A Strange Itch, Trouble Breathing, Then Anaphylactic Shock
A Strange Itch, Trouble Breathing, Then Anaphylactic Shock
By LISA SANDERS, M.D. JAN. 4, 2018
“I can’t breathe,” the woman panted, her voice a husky monotone. Her sister looked anxiously at the clerk at the triage desk at the University of Iowa hospital emergency room. The woman’s breath was rapid and coarse. Her chest heaved with the work of simply breathing. She pulled at the neck of her sweatshirt — suddenly it was too tight. She pulled it over her head and dropped it to the floor. She was naked beneath the top; she had been in bed when this attack came on.
The 54-year-old woman was helped into a wheelchair and whisked into the inner sanctum of the E.R. What followed was a blur of concerned faces, needles and medical data. Her blood pressure was dangerously low; her heart was racing. She was given epinephrine and steroids, but it was hours before she could explain what had happened that night.
She was staying at her mother’s house in rural Iowa, she told the doctors. Just as she was going to bed, she felt a sudden tingling in the palms of her hands. She recognized the sensation immediately: Twice in the past eight years, she had felt the same strange itch on her hands and sometimes her feet. Each time it was quickly followed by a terrifying sense of her throat closing.
Anaphylactic Shock
She had driven herself to her sister’s house, several miles away, and her sister drove her the rest of the way to the hospital. She opened the car window to let in the frigid winter night air. She struggled to breathe. Black spots swam before her eyes, but she willed herself not to pass out.
She had had this kind of allergic reaction twice before but never as severely. She knew from her own research that this was anaphylactic shock — a potentially deadly allergic reaction. After she got the medications, the woman’s symptoms resolved. She stayed in the hospital overnight, and when it was clear that the episode was over, she went back to her mother’s house. She made an appointment to see a local allergy specialist right away.
A Mystified Allergist
The specialist spent nearly two hours going over everything the woman had been exposed to — food, plants, toxins, anything that might have triggered this nearly fatal allergic reaction. There were no new exposures that day, nothing she hadn’t eaten or touched many times before and after this latest attack. The most common cause of severe allergic reactions in adults is food, but the allergist couldn’t identify any likely suspects. He was mystified. He asked her to share her diagnosis when she got one.
For months after returning to her home on Long Island, the woman was anxious about everything she ate, and she worried every night when she went to bed. She always kept a bottle of Benadryl and an EpiPen with her, but still she was terrified about what might happen if she was too far from a hospital the next time.
‘I Need a Nurse!’
When her next attack happened — just 10 months later — she was already in Brookhaven Memorial Hospital in East Patchogue, N.Y. She was being treated with antibiotics for a devastating case of gastroenteritis due to salmonella. Her first meal, after days of nothing but clear liquids, was beef brisket with potatoes and carrots. It smelled good, but she had no appetite. She made herself eat a few bites anyway, knowing it was her first step toward going home.
A couple of hours later, she felt a strange itch on the top of her head. She scratched reflexively. Then the recognition hit her like a slap: Not now, she thought. She grabbed the IV pole, still dripping fluids into her system, and ran out into the hallway. “I need a nurse,” she shouted. Her heart was pounding, and she knew what was coming next. Hospital staffers in scrubs descended on her. Was she having a panic attack? No, an allergy attack, she told them.
They helped her back into bed and gave her oxygen, Benadryl and steroids. “What happened?” someone asked. She told the whole story, plus something she now realized — every one of her attacks seemed to come a few hours after she ate beef. She didn’t go through this every time she had a hamburger or steak; meat was a regular and much-loved part of her diet. But she was pretty sure that she had steak — or beef brisket, this time — before each episode.
Her doctors were dubious. New food allergies — especially severe ones like hers — are uncommon in adults. This was much more likely to be an allergic response to one of the antibiotics they were giving her. The patient, though, found that theory hard to swallow. It might explain this episode, but what about the earlier ones? She hadn’t been on antibiotics then. The doctors had no answer.
