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hives from red meat allergy

Nov 17, 2009 - 9 comments
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hives

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To Fellow Hives Sufferers -

Please read this article from the Washington Post. I believe it solves a several-year mystery for me, and I hope it can help someone else.


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CORRECTION TO THIS ARTICLE
The column misstated the name of a sugar present on meat linked to a food allergy. It is galactose-alpha-1,3-galactose, not alpha-galactosidase.
Was it a sudden seafood allergy? No.
Research sheds light on dangerous reactions
By Sandra G. Boodman Special to The Washington Post
Tuesday, October 20, 2009

This cannot be happening again, Hayden Newell thought as the angry, red, ferociously itchy welts encircled his waist and spread up his arms. The 57-year-old metallurgist from tiny Boones Mill, Va., who was attending a business lunch in Florida, knew what would probably happen next: His lips would grow numb, making it hard to speak, he would become short of breath and his blood pressure would plummet: all unmistakable signs of anaphylaxis, a potentially fatal allergic reaction. Newell knew from experience that he had to get to an emergency room -- fast.

The same thing had happened a month earlier, in August 2008, an event that culminated in an early-morning ambulance ride to a hospital in Roanoke. At the time, his general practitioner suspected that Newell had developed an allergy to the oysters he had eaten the previous night. But tests revealed no shellfish allergy, so Newell had grazed at a buffet, sampling shrimp, scallops and meatballs.

What, he wondered, as a colleague drove him to a Florida ER, could be causing these frightening episodes that came out of nowhere?

The probable answer did not emerge until nearly six months later, and it seemed downright bizarre. The diagnosis, shared by a growing number of patients on two continents and described in two recent studies, has upended long-held views about an allergy previously considered rare.

"It has changed our thinking," said Newell's allergist, Saju Eapen of Roanoke."This was not something we looked for in the past."

* * *

In July 2008, Newell spent several days visiting his nephew in rural North Carolina. Three days after returning home he noticed a red spot between two toes on his left foot, evidence of a tick he had picked up while walking barefoot in the country. He extracted it and, assuming the bite had become infected, called his doctor, who prescribed an antibiotic.

Problem solved, Newell thought.

But a month later, hours after a dinner that included oysters Rockefeller and filet mignon, both of which he had eaten many times before, Newell awoke at 3 a.m. to discover that his chest and waist were blanketed by itchy hives.

"I wasn't sure what was going on," Newell said, so he got up and took a shower, increasingly alarmed by the huge, spreading welts. "I got into bed and tried to relax until morning."

At 7 a.m., while driving to his general practitioner's office, Newell realized his lips felt numb. He sat in the empty waiting room, hoping the doctor would arrive soon, while he could still talk. Instead, the nurse took one look at him, he recalled, and said, "You're having anaphylactic shock. We need to get you to a hospital right away." She called 911, and Newell was whisked by ambulance to a nearby ER, where he was given Ben-adryl and other drugs to counteract the severe allergic reaction. His doctor, thinking he might be allergic to oysters, sent him to Eapen.

The allergist performed skin tests and took blood samples, warning Newell to stay away from shellfish. A few weeks later, after tests found nothing, he was told it was safe to eat seafood. The next month was the fateful Florida buffet. This time, the hives appeared more quickly, in less than an hour.

"I figured, it's got to be some kind of seafood," said Newell, who this time had eaten crab and scallops, but not oysters.

Eapen said that at this point he wasn't sure whether Newell was suffering from a true anaphylactic reaction or chronic hives, which can cause anxiety and shortness of breath. He prescribed an EpiPen, a device that administers an emergency epinephrine injection, which he told Newell to carry at all times. Then he handed him an order for a blood test. In the event of another attack, he told Newell, doctors should test his blood for levels of serum tryptase within three hours. An elevated reading would indicate true anaphylaxis, not just anxiety.

Newell didn't have to wait long. In December, after eating chicken and beef -- but not seafood -- he was driving home from a business lunch in Norfolk when he felt the unnerving itching.

"I was thinking, 'I won't be able to eat anything,' " as he pulled off the highway and headed for the nearest hospital, he recalled. The episode did lead to one definitive answer: His serum tryptase level was elevated, which meant the anaphylaxis was genuine. But what was he so violently allergic to?

At an appointment the following day, Eapen asked a crucial question: "Do you remember if you had beef when you had shellfish?" The answer, Newell said, was yes, every time.

Eapen said he thought knew what was wrong. When the allergist asked about tick bites, Newell told him about the July incident.

Eapen took a blood sample and told Newell he was sending it to a lab at the University of Virginia School of Medicine for testing that might point to the suspected culprit: an allergy to red meat. Eapen was familiar with groundbreaking work underway at U-Va.'s allergy clinic that had found a link between a reaction to tick bites and the development of a sudden allergy to red meat, as well as pork and lamb, in people who had eaten it all their lives without incident.

A team headed by U-Va.'s Thomas Platts-Mills, an internationally prominent allergist, published a study in February detailing the cases of 24 adults who developed a sudden allergy to red meat. Eighty percent had reported being bitten by ticks weeks or months before the allergy appeared, and many had experienced anaphylaxis as much as six hours after eating red meat, a highly unusual occurrence because food allergies typically cause violent reactions within minutes.

