Could a tick bite explain why a patient suddenly reacts to beef, pork, or even a gelatin-containing medication?
In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Don Weinberger, PharmD, PMSP, discusses alpha-gal syndrome, an emerging tick-borne allergy to red meat and other mammal-derived products. He breaks down how the lone star tick sets off the immune response, how to recognize symptoms ranging from hives and GI upset to life-threatening reactions, and what healthcare professionals should consider when a patient presents with a possible delayed reaction.
You’ll hear practical insights on hidden triggers in medications, supplements, and vaccines, including gelatin, heparin, and lactose, along with counseling pearls on avoiding exposure, emergency preparedness with diphenhydramine and epinephrine, and when to refer to urgent care. Plus, Don walks through a patient case, helping healthcare teams stay ahead as the lone star tick’s range expands and alpha-gal syndrome becomes more common in practice.
This is an excerpt from our November 2025 Pharmacy Essential Updates webinar series.
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No CE credit is available for this bonus episode.
If you are interested in CE, credit is available for our full episode on ticks, linked below.
The clinical resources related to this podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Help Patients With Alpha-Gal Syndrome Avoid Reactions
- Clinical Capsules: From Tick Bite to Treatment: Managing Lyme Disease Risk
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Transcript:
This transcript is automatically generated.
This transcript is automatically generated.
00:00:00 Narrator
Could a tick bite make your patient allergic to beef, pork, and lamb?
00:00:04 Narrator
What ingredients and medications or vaccines could cause reactions in patients with alpha-gal syndrome?
00:00:15 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:21 Narrator
On this special bonus episode, Associate Editor and Clinical Pharmacist Don Weinberger breaks down alpha-gal syndrome, an emerging tick-borne allergy to red meat and other mammal-derived products.
00:00:33 Narrator
He shares how to recognize reactions, which medications, vaccines, and ingredients can be hidden triggers, and other key things healthcare professionals need to know before recommending treatment, in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:46 Narrator
No CE credit is available for this episode, but we wanted to share this content with you, especially since it relates so well to our last episode on tick bites.
00:00:55 Narrator
Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday.
00:00:59 Narrator
Bring concise, actionable insights from TRC experts straight to your ears.
00:01:03 Narrator
With that, let’s get started.
00:01:10 Don Weinberger
You’ve probably been hearing buzz about this alpha-gal syndrome, an emerging concern currently estimated to affect about half a million people in the United States.
00:01:21 Don Weinberger
This article is coming from our past July 2025 issue, and is available on our website to read if you search for alpha-gal syndrome.
00:01:30 Don Weinberger
We’ll start off with the case.
00:01:32 Don Weinberger
A patient comes to your pharmacy complaining of diarrhea and stomach pain.
00:01:37 Don Weinberger
He also complains of having waves of nausea and he vomited less than an hour ago.
00:01:43 Don Weinberger
He also has itchy welts on his neck.
00:01:47 Don Weinberger
He says all of these issues started 4 hours after eating lunch.
00:01:52 Don Weinberger
He’s obviously in a lot of discomfort and would like some over-the-counter recommendations.
00:01:58 Don Weinberger
What do you think is going on?
00:02:00 Don Weinberger
What else should be known about his signs and symptoms before treatment can be recommended?
00:02:07 Don Weinberger
So let’s dive into the topic.
00:02:09 Don Weinberger
Alpha-gal does have a superhero-like name, but it’s something more like a villain, if anything.
00:02:17 Don Weinberger
Specifically, alpha-gal is a common sugar molecule found in the tissues of most mammals, such as cows and pigs, as well as in the saliva of some ticks.
00:02:28 Don Weinberger
But this molecule is not found in human tissue.
00:02:33 Don Weinberger
And the lone star tick, with its characteristic lone white star on the back of the females, its bite is worse than its bark.
00:02:42 Don Weinberger
The saliva of this tick can transmit the alpha-gal molecule to the bloodstream in humans, causing all sorts of medical issues we will discuss in one moment.
00:02:53 Don Weinberger
Distribution mainly is in the south and eastern regions of the United States, but the estimated distribution is showing its spread north and west toward the middle of the country.
00:03:04 Don Weinberger
So why should we be concerned?
00:03:07 Don Weinberger
Let’s put all this tick-talk into perspective.
00:03:12 Don Weinberger
First, the lone star tick bites a human, transferring the alpha-gal molecule into the human bloodstream.
00:03:20 Don Weinberger
The human’s immune system may then become sensitized to alpha-gal over the course of weeks to months.
00:03:28 Don Weinberger
Later, when that person eats mammalian meats like beef, pork, or lamb, and in some cases mammal-derived products like dairy, cheese, and milk that contain alpha-gal molecule, the immune system reacts to it in an IgE-mediated allergic reaction, usually about two to six hours after consumption.
00:03:48 Don Weinberger
These symptoms can range from mild to life-threatening, like hives, itching, and rash, gastrointestinal issues like nausea, vomiting, diarrhea, and stomach pain.
00:04:01 Don Weinberger
More serious side of things include swelling of the lips, face, throat, and eyelids, all the way down to shortness of breath and wheezing.
