dairy for other reasons, usually lack of lactose, but this isn't one of them. If they do have symptoms, obviously it's reasonable to recommend an avoidance diet with dairy. That's very challenging to do sometimes, but that's thing. So that, you know, so again, perfectly fine to have chicken, perfectly fine to have fish, but avoid uh mammalian meat, avoid uh diet dairy if you have those symptoms. Where pharmacists kind of get into into into role is that there are many bovine or porcine-based products, such as gelatin, marshmallows, gummy bears, and other desserts that may not be tolerated. And and in fact, some super sensitized patients have even developed reactions from smelling frying bacon. I mean, unbelievable, you know. But but again, you know, where where where pharmacists kind of get into roll is is gelatin. Unfortunately, or fortunately, depending on how you look at it, gelatin is is part of the inactive ingredients of a wide, wide, wide variety of medications, particularly encapsulated medications, because usually decapsule is gelatin. And so that that gets to be a real deal. Also, there are monoclonal antibodies that have alpha gal as part of their structure, in particular Setuxamab, Abaticep, and in my world, where I've done a lot of research in in RA and Crohn's disease and phliximab all contain alpha gal. And in fact, some of the first deadly reports of of alpha gal people who had died from it were people who received these drugs, had an allergic reaction and died, and then kind of they kind of retroactively went back and figured out they had alpha gal syndrome all along. And had they had we known that, we probably wouldn't have given those drugs. There's been some talk about perhaps that becomes part of the screening for before starting those medications, just a screen for alpha gal syndrome. And I certainly think that's something reasonable to consider, you know. Uh heparin is actually derived from from postine and bovine sources. There are several case reports of of it causing reactions, but though interestingly, it's usually in by continuous infusion. So the low doses that we use for DBT prophylaxis in the hospital don't seem to be a problem, and anoxaparin doesn't seem to be a problem. And again, probably the low molecular status is kind of what's going on there. Again, that makes it really tricky tricky because people do develop allergic reactions, you know, to a variety of medications, and we just not associated that with alpha alpha gal syndrome. Right, right. You know, so that that that makes it that makes it kind of interesting. So if you had a patient who had known alpha gal syndrome, say, and they had a heart attack and they needed to go to the calf lab and we're going to give them lots of

Vaccines, Heparin, And Workarounds

SPEAKER_03 20:05

heparin, what are you going to do in that case? They've got to have the heparin.

SPEAKER_02 20:09

Right, right.

SPEAKER_03 20:09

You know, so you have, you know, in a case like that, I think that's where the pharmacist really has to kind of think on their feet, right? Can we use an alternative anticoagulant that's not derived from a porcine or bovine source like argatroban or bivalutin? Or do you pre-medicate? Because there's been a couple of case reports where people are pre-medicated with antihistamines and steroids before receiving heparin, and they've tolerated things just fine. So it just, I don't know. I mean, this is tricky for the pharmacist because gelatin is just it's in a lot of a lot of medications.

SPEAKER_01 20:45

It's interesting. I mean, you brought up the comparison to celiac and when there was a lot of awareness around gluten and medications, just you know, in the past couple of decades, that started coming up more frequently. And this really does parallel to me that sort of situation where you have sort of this broad range of sensitivity from celiac to gluten sensitivity, you know, that's sort of a spectrum. And that's sort of the same thing we're saying here with Alpha Gal, you can have all levels of severity and sensitivity to products or not. So, you know, it's worth noting not everyone with Algal syndrome will respond poorly to gelatin and medications. So it's a very it's a spectrum. But also the comparison to gluten is that gluten is often sometimes hidden in medications that you might not realize too. And so sometimes it comes down to looking at the inactive ingredients and identifying, and and you mentioned vaccines is another great example of that, where you might not think of gelatin being in some vaccines or some medications. Capsules are a big clue, but outside of that, there might be other ingredients that you're not that aren't necessarily coming to mind. And sometimes it needs to be that sort of case by case basis where you're checking and then evaluating the risk to that patient, given what other alternatives might exist. So, as you said, it's a it's a complex situation. And I think, you know, first. First and foremost, it seems like awareness about this is the most important thing, so that we are aware of what this is if people are asking about this, and then recording it in patient profiles, assessing just like we would with any sort of drug allergy, right? Assessing the patient's past response, what they reacted to, how severe their symptoms were, and then using that to help guide what action to take. Uh, it is challenging, as you said. Can you mention a couple as expand a little bit about the vaccine side of things there?

