DEAR DR. ROACH: I was recently diagnosed with alpha-gal syndrome (AGS). I live in the country, but I do not remember having a tick on me. My husband and I are very cautious and always check for them. I am struggling to understand what exactly are my symptoms and what I can and cannot eat. I don’t know if I am someone who can have dairy or not.
The biggest challenge seems to be eating out. If I order chicken, fish or vegetables and they are cooked on the same grill as meat, then it is not safe to eat due to cross contamination. Also, dairy, lard and whey are in many food items.
Is there a specialist I should consult? My doctor seems to know about some of this, but is unable to answer many of my questions. Any information you can share would be helpful. — S.N.
ANSWER: AGS is an allergy to galactose-alpha-1,3-galactose, a carbohydrate allergen found in all mammalian meats, such as beef, pork and lamb. The allergy can be serious as people develop symptoms, including various syndromes like skin itching and rashes; gastrointestinal symptoms; and even anaphylaxis, a severe allergy syndrome of cardiovascular collapse.
These reactions are delayed compared to other typical allergic responses, with people often developing symptoms the night after consuming meat, about two to six hours after consumption. A blood test for alpha-gal allergies can confirm the diagnosis.
These symptoms usually begin after getting bitten multiple times by a Lone Star tick. The tick has alpha-gal in its saliva, which triggers the sensitivity. Many medical professionals are unaware of this newly described condition (40% reported never having heard of the syndrome), which can prevent a diagnosis from being made in a timely fashion.
Because the condition is new, there are some factors we don’t really understand about it, like why some people tolerate muscle meat from an animal, but react strongly to organ meat. There just aren’t answers to some of the questions you might be asking. For example, milk, whey and gelatin sensitivity have been described with AGS, but not lard (at least that I could find).
Sometimes a person tolerates cooked meat, but is intolerant of raw (or barely cooked) meat. Some people lose the allergy over time (usually a few years), but additional tick bites may bring it back.
The ideal specialist is an allergist. You should certainly have, and know how to use, an epinephrine injector in case of a severe reaction.
DEAR DR. ROACH: A dietician recommended that I drink six glasses of water every day. I tend to drink most of the water in the morning and early afternoon. My husband thinks I should drink it “equally” throughout the day. His logic is that I don’t retain enough water to stay properly hydrated throughout the evening and night. Does timing really matter? — C.R.
ANSWER: Your body has a system in place to hold onto water so that you don’t need to drink during the night. Unless you are losing unusually high amounts of water (as you would in a very dry and hot environment, for example), there is no reason to hydrate at night. Most people realize that doing so will cause you to visit the bathroom rather than sleep.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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