Spotlight: Q&A with Jonathan A. Edlow, MD
When Dinner Becomes Dangerous: Q&A on Alpha-Gal Syndrome
In New England, when an emergency department patient mentions a recent tick bite, clinicians instinctively think of Lyme disease, the tick‑borne infection named for the Connecticut town where it was first identified. But new data shows they now need to consider something else: a tick‑borne allergy that can trigger delayed, dramatic, and potentially life‑threatening reactions hours after a patient eats dinner.
Jonathan A. Edlow, MD, a professor of emergency medicine at BIDMC, is sounding the alarm. In his recent paper in the Journal of Emergency Nursing, Edlow highlights alpha‑gal syndrome — a tick‑associated allergy to mammalian proteins found in meat and certain medications like heparin — as an underrecognized cause of anaphylaxis in emergency settings, particularly in regions where clinicians may not expect to see it.
During the COVID‑19 pandemic, Edlow and his wife relocated to Virginia. Even so, Edlow has remained closely connected to BIDMC — participating remotely in conferences, educational programming, and quality‑improvement work — while gaining firsthand exposure to regions where alpha‑gal syndrome has become a commonplace diagnosis. That vantage has given him a front‑row seat to how rapidly the geography of the condition is changing.
We spoke with Dr. Edlow about why alpha‑gal syndrome is so easy to miss and why emergency clinicians at BIDMC and beyond need to have it on their own radar now.
Questions & Answers with Dr. Edlow
Your paper shows that people with alpha‑gal syndrome often wait, on average, about seven years for a diagnosis. Why does it take so long?
Edlow: The diagnostic complexity really lies in being aware of it. The diagnostic test itself is a simple blood test, but what makes it hard is that the symptoms are delayed. People tend to develop symptoms six or eight hours after eating, and you don’t associate the meal you had six hours ago with what’s happening now. Most allergies are to proteins — this is different because it’s a sugar molecule. The alpha-gal molecule is in the saliva of the tick. You get exposed through a tick bite, your immune system reacts to it, and then later you eat mammalian meat and you’re exposed to the same molecule again. That’s when people can develop anything from hives to full-blown anaphylaxis. Once you know that, it really changes how you think about these patients. This isn’t rare. It’s just underrecognized.
Why does alpha‑gal syndrome matter now in Massachusetts?
Edlow: For a long time, this was thought of as a southeastern problem. I have several neighbors and people that I know of down here who do have alpha‑gal syndrome. The lone star tick was primarily a southeastern tick, but now it’s all along the eastern seaboard. The scientific name is Amblyomma americanum, and its range has expanded all the way up to Maine, probably mostly because of weather‑related changes in the country – and on the whole planet. It’s definitely all over Massachusetts, and certainly on the Cape and the islands. It overlaps with the blacklegged tick, which is the vector for Lyme disease. So we’ll be seeing it more in the Northeast.
Why are emergency nurses so central to catching this — and what should clinicians be asking differently now?
Edlow: Nurses are the ones doing triage. They’re often the first people taking a detailed history, and they’re the ones who hear the timeline. If alpha-gal isn’t on your radar, you don’t ask the question. Now I ask about tick exposure — not just whether someone remembers a tick bite, but whether they spend time doing outdoor activities that place them at risk for tick bites. I ask about gastrointestinal symptoms, and I ask what they ate six or eight hours ago. Those are all questions I wouldn’t have asked ten years ago.
How was alpha‑gal syndrome first discovered?
Edlow: In 2004, researchers were studying a new chemotherapeutic agent for colon cancer. Overall, the rate of allergic reactions was pretty small — about 2-3 percent. But, when people started looking at the data geographically, they noticed something strange: patients in the southeastern United States were having reactions at much higher rates than patients in the Northeast. In Tennessee, around 20 percent of people had antibodies to this molecule, while in Boston it was well under one percent. That pattern became clear within about three years, and within another year they had identified the culprit. When researchers interviewed patients, people were saying things like, ‘I got bit by a tick six weeks ago,’ or ‘two weeks ago.’ That led them to do the epidemiologic work and identify a specific tick — the lone star tick — as the source.
What’s the most important takeaway you want emergency clinicians to remember?
Edlow: Alpha‑gal syndrome is an important, growing cause of anaphylaxis and other serious allergic reactions. If you can think to ask about it, you can diagnose it. And once it’s diagnosed, it’s preventable. That’s what makes awareness so critical — because if clinicians don’t think of it, patients keep getting exposed, and they keep coming back with potentially life‑threatening allergic reactions that could have been avoided.
About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.
Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.