SPEAKER_03 22:29

Absolutely. Yes, and and and yeah, this is this gets tricky. There are a wide range of vaccines that contain gelatin in their formulation. Some of them in the United States are relatively rare. We don't give a ton of yellow fever vaccines, for example, but and most of the MMRs contain gelatin and the varicella vaccine contains gelatin. So that is going to be, I think, tricky when it comes to uh immunization with with those kind of with those with those vaccines. Now, there is it there is a small study that I found and it was an analysis of about 2,700 patients who had confirmed

Hidden Sources And Pharmacy Triage

SPEAKER_03 23:08

alpha Gauss syndrome, and they found no significant increase of risk of anaphylaxis, not necessarily no reactions, but anaphylaxis in in patients receiving vaccines when they compared the ones with and without gelatin. So, you know, I I would say now again, I'm not saying, oh, you know, don't worry about it, right? Right, right. But it but we have a very we have a small study that suggests that at least anaphylaxis is very rare with with gelatin containing vaccines and confirmed AG. Um, but the the the the papers I read, the experts in this field, I mean, the experts in a field that's literally not existed but prior to 2007, you know, they all say they all recommend trying to find gluten-free alternatives for for this when possible. Again, you may not have a choice. You know, there may not be a gelatin-free vaccine. So it it it it's it's it's going to be tricky. And uh, you know, we always talk about pharmacists having to think on their feet. It's something I tell my students is is is you know, the hallmark of a of a pharmacist is being able to kind of think outside the box sometimes. And this is this is absolutely going to be a case of that, I think, for pharmacists to to do such a thing.

SPEAKER_01 24:21

So I think one of the things you mentioned a bunch of meds to be aware of, which was a great sort of highlighting those, those key examples. The other ones that come to mind too, that as you said, sort of might be under the radar, are desiccated thyroid products that are moved from heaven, potentially. Those are sort of getting phased out more and more, but some people are still on them. And then some pancreatic enzymes too would be a potential issue too. Again, thinking about the poresine sort of contributing factor there. And then in with the vaccines, you know, there are resources online, like CDC has their pink book, which does list specific incipients. So those are able to find. But just in general, in terms of the prevention, I think one thing that we could see as a positive here is that gelatin has also been avoided by some patients for years for either religious or cultural insurance. And or if people are vegetarian or vegan, I think there's a lot more of awareness of that now and labeling now, but not so much with medications. And so from a food perspective, I think there's a more awareness, more labeling around this, because I I think I don't think meat necessarily has to be reported, but milk does. So if they have the dairy sensitivity, that's at least reported. But with the meat, it's not necessarily reported on labels. And so looking for even vegetarian-friendly on labels is is helpful. But I I say that just to say for people who are following dietary restrictions for other reasons, this ties into that too. So at least there's some so it there's awareness around it in general.

SPEAKER_03 25:54

Yeah, no, actually, you know, and and thank thank goodness for that, right? I mean, right, right. We would we would have zero information on this if we didn't have some, you know, at least partial experience with people who

Prevention, Ticks, And Exposure Risk

SPEAKER_03 26:06

needed to avoid gelatin for religious or other reasons. Yes.

SPEAKER_01 26:09

Right, right, right. And so if we think about, you highlighted a good set of practice pearls for pharmacists, and we talked about sort of that awareness, asking, uh, documenting in the patient profile, you know, thinking about this proactively in terms of medication reviews, any other sort of practical tips that pharmacists can be helping patients with? I'm I'm also thinking about how to help patients read labels, either over-the-counter or you know, prescription, but any other sort of tips and tricks that we should be aware of?

SPEAKER_03 26:37

I mean, I think that that you know, patients often do come to their pharmacist and especially in the community setting with you know, symptoms, you know, have been having stomach problems, you know, what do you think is going on here? Sort of stuff. I, you know, I'm I'm taking, you know, I'm taking my desiccated thyroid, which, you know, that's a whole nother whole other game changers we can talk about why that's that's not a good thing, but that's that's okay. But you know, but but for whatever reason, they're they're taking that and they're saying, you know, all of a sudden, I you know, I never had a problem for years, you know, and now all of a sudden, a couple hours after I take my thyroid, I start to get stomach problems. Well, you know, gee, you know, and I think, you know, I just just the that awareness, right? Because, you know, just saying, well, huh, that's kind of weird. Have you been camping recently or did you have, you know, you know, sort of thing? And if and if the story kind of lines up, you know, then you know, referral to an allergist immunologist is you know, and I think and until that happens, you know, you know, saying, well, maybe, you know, obviously try to avoid, you know, some of these, some of some of these things, right? But I think I think helping patients recognize what is an incredibly new entity and and and and you know, you know, getting them to the right resources, I think is is really where far like pharmacists in the community can play a play a big, big role.

SPEAKER_01 27:51

Yeah, that referral. And again, being aware of it, having it sort of top of mind when those symptoms come up and doing a little bit of digging, as you said. Um, in terms of prevention, I think that's also uh obviously we are encouraging tick prevention measures regardless of this. And uh there is no specific prevention measure unique to Alpha Gal. It's just preventing tick bites in general. Can you run through a few of those key points that we want to remind patients about there?

