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5 months ago

A new allergy is spreading across the US and most doctors have never heard of it A 47 year old walked into the ER in feeling faint with swollen eyelids, an itchy rash, and 3 weeks of watery diarrhea after every meal. For the past 5 days the diarrhea had progressed to crampy abdominal pain, nausea, and vomiting. His HR was high. BP was low. Hives across his scalp, neck, shoulders, abdomen, and groin. Lips swelling. Then his blood pressure crashed. > white cell count massively elevated > lactic acid high indicating poor tissue perfusion > troponin elevated suggesting cardiac stress > procalcitonin elevated suggesting possible infection > kidney function declining They pumped 4 litres of IV fluids. Blood pressure came back. Heart rate stayed high. Then it crashed again. 2 more litres. Antibiotics. H2 blockers. Glucocorticoids. Then 10 more litres. He was moved to the ICU on epinephrine. Blood and urine cultures came back negative. Not sepsis. By day 3 he was improving. Rash fading. Pain settling. Then on day 4 it all came back. Chest tightness. Difficulty breathing. Worsening rash. Tachycardia. Hypotension. Oxygen dropping. Wheezing. Epinephrine rescued him again almost immediately. His bloodwork from day 1 finally returned. Elevated IgE. Elevated tryptase. This was mast cell driven anaphylaxis. Something was triggering a massive allergic response. But to what? He had no new medications. No new foods. No known allergies. No travel. Then someone asked what he ate 4 hours before the day 4 flare. Beef He also mentioned he had eaten venison (meat from a deer) 2 days before the original ER visit. And that he is a deer hunter who had recently been hunting white tailed deer in southeastern Michigan. He had alpha-gal syndrome. Alpha-gal is a carbohydrate found in all nonprimate mammals. Humans don’t naturally have it. But if you get bitten by a lone star tick that has previously fed on a deer or other mammal the tick’s saliva introduces alpha-gal into your bloodstream. Your immune system produces IgE antibodies against it. And now every time you eat red meat your body treats it as a foreign invader and launches a full allergic response. The reaction is delayed by 3 to 6 hours after eating which is why it’s so hard to connect to food. Most allergies hit within minutes. Alpha-gal waits. That delay is what made this case so difficult to crack. The lone star tick used to be confined to the eastern and southeastern United States. It has now spread into the upper Midwest, the Northeast, and eastern Canada. The cause is climate change. Warmer temperatures. Shifting precipitation. Expanding habitats for both the tick and the white tailed deer it feeds on. Alpha-gal syndrome cases in the US have surged from near zero to over 110,000 suspected cases in the last decade. Most physicians have never seen one. Many don’t even know it exists Climate change isn’t just about rising sea levels and wildfires. It’s changing which diseases show up in your doctor’s office. And if your doctor isn’t thinking about it you might end up in the ICU for eating a BURGER

docxusofficial's tweet photo. A new allergy is spreading across the US and most doctors have never heard of it

A 47 year old walked into the ER in feeling faint with swollen eyelids, an itchy rash, and 3 weeks of watery diarrhea after every meal.

For the past 5 days the diarrhea had progressed to crampy abdominal pain, nausea, and vomiting.

His HR was high. BP was low. Hives across his scalp, neck, shoulders, abdomen, and groin. Lips swelling.

Then his blood pressure crashed.

> white cell count massively elevated
> lactic acid high indicating poor tissue perfusion
> troponin elevated suggesting cardiac stress
> procalcitonin elevated suggesting possible infection
> kidney function declining

They pumped 4 litres of IV fluids. Blood pressure came back. Heart rate stayed high.

Then it crashed again.

2 more litres. Antibiotics. H2 blockers. Glucocorticoids. Then 10 more litres. He was moved to the ICU on epinephrine.

Blood and urine cultures came back negative. Not sepsis.

By day 3 he was improving. Rash fading. Pain settling.

Then on day 4 it all came back. Chest tightness. Difficulty breathing. Worsening rash. Tachycardia. Hypotension. Oxygen dropping. Wheezing.

Epinephrine rescued him again almost immediately.

His bloodwork from day 1 finally returned. Elevated IgE. Elevated tryptase. This was mast cell driven anaphylaxis.

Something was triggering a massive allergic response. But to what?

He had no new medications. No new foods. No known allergies. No travel.

Then someone asked what he ate 4 hours before the day 4 flare.

Beef

He also mentioned he had eaten venison (meat from a deer) 2 days before the original ER visit. And that he is a deer hunter who had recently been hunting white tailed deer in southeastern Michigan.

He had alpha-gal syndrome.

Alpha-gal is a carbohydrate found in all nonprimate mammals.

Humans don’t naturally have it.

But if you get bitten by a lone star tick that has previously fed on a deer or other mammal the tick’s saliva introduces alpha-gal into your bloodstream.

Your immune system produces IgE antibodies against it.

And now every time you eat red meat your body treats it as a foreign invader and launches a full allergic response.

The reaction is delayed by 3 to 6 hours after eating which is why it’s so hard to connect to food. Most allergies hit within minutes. Alpha-gal waits. That delay is what made this case so difficult to crack.

The lone star tick used to be confined to the eastern and southeastern United States.

It has now spread into the upper Midwest, the Northeast, and eastern Canada.

The cause is climate change. Warmer temperatures. Shifting precipitation. Expanding habitats for both the tick and the white tailed deer it feeds on.

Alpha-gal syndrome cases in the US have surged from near zero to over 110,000 suspected cases in the last decade.

Most physicians have never seen one. Many don’t even know it exists

Climate change isn’t just about rising sea levels and wildfires.

It’s changing which diseases show up in your doctor’s office.

And if your doctor isn’t thinking about it you might end up in the ICU for eating a BURGER

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