Case Presentation: A 56-year-old male presented to the emergency department with acute-onset severe hypotension, light headedness, rash, nausea, and vomiting. He progressed to develop widespread urticaria and facial flushing. He was previously in his normal state of health. He reported eating “meat and potatoes for dinner”. Social history was pertinent for frequent tick exposure as the patient was an avid hunter. He reported pulling dozens of ticks off his skin on one specific occasion. Laboratory evaluation revealed an anti galactose-alpha-1,3-galactose IgE level of 16.9 kU/L. Following advice to avoid mammalian meat, IgE levels decreased to < 2.0 kU/L. Upon supervised meat reintroduction, he remained asymptomatic, allowing resumption of meat consumption while monitoring for symptom recurrence.
Discussion: Alpha-gal syndrome (AGS) is tied to lone star tick exposure and presents as delayed allergic reactions to galactose-alpha-1,3-galactose (alpha-gal) following consumption of mammalian meat. Its delayed symptom onset (3-8 hours) poses a challenge for accurate identification. Patients may encounter difficulties in managing AGS due to restrictive diets, navigating hidden meat additives, and the presence of animal derivatives in healthcare products such as heart valve replacements. Diagnosis typically involves immunoassays measuring anti-galactose-alpha-1,3-galactose IgE levels along with a history and physical exam consistent with anaphylaxis. Treatment includes a mammalian meat guided elimination diet followed by safe reintroduction with monitored oral challenges.
Conclusions: AGS represents a unique challenge due to its potentially delayed onset of symptoms. The “classic presentation” is the patient that develops IgE-mediated symptoms in the middle of the night after consuming meat for dinner with a history of tick bite exposure. AGS should be considered in the differential for a patient presenting with unexplained delayedsevere allergic reactions, particularly those with a history of tick bites or new-onset anaphylaxis