Was a Tick to Blame?
A nurse had a different theory about what happened, one the patient had heard before but never believed. There was some kind of tick, the nurse told her, whose bite could make you allergic to meat. She didn’t know much about it. But, the nurse suggested, she should check it out.
The woman had been bitten by ticks before — who on Long Island hasn’t? But was it really possible for a bite to produce this crazy reaction? Indeed it was, she discovered, when she got home and began doing some research. The bite of the lone star tick — named for a white spot shaped like Texas on the arachnid’s back — could cause an allergic reaction to mammalian meat. The trigger was a sugar, identified as galactose-α-1,3-galactose and more casually known as alpha-gal, a carbohydrate found in the flesh of all nonprimate mammals.
How the tick bite triggers this allergy is not yet known. The link between the tick — whose range extends from southern Florida to Maine and as far west as Iowa — and the resulting alpha-gal allergy was first described in 2009 by Thomas Platts-Mills, a professor at the University of Virginia, who himself developed the disorder. Unlike most food allergies, in which symptoms occur within minutes of consuming the allergen, the alpha-gal reaction is delayed. The symptoms — ranging from a rash to nausea to shortness of breath and even anaphylaxis — can appear four to six hours after a meal containing meat. Stranger still, the reaction doesn’t occur after every exposure.
A Diet Changed Forever
The diagnosis of mammalian meat allergy (M.M.A.) can be confirmed with a blood test that identifies antibodies to alpha-gal. The patient contacted Diane Cymerman, an allergist she had seen years earlier for seasonal allergies. Cymerman asked her to list all the foods she consumed before her last episode in the hospital and had her blood tested for antibodies to everything on the list, down to the black pepper and parsley seasoning. And to alpha-gal.
The first results came back the following week: She had a moderate allergy to beef, but everything else was normal. The following month, the test results for alpha-gal antibodies came back. She was wildly allergic to galactose-α-1,3-galactose. Cymerman called the patient with the news. She had to avoid eating meat from mammals — and everything derived from them, including Jell-O and other foods and medications made from gelatin. Even safe foods cooked on a grill that has also been used for meat can be contaminated with enough alpha-gal to trigger a reaction.
The patient contacted the allergist back in Iowa and told him what she had. He was amazed. He had only recently heard a lecture on this phenomenon. He had never seen it before her case.
It hasn’t been easy for this Iowa transplant to give up beef and other meat that comes from mammals. Some days, she tells me, just thinking about a juicy hamburger or steak makes her stomach growl. But she remembers her terror and that long drive to the Iowa hospital and sticks to chicken, fish and vegetables.
Lisa Sanders, M.D., is a contributing writer for the magazine and the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.” If you have a solved case to share with Dr. Sanders, write her at Lisa.Sandersmd@gmail.com.
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**Comment**
For more on Alpha-Gal: http://alpha-gal.org
Approx. 5 Min.
Great video by Dr. Greger at nutritionfacts.org on tick bites, meat allergies, and chronic urticaria
https://madisonarealymesupportgroup.com/2016/02/05/paralysis-tick-the-immune-system/ Australian allergy specialist Sheryl van Nunen got her red meat allergy mystery solved when there was a surge in allergic reactions in the U.S. to a drug, Cetuximab, used to treat colorectal cancer developed using a mouse cell line, also containing alpha-gal.
Pause
If you haven’t read the articles on vaccines, please do.
https://madisonarealymesupportgroup.wordpress.com/2015/06/19/a-word-on-vaccines/ and https://madisonarealymesupportgroup.wordpress.com/2015/07/15/vaccines-continued/
Some vaccines used to be run through mouse brains. This is important to know as mice are one of the biggest reservoirs for borrelia, the causative agent known to cause Lyme Disease.
More damning evidence of the mouse/vaccine connection: https://madisonarealymesupportgroup.com/2017/10/15/vaccines-and-retroviruses-a-whistleblower-reveals-what-the-government-is-hiding/