Similar findings were reported in the Medical Journal of Australia in May by a team of Sydney allergists.

So how does a tick bite trigger a sudden allergy to meat?

Scott Commins, an assistant professor of medicine and lead author of the U-Va. study published in the Journal of Allergy and Clinical Immunology, said that in susceptible people such as Newell, a tick bite that causes a significant skin reaction seems to trigger the production of an antibody that binds to a sugar present on meat called alpha-galactosidase, also known as alpha-gal. When a person who has the antibody eats meat, it triggers the release of histamine, which causes the allergic symptoms: hives, itching and, in the worst case, anaphylaxis.

But many questions remain unanswered, said Platts-Mills, whose research is continuing. His lab has collected data on more than 300 patients from across the country and abroad.

"We're sure ticks can do this," he said. "We're not sure they're the only cause." Nor do researchers know why anaphylaxis is so delayed or why only some people develop a problem after tick bites. They do know that the allergic reaction is dose-related: Eating a tiny amount of meat probably won't cause a serious reaction. A large steak will.

Commins said researchers have also observed that people with certain blood types appear to be more at risk. Those with the rarest types -- B and AB -- do not appear vulnerable, because their blood is chemically similar to alpha-gal.

Climate appears to play a role: Blood samples from Boston and Scandinavia almost never reveal alpha-gal antibodies, which are common in samples from patients in Virginia, North Carolina and other parts of the South, as well as parts of Australia.

Testing of Newell's O-positive blood in Platts-Mills's lab revealed very high levels of alpha-gal, and other tests confirmed that after more than a half-century of eating meat, he now had an untreatable allergy. Newell is now enrolled in a large allergy study at U-Va.

Eapen can't advise Newell -- or the 30 or so other patients in his practice found to have a meat allergy -- to do much except avoid red meat, lamb and pork.

An enthusiastic cook, Newell said he misses making and eating his favorite dishes: beef bourguignon and beef Bolognese. The biggest problem, he said, is avoiding meat at business lunches, which often take place in steakhouses.

"It's probably better for me in the long run," Newell said wistfully, "but I'd still like a nice steak occasionally."

If you have a medical mystery that has been solved, e-mail us at ***@****. To read previous mysteries, visit http://www.washingtonpost.com/health.

View all comments that have been posted about this article.


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by Elizabeth61, Dec 05, 2009
Well, perhaps this solves the mystery.  I had my first reaction in 2000.  I thought it was some kind of food poisoning.  My palms and soles itched uncontrollably.  I was sick at my stomach and short of breath.  Finally, after a couple of hours of sheer hell, I broke out in hives all over my body, which, oddly enough, came as quite a relief compared to the other symptoms.  I had no idea what had caused my reaction, but a couple of years later, after experiencing these symptoms on three other occasions, I was able to trace my allergic reaction to consumption of ground beef.  For a while, that was all I had to avoid, but later I started having the reaction to steak and now, even lamb.  Pork, for some reason, does not seem to trigger it.  I have lived in the American south most of my life.  Ticks are everywhere out here in the country and I cannot count the number of tick bites I've had.  Sure sounds like that's what's caused the reaction.  For anyone else out there with this malady, all I can say is avoid the red meat.
~ Elizabeth

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by mdyer909, Jul 10, 2010
I've been primarily a vegetarian for a few months.  Over the 4th we had friends come for dinner so I bought some big t-bone steaks (organic grass fed) from a farm nearby.  I got up in the middle of the night because my feet itched and when I looked in the bathroom mirror I was covered in red welts.  Never had that happen before (my last meat was some lamb at Easter).  I took some benadryl and went back to bed, by noon the next day the hives had gone away.  I live out in the woods and get bit by ticks all the time, but this was the first time I ever had an allergic reaction to anything except some medicine I got when I was a kid.  Weird.

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by Thomas00, Jul 10, 2010
I have this same problem,I moved to the country in Missouri about 5 years ago from Arizona,after a year passed I had tic and chigger bites, but I only get bad hives after eating beef in resterants,when I cook beef at home (no hives) except one time when using a stake sause with MSG added,I found that beef with MSG on it gives me hives after about 2 hours.
  Here is another bit of info for you, after a episode i took a hot shower (never do this) my hart almost stopped I was rushed to the  ER, hart beet 30 over 70. and I found out at work I stepped into the freezer after a episode it went away faster.

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by jsymes, Jul 18, 2010
I have been suffering from red meat allergy for 14 years.  I just found the Washington Post article today.  I experience anaphylaxis when I eat beef/pork/venison. Symptoms start 4-5 hours after eating meat. I NEVER eat meat other than fish or fowl. I sure do miss pork chops and good ole southern chicken fried steak!!!

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by 1barry, Sep 01, 2010
Twenty years ago I moved to tick infested eastern Long Island. Ten years ago I began to have allergic reactions
to red meat. From icthy palms to huge welts and swollen feet. I have never heard of this connection to tick bites.
I do however, have two friends in the neighborhood who have developed similar reactions after eating red meat.
Would love to get more information on this.

