New Jersey man is first documented death from tick-related red meat allergy

A 47-year-old man from New Jersey died within hours of eating a hamburger at a barbecue in the summer of 2024.

He had no major medical problems before, nor did his autopsy find a cause of death.

But several months later, researchers at the University of Virginia pieced together a diagnosis: severe anaphylaxis linked to alpha-gal syndrome. It was a tick-related red meat allergy the man didn’t know he had.

He would turn out to be the first documented death from anaphylaxis related to the red meat allergy, according to a study published Wednesday in the Journal of Allergy and Clinical Immunology: in Practice.

In most cases of alpha-gal syndrome, the culprit is a Lone Star tick, which can transmit a sugar molecule called alpha-gal to a person during a bite. This can trigger the person’s immune system to react to the molecule, also found in meat from mammals, including beef, pork, and lamb, and in dairy and gelatin products.

The man had received 12 to 13 bites around his ankles earlier that summer from what his wife had thought were “chiggers.”

However, the bites were likely from the larvae of Lone Star ticks, which look similar to chiggers.

Lone star ticks are native to the eastern United States, but were traditionally limited to southern states because of deforestation in early America. Forest regrowth and climate change have helped the ticks reclaim their territory and expand.

Lone star ticks have been found in Pennsylvania since 2011, including in Bucks, Chester, Delaware, and Philadelphia Counties. A 2008 Rutgers study found them in every South Jersey county.

The man who died was not identified in the newly published case study, nor was it revealed where he lived in New Jersey.

The Centers for Disease Control and Prevention says nearly a half-million people are suffering from alpha-gal syndrome nationwide.

Although this is the first deadly case documented that’s linked to the red meat allergy, reactions to the alpha-gal sugar in the chemotherapy cetuximab have led to other deaths, however this is rare.

Researchers say the man’s case calls for increased awareness of the symptoms of anaphylaxis, which go beyond hives and trouble breathing.

“If you get the worst abdominal pain in your life, you need to consider the possibility of an allergic reaction,” said Thomas Platts-Mills, an allergist and immunologist at the University of Virginia and lead author on the study.

What happened

The 47-year-old airline pilot had gone on a camping trip in an unidentified location with his wife and children back in the summer of 2024. They spent the whole day outside, followed by a meal of beef steak at 10 p.m. It was an unusual choice for the family, who normally ate chicken.

Four hours later, the man woke up with abdominal pain that became so severe that he “was writhing in pain,” according to the study’s recount of the events. That was paired with diarrhea and vomiting.

After a couple of hours, his symptoms improved, and he fell back asleep.

The next morning, he rose feeling well enough to get a five-mile walk in before breakfast.

He thought about consulting a doctor, but ultimately decided against it, unsure what he would say happened. Separately, he told one of his sons that he thought he was going to die during the episode.

Two weeks passed, and the family, now home in New Jersey, attended a barbecue where the man ate a hamburger at around 3 p.m. He went home and spent an hour mowing the lawn.

A few hours later, his son found him unconscious on the bathroom floor, surrounded by vomit.

His son called 911 at 7:37 p.m. and initiated resuscitation until the paramedics arrived, but even after his father was transferred to the hospital, doctors could not save the man.

An autopsy found no obvious problems with his heart, lungs, brain, or abdomen, and concluded it was a “sudden unexplained death.”

The man’s wife, however, asked her friend, a pediatrician, to review the autopsy report. Suspecting the man could have had alpha-gal syndrome, the pediatrician contacted Platts-Mills, who first identified the syndrome back in 2007.

Solving the mystery

When Platts-Mills heard that the postmortem report gave no cause of death, he thought, “You can’t leave this lady losing her 47-year-old husband for no reason. That’s impossible.”

He arranged for a sample of the man’s blood to be sent to his lab for testing.

When they received it in April, their first move was to screen for a protein called immunoglobulin E, which the immune system releases during allergic reactions. They wanted to know whether his body was sensitive to anything it shouldn’t have been.

Unsurprisingly, the test came back positive for rye grass and ragweed, two common seasonal allergens.

But so did two other substances: alpha-gal and beef.

While this helped establish his allergy to alpha-gal, their next step was to confirm whether he had anaphylaxis when he died. They sent the sample to be tested for an enzyme called tryptase, which the body releases during severe allergic reactions. High levels could indicate that he died from severe anaphylaxis.

Not long after, a scientist called Platts-Mills to apologize and tell him they had to redo the test.

Platts-Mills thought, “Oh my god, was it negative?”

Instead, the scientist would tell him the levels of tryptase were bafflingly high.

At more than 2,000 nanograms per milliliter, there was so much tryptase in his system that they needed to dilute the sample and retake the value. That number astonished Platts-Mills, who himself had never seen levels surpass 200 nanograms per milliliter.

“It absolutely says that he died of anaphylaxis,” Platts-Mills said.

It is unclear why he had such a severe case of anaphylaxis. While the study listed some factors, such as his drinking beer with his burger and being exposed to ragweed pollen, that potentially could have influenced his outcome, Platts-Mills said these “probably weren’t really the reasons why his anaphylaxis was more severe.”

Anaphylaxis very rarely causes death. One study found only 0.3% of cases in the emergency room are fatal.

One of the takeaways from the man’s experience is not to ignore abdominal pain, Platts-Mills said. While many people know to look out for more common signs of anaphylaxis, such as hives and difficulty breathing, having abdominal pain without other symptoms can be a dangerous form of the reaction.

In most cases, this pain takes three to five hours to show up after eating red meat. Had the man known his previous episode of abdominal pain was anaphylaxis, he could’ve avoided eating the burger.

“That’s the tragedy from my point of view,” Platts-Mills added.

Living with alpha-gal syndrome

Samuel Moore, a cranberry farmer in Shamong, deep in the New Jersey Pinelands in Burlington County, has had many close calls and a handful of hospital visits because of alpha-gal. He was diagnosed several years ago and knows a handful of other locals who’ve been bitten and diagnosed.

So far, Moore said there’s been no treatment that’s helped.

“The only treatment,” he said,” is vigilance.”

That means exhaustive label reading at the grocery store, rarely, if ever, dining out, and getting to know local deli owners personally. Moore said he could have a flare-up due to proteins left over on a lunchmeat slicer.

“I’ve come to the point where I’ve felt anaphylaxis coming on and my throat closing up,” he said. “It’s not just breaking out in hives.”

Moore recently celebrated his 52nd birthday at a plant-based restaurant in Haddonfield, where he was able to eat anything on the menu.

“And I’ll tell you, I was still a little nervous,” he said.

One of Moore’s friends, Albertus “Chippy” Pepper, also contracted alpha-gal syndrome. Like Moore, he’s a cranberry farmer, often outside in the bogs or clearing brush. His new diet has become a little bland.

“I eat chicken, chicken, chicken, and more chicken,” he told The Philadelphia Inquirer in 2023.

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