Waning Sensitivity And Rechallenge

SPEAKER_03 28:20

Yeah. So, you know, again, when going outside, working outside, camping, you know, long sleeve shirts, if you know, if you can, you know, appropriate insecticides, you know, that you can spray on you that that prevent that, you know, checking daily, you know, to see if you have any tick bites. Um, again, that's something that a lot of people just forget to do or something like that. So I mean, I think all those things kind of make sense. If you are in a place where you've got, you know, you you have a big backyard and you've got a big wood pile, for example, that's where tick the ticks tend to congregate. I would, you know, you whenever you're working around there, you know, try to to take tick prevention measures as much as you possibly can. Those, I mean, you know, and and as you point out, that's true for, you know, we have lots of tick-borne illnesses. It's not just for alpha gal, right? Yeah.

SPEAKER_01 29:05

Right, right. Yeah. So those insectropellens, the permethrin, and also checking pets too. Yes, yeah, always forgot about pets. Bring it into the house too. And I saw with Alpha Gal in particular, focus paid on uh raising awareness for hunters because they're often low to the ground and the forests and these deep grasses. And so that's a a prime sort of risk that is increasing your opportunity for being exposed. So yeah, some of those best practices, but nothing specific to alpha gal prevention. So it's just one of those. Unfortunately not.

SPEAKER_02 29:34

Unfortunately not.

SPEAKER_01 29:36

But what I did find super interesting was that alpha gal sensitivity can wane with time, but if you are re-exposed with another tick bite, it could actually you could have symptoms again, sort of this re-sensitization. That was really interesting to me. So even if you've been diagnosed, you you have alpha gal syndrome, you know, the potential that it can decrease with time is possible, but also the per the potential for it to become sort of not reactivated necessarily, but that you could be bitten again and be resensitized. Is that fair?

SPEAKER_03 30:08

Like, yeah, no, absolutely. And and yeah, that that's a good point that you know I think the the the thought about about allergies being lifelong in in many areas is starting to shift. I mean, we certainly know in in many drug allergies that uh, you know, early allergies, allergic reactions wane over time. And I think that's true with this, that that the you know, the at least the existing evidence suggests that that your the response to red meat goes down over time. Now, again, you know, it I think it's kind of up to the patient to say, well, you know, gee, it's been two years since I've had red meat, right? You know, and I really feel like McDonald's today, you know, you know, I haven't had any, you know, I haven't had any red red meat. You know, do you want to do you want to risk it, basically?

SPEAKER_02 30:54

You know, right, right.

SPEAKER_03 30:55

Unfortunately, uh, the things I read anyway suggest that, you know, you unfortunately really can't use the IgE,

Practice Pearls And Closing

SPEAKER_03 31:02

like a repeat IgE level to say, oh no, you're perfectly safe to have red meat, right? Yeah, you know, and and I think that's what we really we it would be very nice if we could come up with some sort of specific test that basically says, okay, your anti, you know, your antibody levels are zero, and it's you know, it's okay to do. The one paper I read did suggest that skin prick tests might help. And and and skin prick tests do tend to be a little more specific for allergies. And so, you know, I suppose if you had someone who just had to have red meat or someone who was very, very sensitive to gelatin and had just gotten tired of, you know, having to deal with these meds and all this other stuff, you know, and it's been two or three years since they've they've been really good, they've avoided all this stuff. And is it worth going to an allergist to have a have a skin test to see, okay, well, gee, you don't seem to be having a reaction to that. Your your IgE level repeat is relatively low. We could certainly try a small dose of something, you know, again, maybe you know, a small dose of meat and a dose of meat. I don't know, a small, a small amount of eat meat. Yeah, that's not a little strange. You know, a small amount of of meat and just and just watch you and see what happens. I, you know, that you know, but again, nobody knows because this is just too new of a of a of an entity to really have solid data on what we're supposed to do.

SPEAKER_01 32:20

Yeah, yeah. Tricky situation, and I think it will continue to as hopefully get more attention, and pharmacists will sort of be on the front lines to help identify patients who may need additional referral, but also patients who need support with medication selection if there's if there are medications contributing to some of those symptoms. So really important for us to be here.

SPEAKER_03 32:40

Absolutely, absolutely.

SPEAKER_01 32:42

Okay. Well, very interesting discussion, and it's about all the time we have for today, but so happy to have you here, Jeff, and and just to help clarify some of these interesting points. It's just such an important topic, I think, for us to increase awareness. Also, really, really thankful for your expertise here.

SPEAKER_03 32:55

Thank you. Thank you for having me as always.

SPEAKER_00 32:57

Awesome. And that's it for this week. Be sure to log in to Healthmart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.