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by deborainva57, Oct 07, 2010
This past monday I was staying at a cabin in the Va. Blue Ridge Mountains.  Had just come in from the Parkway around
4:00 p.m. and suddenly had severe stomach cramping and within about three minutes entire body broke out in small hives all over.  Ran down stairs and took 2 benadryl , that by some miracle I had brought with me.  Still felt sick and within about 3 or 4 more minutes my lips tongue and throat began to close to where I could barely make a whisper and had trouble breathing and also felt like I was going to black out, but didn't.  My Husband had already called 911 and a rescue team got there in about 10 or 15 Minutes.  By then the benadryl was beginning to take affect.  They transported me to a community hospital about 40 Minutes away.  I had heard of this allergy a couple of months ago because my cousin who also lives in Va. has just been diagnosed with this allergy to all red meats.  I am in my fifties and have had many tic bites over the years and have had several lyme disease tests run and were always negative.  I mentioned the possibility of the red meat I had eaten about 4 hrs. before and told him about the UVA Study and he just gave me (the look) as if I was crazy or somthing so I didn't say anything else to him.  They treated me with adrinaline drip and some other type of shot, then sent me back to the cabin with some benadryl,Zantac, & Epipen.  The last couple of days I get tired very easily and have had my tongue feel like it was beginning to swell again so I would take a couple of benadryl and the tongue would go back to normal.  I hope this red meat will be out of my system very soon.  Will be calling UVA  
next week to make an appointment to get tested before I eat any more beef, pork, or lamb.  I'm not ready to learn how to use the epipen quite yet. I hope in this case that the E.R. doctor is right in giving me that(Im Crazy Look), because I sure will miss my pork products. Wish Me Luck!!  Debora, Forest, Va.  October 7,2010 7:39p.m.

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by kateyj2010, Oct 18, 2010
Debora, your experience was strikingly similar to the one I had earlier this summer, after several tick bites.  I have been allergic to red meat for 8 years, but back then, no doctor took my conclusion seriously.  After this summer's event, I've been tested and confirmed highly allergic to beef/pork/lamb, and most recently, also to dairy.  BUMMER!  I have also been tested for the alpha-gal antibody being researched by UVA.  

To anyone reading this thread, this allergy can be life-threatening.  UVA has a blog site now, called "mammalian meat allergy".   Testing will confirm whether you have the alpha gal antibody and whether you are allergic to mammal meats and dairy.  Ask your doctor for RAST blood testing, not skin testing.  People who have this allergy need to avoid all red meat.  It's been a life-changer for me.  Not everyone is as sensitive as I have become, after my most recent tick exposure, but it also appears that this allergy doesn't always produce the same symptoms, even in the same person, and you may get away with eating red meat on occasion, but never know when the anaphylaxis could occur.  

Debora, I'm also going to UVA in the next week and love hiking in the Blue Ridge, just arrived here for the next few weeks.  Would like to hear more from you.  

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by texasfire83, Nov 21, 2010
I live in Texas and have never had a tick bite. I had a severe anaphylaxis reaction earlier this year to what I assumed was shell fish. I've eaten it for years with no problem but had shell fish atleast once a week for a couple of months when I had my first episode. I've avoided all shell fish, then I started getting hives after eating chicken, a couple months later beef. More recently eggs are causing me to have hives. I've also been getting really bad heartburn when I'm getting ready to have a particularly bad hives outbreak. Research I've done on hives with heartburn has lead to the h-pylori bacteria, a bacteria that is believed to cause ulcers. I had been diagnosed with h-pylori in spring 2009 and went through the treatment. I never went back for followup testing to see if the treatment had worked, it doesn't always. My doctor has ordered testing for the bacteria, I hope that's what it is and treatment works this time, I don't know I can eat at this point.  I haven't had any meat or poultry in over a month. I haven't had a hives free day in 2 months.

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by eick, Aug 08, 2012
I live in Missouri and I am not really sure about the tick and chigger bites.  For the last eight years I have been extremely sick.  Everyone seems to be mild compared to what I have.  It all started with beef, then pork, then turkey, then chicken, then fish, then eggs, then cheese, then milk, then purine protien vegetables and finally wheat and grains.  I have blisters all over my feet all the time.  I carry an epi-pen with me all the time along with Benadryl and so on everywhere I go.  I can hardly get through a meal without a reaction.  I am not sure what is causing all of this but I am finding more and more about it every day.  I have to be careful because processed foods have all kinds of things in them that set the reaction off.  No one knows what to do with me so I have had to figure this all out on my own.  My doctor helps me by giving me what I need to survive.  There is a lot more to say but I am getting somewhat better by learning what not to eat. However, my feet and legs burn and itch along with my body depending on how bad I am at the time.  The pain gets so bad after a reaction that I can't sleep and have to use a wheelchair.  I also have neuropathy along with other severe problems because of this.  Of course no one understands this and there is no help because no one can be allergic to protein.  I desperately need help.  I am learning more everyday keeping notes and taking pictures.  If there is someone who can help me please let me know.  Thank you!  Jan



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