Overview:
Health care professionals in Massachusetts will be required to report cases of alpha-gal syndrome to the Department of Public Health starting on April 1 to track the activity and movements of the lone star tick, which has been associated with the syndrome. Alpha-gal syndrome is an allergic reaction to the alpha-gal sugar molecule found in most mammalian meat and some other products made from mammals, such as cheeses, and can be treated and prevented similarly to most allergies by avoiding allergy-triggering foods and products, and using an EpiPen when needed.
In the wake of increasing cases on Martha’s Vineyard and Cape Cod, health care professionals will be required to report cases of alpha-gal syndrome, an allergic reaction associated with bites from the lone star tick, to the Massachusetts Department of Public Health starting on April 1.
The lone star tick, which has a scientific name of amblyomma americanum, has been moving from the Southeast to the Northeast, and populations have skyrocketed on Martha’s Vineyard and Cape Cod in recent years. In a statement, the Department of Public Health said making the syndrome reportable will help track the tick’s activity and movements.
“By making alpha-gal syndrome a reportable condition by health care providers and laboratories, DPH will have the ability to measure the impact of this disease on public health and raise awareness among health care providers to improve diagnosis and management,” Public Health Commissioner Dr. Robert Goldstein said in a statement. “Using this data-driven approach, we also aim to educate residents so that they know how to take measures to protect themselves from tick bites.”
Meg Ryan, a public health nurse at the Franklin Regional Council of Governments (FRCOG), explained that alpha-gal syndrome is not really a disease, but rather, an allergic reaction to the alpha-gal sugar molecule found in most mammalian meat and some other products made from mammals, such as cheeses. It can be treated and prevented similarly to most allergies by avoiding allergy-triggering foods and products, and by using an EpiPen when needed.
“Alpha-gal is a sugar molecule that exists in mammalian meat. … The tick will transmit that sugar through a bite and you can develop an allergy. It’s not always like other allergies, where reactions are more immediate; it may come on more gradually, and you can get a reaction two to 10 hours later,” Ryan explained. “You may have a burger for dinner and wake up at midnight with diarrhea, but once you figure out it’s an allergy, you can treat it like an allergy.”
Mammals that have the molecule do not suffer any allergic reactions due to it, but humans do not have the sugar molecule, and when they develop it through a tick bite, it can trigger reactions to eating other foods that contain that molecule.
Allergic reactions can include hives or an itchy rash, heartburn, indigestion, severe stomach pain, nausea, vomiting, diarrhea, a drop in blood pressure, dizziness, cough, wheezing, shortness of breath/difficulty breathing, anaphylaxis, or swelling of the lips, throat, tongue or eyelids.
According to the Department of Public Health, high amounts of the alpha-gal sugar molecule may be found in meat such as beef, pork, lamb, deer (venison), goat or rabbit. Other foods and food products that may contain alpha-gal include dairy products like milk, cheese, yogurt and ice cream; gelatin made from beef or pork; foods made or cooked with mammal fat such as lard, tallow or suet; and meat-based broths, bouillon and gravy.
Foods without the alpha-gal sugar molecule include chicken, turkey, duck, pheasant, quail, fish, shellfish, seafood, eggs, fruits and vegetables.
Ryan said making alpha-gal syndrome reportable will help the state and health care professionals learn more about it and prepare for a potential future increase in cases.
“Massachusetts, like every other state and the federal government, has a list of diseases it wants reported. These diseases are reportable for a few reasons: one, because we want to learn more about the disease; two, we want to keep people from getting the disease and do contract tracing,” Ryan said. “It’s being added because it’s a thing to worry about in other parts of the state, and it’ll start to become a thing to worry about in the coming years.”
On Martha’s Vineyard, positive allergy tests have increased from 32 in 2021 to more than 500 in 2024.
“I don’t expect to see much of anything for a while,” Ryan said, “but it did explode on Martha’s Vineyard.”
Ryan said that while lone star ticks may not be prevalent in Franklin County and there may be those who argue they don’t exist here, she has seen them, and someone handed her a lone star tick last year.
The Department of Public Health is initially making alpha-gal syndrome reportable for one year, with the possibility of extending the reporting period for another year. Ryan said she hopes this period will provide insight into how the sugar molecule is transferred.
“One of the things we don’t know is how long the tick needs to be on you to transfer that sugar molecule,” Ryan noted. “We just don’t have that information yet.”
Ryan said the steps that residents can take to avoid alpha-gal syndrome are the same as all measures taken to protect themselves from tick bites: wearing long-sleeve clothing and pants; wearing lighter colors that make the tick more visible on the fabric; wearing insect repellant that contains DEET; treating clothing and outdoor gear with permethrin; and doing regular tick checks after spending time outdoors.
She added that the University of Rhode Island has a “tick encounter” website at web.uri.edu/tickencounter/tickspotters where people can submit photos of ticks and get them identified, however, getting bit by a tick does not necessarily mean the person will develop a reaction, and not every tick carries the sugar molecule. People can submit their ticks to be tested by visiting tickreport.com.
According to the February tickborne disease report from the Department of Public Health, there were no emergency room visits in Franklin County associated with any tickborne illnesses. However, tick activity does not typically pick up until the weather is warmer.
Ryan said that adding alpha-gal syndrome to the list of reportable syndromes now is ideal, as people are starting to spend more time outside and ticks are starting to wake up from their dormant period.
“The most active period for ticks is now through June and then again September through November,” Ryan said.
A fact sheet on alpha-gal syndrome is available at mass.gov/info-details/alpha-gal-syndrome-ags.