00:04:11 Don Weinberger
Now let’s get to some questions that I have no doubt you have.
00:04:15 Don Weinberger
For patients who have been diagnosed with alpha-gal syndrome, diagnosis is usually with an IgE-mediated lab test.
00:04:22 Don Weinberger
What do they need to avoid in the future to prevent reactions?
00:04:26 Don Weinberger
Okay, so let’s go and look at where the alpha-gal molecule actually shows up.
00:04:32 Don Weinberger
People hear red meat allergy and think it’s just steak, but it’s a little more complicated than that.
00:04:39 Don Weinberger
So as you may guess from earlier, the big source is mammalian products, like I said, beef, pork, lamb, and sometimes dairy.
00:04:48 Don Weinberger
If it comes from a mammal, it’s usually a no-go.
00:04:52 Don Weinberger
But non-mammalian sources of food, such as chicken and fish, are still fine to consume in those with alpha-gal syndrome.
00:05:03 Don Weinberger
Also, anything with gelatin may be a problem too.
00:05:06 Don Weinberger
So if patients are taking medications or supplements that contain gelatin, such as in a capsule, they can open them and sprinkle it over food if needed.
00:05:17 Don Weinberger
And you could check the package insert or call manufacturers to ensure it’s okay to open the capsule first.
00:05:24 Don Weinberger
And some vaccines like MMR and varicella can be an issue for those with alpha-gal syndrome due to its gelatin components.
00:05:32 Don Weinberger
In these cases, it’s best to have the patient’s medical provider help them weigh risk versus benefits with those particular vaccines.
00:05:43 Don Weinberger
And then there’s ingredients you may not even think about, like lactose, heparin, arachidonic acid.
00:05:50 Don Weinberger
These can sneak into medications that may cause issues in patients with alpha-gal syndrome.
00:05:55 Don Weinberger
Plus things like glycerin, lactic acid, oleic acid.
00:05:59 Don Weinberger
These can be animal-derived or plant-derived.
00:06:02 Don Weinberger
So you really have to check the source behind those first.
00:06:07 Don Weinberger
So is alpha-gal syndrome treatable?
00:06:11 Don Weinberger
Alpha-gal syndrome is currently not curable, but patients can prepare themselves for accidental exposure and reactions.
00:06:20 Don Weinberger
For instance, they can carry allergic treatments like diphenhydramine 25 to 50 milligram oral doses and emergency epinephrine, especially if patients have had a severe reaction in the past.
00:06:34 Don Weinberger
Keep in mind that there are ongoing studies that involve vaccine and immunotherapy for prevention and treatment of alpha-gal syndrome.
00:06:43 Don Weinberger
Patients may ask you, does my body’s immune response to alpha-gal eventually go away?
00:06:52 Don Weinberger
So alpha-gal syndrome is usually a lifelong condition, but in some cases, the body’s immune response may improve or resolve over time.
00:07:04 Don Weinberger
First, patients should avoid further tick bites since antibodies may decline over time if further exposure is prevented.
00:07:12 Don Weinberger
They can protect against ticks with protective clothing, use of tick repellent, or just avoiding those tick-infested areas.
00:07:21 Don Weinberger
Continue to ask about all allergies and document them in patient profiles.
00:07:27 Don Weinberger
Like I said earlier, there is a lab test available that can test the IgE antibodies to alpha-gal red meat allergens.
00:07:35 Don Weinberger
You can also work with your IT department if your pharmacy system doesn’t trigger alerts for alpha-gal syndrome.
00:07:43 Don Weinberger
Check package labeling and contact manufacturers if you’re unsure of ingredients before the patient takes it.
00:07:50 Don Weinberger
You can also use our NatMed Pro website to help obtain this label info.
00:07:57 Don Weinberger
Let’s go and get back to our patient.
00:08:00 Don Weinberger
To recap, he’s having gastrointestinal issues as well as skin reactions about four hours after his meal.
00:08:08 Don Weinberger
So knowing what we know now about potential alpha-gal syndrome and its symptoms, the patient can take 25 to 50 milligrams of diphenhydramine.
00:08:17 Don Weinberger
But he should be referred to urgent care or emergency department to be evaluated further for his symptoms.
00:08:25 Don Weinberger
There, they can also get a lab test to determine if he has alpha-gal syndrome or not.
00:08:31 Narrator
Thanks for listening.
00:08:32 Narrator
We hope today’s episode gave you practical insights you can use right away.
00:08:37 Narrator
We’ve linked the resources we mentioned and more on today’s topic right in the show notes.
00:08:42 Narrator
Those links will take you straight to our websites where you’ll find even more concise, evidence-based charts, articles, and tools.
00:08:49 Narrator
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00:08:52 Narrator
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00:08:57 Narrator
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00:09:01 Narrator
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00:09:05 Narrator
Looking for more?
00:09:06 Narrator
Explore our other TRC podcasts like Medication Talk, Rumor versus Truth, and Natural Medicines Evidence in Practice, or dive deeper with our full Pharmacy Essential Updates webinar series.
00:09:18 Narrator
Thanks for listening.
00:09:19 Narrator
Stay sharp, stay current, and join us next time on Clinical Capsules.
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