Specialized testing diagnoses uncommon allergy to red meat: Joseph Ducaji, M.D.
Traditionally every fall, Joseph “Joe” Ducaji, M.D., an anesthesiologist affiliated with Memorial Medical Center in Springfield, Illinois, had gone deer hunting for two to three weeks. He loved “sitting in a tree stand watching wildlife.” Recently, however, one of Joe’s hunting trips was spoiled when the night before his trip, he woke up “feeling terrible” and had to cancel the outing. Joe could only equate his illness to the steak he’d eaten for dinner the evening before. For a couple of years prior, he’d been having “gastrointestinal trouble,” particularly whenever he ate steak or other fatty red meat. Dairy products had also begun to make him feel ill.
“I thought I had irritable bowel syndrome,” says Joe, who had his gall bladder removed to address the problem. This relieved his symptoms for a time, but they eventually started coming back.
For example, one warm Sunday in October, Joe and his family enjoyed a steak dinner together outside. Following dinner, Joe prepared to go for a swim in the family’s pool. Before entering the water, however, Joe noticed hives on his arms. “I thought that was weird, but I got in the pool … and I couldn’t even swim because I was so busy scratching at the hives that were spreading,” says Joe who, unknown to him, was going into anaphylaxis.
Next came the GI symptoms, so severe that Joe describes it like being given a bowel prep for a colonoscopy. A couple of hours later he got the chills. It was then that Joe called his friend, an ER doctor at Memorial, and described his symptoms, suspecting they had something to do with the steak he’d eaten earlier in the day. Later that night, Joe’s symptoms subsided, and by the next morning, his friend had texted him information about a disease called alpha-gal syndrome (AGS). “I had never heard of it,” Joe says. “As I read what he had texted me, I thought, ‘Man, this sounds like me.’ Because it’s a meat allergy that you can obtain from a tick bite.”
Ticks can carry more than just Lyme disease
Alpha-gal (galactose-α-1,3-galactose) is a sugar molecule found in most nonhuman mammals, most notably cows and pigs, but also lamb, deer, and rabbits. With AGS, symptoms manifest two to six hours after ingesting red meat or dairy products containing alpha-gal. According to Joshua Bornhorst, Ph.D., co-director of Mayo Clinic’s Clinical Immunoassay Laboratory and Metals Laboratory, AGS occurs when a patient “develops antibodies against this molecular component of red meat, alpha-gal.”
AGS is typically found in the southern and southeastern United States. The offending tick is of the lone star variety, although other ticks can bring about AGS in humans. Sure enough, symptoms include hives or itchy rash, indigestion, nausea and vomiting, and diarrhea. AGS can also cause breathing difficulty, swelling of the throat, and a drop in blood pressure. Allergic reactions can be life-threatening.
After Joe had to miss the opening day of deer hunting season for the first time in many years, he went to his allergist to report his strange reactions to meat. The allergist told him to refrain from eating mammalian meat of any kind for six months and ordered a test to check for alpha-gal levels. Results would take two weeks because Joe’s blood sample needed to be shipped out of state for this specialized test. A few days later, Joe was informed his sample was hemolyzed, which meant it had been compromised and was unreliable. At that point, Joe decided to visit another allergist at a different institution.
When this new allergist asked if Joe remembered being bitten by a tick while hunting, he told her he had no memory of this. “I was always worried about Lyme disease — I’d never heard about AGS before,” says Joe, who always used Permethrin tick spray and kept his body covered while hunting. “But a tick still got me somehow.”
The new allergist ordered the test for AGS and said results would come back in only two days. When the results came through his patient portal, Joe had tested positive. He also noticed the test was done at Mayo Clinic. He was amazed at the two-day turnaround time, yet not surprised.
“Having been to Mayo, I get it,” says Joe, who did his physician training at Mayo Clinic. “You see the difference with the Mayo product versus the rest of the world. As soon as I saw Mayo Clinic’s name on my test, I had no doubts that the test results were accurate.”
Given that Joe had gone into anaphylaxis at least twice already, it was critical to his health to get those test results back ASAP. Thankfully, Mayo Clinic was one of the first reference labs in the country to adopt alpha-gal IgE serum testing.
“This testing is performed by a high throughput instrument that looks for antibodies against alpha-gal,” Dr. Bornhorst says.
Trading red meat for fish and fowl
Joe’s diagnosis of AGS has significantly altered his life. “I can eat fish and chicken, and I avoid dairy,” he says. “This is the best I’ve felt in I don’t know how long.”
As for his annual hunting trips, Joe is developing new strategies to safely enjoy outdoor activities. And he’s still consulting with other physicians to see if, for example, he’ll need to go on a statin, as AGS increases one’s risk of a heart attack. Meanwhile, he’s exercising more and keeping loyal to his new, healthier diet. Thanks to Mayo Clinic’s AGS test panel, he’s informed and armed for life ahead.
You can listen to Joe tell more of his story and learn more about Mayo Clinic’s AGS test panel in the video below.