New Jersey man is first known death from meat allergy triggered by tick bites

The man’s case is believed to be the first documented death linked to a red meat allergy.

(CNN) — In the summer of 2024, a previously healthy 47-year-old father collapsed and died in the bathroom of his New Jersey home. An autopsy provided no answers. Everything looked normal, and his death was ruled sudden and unexplained.

His widow reached out to a friend, a pediatrician. Would she read the autopsy report?

The pediatrician, Dr. Erin McFeely, acted on a hunch and contacted Dr. Thomas Platts-Mills, an allergist and immunologist at the University of Virginia who had discovered almost two decades earlier that tick bites could cause people to develop an allergy to red meat.

The allergy is unusual because the reaction doesn’t happen right away. People start to feel sick hours after they unwittingly eat beef, pork or lamb. Often, they’ll wake up in the middle of the night with symptoms that seem more like a bad bout of food poisoning or stomach flu than an allergy.

Because so many people have potentially been sensitized to meat after tick bites but don’t know it, Platts-Mills and others have wondered whether there were unexplained deaths that were really severe reactions to a sugar found on mammalian cells, including those in red meat, called alpha-gal.

The man’s case, which was detailed Wednesday in the Journal of Allergy and Clinical Immunology in Practice, turned out to be exactly what Platts-Mills had feared and is believed to be the first documented death linked to a red meat allergy.

“This is the first time I’ve heard a story that I thought we could sort out,” said Platts-Mills, who is part scientist and part Sherlock Holmes.

“We need the serum” – the clear part of the patient’s blood – which was taken during his autopsy. He asked McFeely, “Can we get it?”

Tick bites turn deadly

The man’s story started with chigger bites, the case study says. But they weren’t chiggers; they were baby lone star ticks, about the size and color of a grain of sand.

The man had been bitten by dozens of these tiny seed ticks on a camping trip with his family.

“And this tick, the mothers, lay 5,000 eggs at a time, and the larvae will bite you,” Platts-Mills told CNN.

In many parts of the eastern United States, the deer population has reached unsustainable numbers. Deer are the main hosts of the lone star tick, and as deer populations have grown, tick populations have exploded.

“That combination of so many deer and so many mothers and the larvae biting means that vast numbers of people are sensitized, of whom a minority get food-related symptoms and then are at risk of severe events,” Platts-Mills said.

Alpha-gal allergy is a reportable diagnosis in only three states – Arkansas, Tennessee and Virginia – so the actual number of cases in the US is not known. The US Centers for Disease Control and Prevention estimates that as many as 450,000 Americans may have the allergy, but Platts-Mills estimates that as much as 5% of the population may be sensitized to red meat because of tick bites and not know it.

Most cases are not severe and can be managed by avoiding exposure to the sugar, which is found in food as well as in some pharmaceutical products. Symptoms range in severity from itchy hives or a rash to nausea and vomiting, indigestion, heartburn, a drop in blood pressure, swelling of the lips or face, dizziness or fainting, and severe stomach pain. Doctors diagnose the condition by taking a careful history and controlled testing for a reaction to the sugar.

Sometime after the camping trip, the case study says, the man’s family ate a late steak dinner. He woke at 2 a.m. with intense stomach pain, diarrhea and vomiting. He was in rough shape, but after two hours, his symptoms subsided.

The next morning, he told one of his sons, “I thought I was going to die.”

His wife said they considered going to a doctor, but since the symptoms had eased, they didn’t know what they would say.

It’s not clear that a doctor’s visit would have helped. Too often, doctors don’t recognize alpha-gal allergy. A 2023 CDC survey found that 42% didn’t know what it was, and 35% said they lacked confidence to diagnose or manage it.

An unrecognized allergy

Two weeks later, in September 2024, the man and his wife went to a cookout, where he had a hamburger about 3 p.m. He drank a beer and came home and mowed the lawn. But by 7:20 p.m., he was vomiting again. His son called his mother and told her, “Dad is getting sick again.”

A few minutes later, the son found his father unconscious on the bathroom floor. He couldn’t be revived.

Platts-Mills says that when he was back in his lab, having gone through the necessary layers of permission to get the man’s postmortem blood samples, he cursed himself for not driving up to New Jersey to collect them himself.

The delivery company lost track of them briefly, he said. He imagined them sitting for hours in the back of a hot truck, the valuable information they contained being baked away.

They finally arrived in his lab in April, and he tested them for levels of immunoglobulin E antibodies, Y-shaped proteins primed to latch onto allergens like ragweed and pollen. The man had antibodies to both alpha-gal sugars and red meat.

Next, Platts-Mills sent some of the blood to the Mayo Clinic lab, which tested it for an enzyme called tryptase that’s made by immune cells called mast cells. Tryptase breaks down proteins and is a marker of allergic reactions.

The man’s tryptase levels were over 2,000 nanograms per milliliter, among the highest values ever recorded in cases of fatal allergic reactions called anaphylaxis.

The man had died of eating red meat – the first known food allergy fatality linked to alpha-gal syndrome.

Other people have died of reactions to alpha-gal sugars, but those cases have involved sugars attached to a chemotherapy drug called cetuximab, which was how the syndrome was discovered in the first place.

“We gave them closure,” Platts-Mills said of the family in the case study. “People make a big fuss about closure, but you don’t get it until you see it.”

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