The strange thing about alpha-gal syndrome is the delay. Someone gets bitten by a tick in June, thinks nothing of it, and then in October eats a burger and wakes up at two in the morning covered in hives. The gap between the meal and the reaction runs two to six hours, long enough that most people never connect the two, and the gap between the tick bite and the first reaction can be weeks or months.

It is an allergy to red meat, caused by a tick, and Suffolk County has more suspected cases than any other county in the United States.

What the federal data actually shows

In July 2023 the Centers for Disease Control and Prevention published an analysis in its Morbidity and Mortality Weekly Report mapping where alpha-gal syndrome was turning up nationally. Because there is no national surveillance system for the condition, researchers went at it sideways: they obtained results from the commercial laboratory that handled nearly all alpha-gal antibody testing in the country before 2022.

Between January 2017 and December 2022 that laboratory processed 357,119 tests covering 295,400 people. Just over 30 percent, 90,018 people, tested positive and were classed as suspected cases.

When the CDC broke those results down by county, one name sat at the top of the list. Suffolk County, New York recorded 3,746 suspected cases, the highest count of any county in the nation, and roughly 4 percent of all suspected cases in the entire country. The next highest was Bedford County, Virginia, with 1,511.

That is a striking result for a place nobody thinks of as tick country in the way the rural South is. It is worth reading carefully, though. A high count can reflect a genuinely high burden, and it can also reflect doctors who know to order the test. Suffolk County has both a large lone star tick population and a medical community that has been paying attention to tick-borne illness for decades. Both things are probably true at once.

How a tick causes a food allergy

Alpha-gal is a sugar molecule that occurs naturally in most non-primate mammals, which means beef, pork, lamb, venison and rabbit, along with products derived from them such as gelatin and dairy. It also occurs in the saliva of certain ticks.

According to the New York State Department of Health, when a tick bites and passes alpha-gal into the bloodstream, some people's immune systems read the sugar as a threat and start producing antibodies against it. From then on, eating anything containing alpha-gal can set off an allergic reaction. In New York the syndrome is associated primarily with the lone star tick, though the state notes other tick species have the potential to trigger it.

Two details from the state's guidance are worth knowing because they cut against the common assumptions. Lone star ticks do not always have the white dot that gives them their name, and the appearance changes across life stages. And bites from larval lone star ticks, the smallest and youngest stage, are also associated with the syndrome. The tick that causes this is frequently one a person never noticed.

Not everyone bitten by a lone star tick develops the allergy.

What a reaction looks like

The state describes symptoms appearing two to six hours after eating something containing alpha-gal, ranging widely in severity:

  • Rash or hives
  • Gastrointestinal symptoms including stomach pain, nausea, vomiting, diarrhea, heartburn and indigestion
  • Swelling of the lips, throat, tongue or eyelids
  • Cough, wheezing, shortness of breath and difficulty breathing

Severe reactions can include a drop in blood pressure, dizziness, fainting, severe stomach pain and anaphylaxis. Anyone having a severe allergic reaction should seek emergency care immediately.

The delayed onset is the reason this goes undiagnosed for so long. A food allergy that announces itself within minutes is easy to trace. One that surfaces in the middle of the night, hours after dinner, with symptoms that read as a stomach bug, is not.

How it gets diagnosed

Diagnosis takes three things together: a detailed patient history, a medical examination and a blood test looking for alpha-gal-specific IgE antibodies.

The state is explicit that the blood test alone is not enough. Some people carry a positive alpha-gal IgE result and never have a reaction, which is why the CDC's figures are described as suspected cases rather than confirmed diagnoses. A positive test is a starting point for a conversation with an allergist, not a conclusion.

There is currently no treatment or cure. Management means avoiding alpha-gal, working with a provider familiar with the condition, and taking tick bite prevention seriously, because new bites can reactivate reactions in someone who already has it.

Poultry and fish do not contain alpha-gal, so chicken, turkey and seafood generally remain safe. On an island where the local food economy leans heavily on fish and shellfish, that is a somewhat gentler landing than it would be elsewhere.

Who is most exposed on Long Island

Anyone who spends time outdoors is at risk, and the state singles out two groups in particular: people who are outside by choice, meaning hikers, gardeners and hunters, and people who are outside for work, meaning farmers, landscapers and construction workers. Most reported cases are in adults.

Long Island's geography does not help. Lone star ticks favor the wooded and brushy edges where lawn meets tree line, which describes an enormous share of Suffolk County, and the East End's farms, vineyards and preserves put a large workforce into exactly that habitat all summer.

Prevention, per the state's guidance

  • Use EPA-registered repellents and check the label to confirm they work on ticks
  • Treat clothing and gear with permethrin, which kills ticks on contact
  • Wear light-colored clothing so ticks are easier to spot
  • Tuck pants into socks or boots, and shirts into pants
  • Walk in the center of trails, and avoid leaf litter and wooded, bushy or grassy areas where possible
  • Check for ticks regularly, outdoors and again at home
  • Tumble clothes on high heat for 10 minutes to kill ticks
  • Shower after time outdoors
  • Remove attached ticks immediately rather than waiting
  • Check outdoor pets, which carry ticks into the house

Prompt removal reduces the risk of several tick-borne illnesses, but the state is direct that alpha-gal syndrome can follow a bite even when the tick is removed quickly. Prevention is the part that works.

This article describes publicly available guidance from the New York State Department of Health and published CDC research. It is not medical advice. Anyone who suspects they may have alpha-gal syndrome should speak with an allergist or their own health care provider.