Joey Wahler (Host): It's a serious allergic reaction. So, we're discussing alpha-gal syndrome. Our guest is Laci Rascher. She's a nurse practitioner. This is Kirby Connections Health podcast, where we help you nourish your wellness journey with Kirby Medical Center. Thanks so much for joining us. I'm Joey Wahler. Hi there, Laci. Welcome.

Laci Rascher, APRN-FPA: Thank you very much.

Host: Thank you. We appreciate the time. So first, in a nutshell, what exactly, for those unfamiliar, is alpha-gal syndrome? And how would you say it's different from more typical food allergies like those involving, say, peanuts or shellfish, right?

Laci Rascher, APRN-FPA: Yes. So as you mentioned, it's an allergic reaction. It typically comes after you've been bit by a tick, typically more than one bite. And more often than not, it's from the lone star tick.

The difference in reactions with a typical food allergy, such as peanuts, you typically have a reaction within a matter of minutes up to a couple of hours. With the alpha-gal syndrome, it's a delayed reaction, typically between two and six hours. And a lot of times, it wakes people up out of their sleep.

Other differences, mostly just the delay. And that triggers us to ask, "Have you been bitten by a tick ever in your history? Multiple, more than one? And were you ever treated for those tick bites?"

Host: Gotcha. So, this is triggered by a tick bite, as you say. But then, it can be exacerbated by exposure to certain foods. So, let's talk about that, please. Which foods, which products would most commonly trigger reactions in people with alpha-gal syndrome? And what are maybe some of the hidden sources of ingredients that patients and families may overlook at times, right?

Laci Rascher, APRN-FPA: Sure. The alpha-gal is also a little different in the sense that it is a sugar reaction as opposed to a protein reaction, which seems kind of odd since it's animal products that typically trigger this. And we often think of mammal products as meat, beef, lamb, chicken, some dairy. Some of those places where hidden meat products can be is in gelatin beef tallow, which we are seeing in cosmetics as well as in cooking, lard, capsules.

So if you're taking a vitamin D capsule, you want to make sure that it's a vegan one. Any of the non-vegan ones can have some of that gelatin in those capsules, as well as other medications that are in capsule form.

Host: What would you say is the biggest ingredient or food that maybe people wouldn't necessarily associate with this that nevertheless is connected with it?

Laci Rascher, APRN-FPA: I'd say honestly a boom in the cosmetic industry with the beef tallow. A lot of people are using it on their faces and their creams. It's kind of blowing up right now. So, it's one that I would think a lot of people wouldn't necessarily think of since they're not ingesting it, but can still trigger some of those reactions.

Host: Interesting. And so, there's a beef component to that makeup?

Laci Rascher, APRN-FPA: Yes. Yes.

Host: Do you think most women know about that regardless of whether they have this condition or not?

Laci Rascher, APRN-FPA: That's a good point. I'm not certain. But I know that a lot of people are using pure beef tallow for fine lines and wrinkles as a facial moisturizer. And literally, you'll see it just about everywhere.

Host: Okay. Well, we certainly learned something there, that's for sure. So, how can patients, general practitioners recognize the typical symptoms of alpha-gal syndrome, especially since reactions, as you point out, are often delayed by several hours after eating, let's say in the case of red meat?

Laci Rascher, APRN-FPA: So typically, it's delayed. A lot of times, it can be misdiagnosed because the symptoms are somewhat vague. Sometimes you have the rash, the hives, the true anaphylactic. But other times, it presents with GI symptoms. And that a lot of times is misdiagnosed as like an irritable bowel syndrome. So, it's really important to get a really thorough history to find out when these reactions are occurring, how far prior to we ate, what we ate. And then, that triggers kind of more of the conversation around the tick bites.

Host: In terms of how this is diagnosed, what are those steps for alpha-gal syndrome and how reliable are they in telling whether this is present?

Laci Rascher, APRN-FPA: Most importantly, good thorough clinical history. You can do a serum blood draw to test for it, but a positive serum blood draw does not necessarily indicate a true alpha-gal syndrome. Some people will test positive but have absolutely no reactions to those products. So in order to be truly positive, you have to have the positive clinical diagnoses, a positive test.

They don't really rely on the typical skin test allergies, even if we're doing mammal-containing products. They're unreliable. There's not usually enough of a reaction for them to make that official diagnoses.

Host: Are there particular red flag clinical scenarios in primary care that should prompt a GP to specifically consider alpha-gal syndrome and order testing for it, would you say?

Laci Rascher, APRN-FPA: Our number one red flag is that reaction that happens hours after being exposed. So when we see those, you know, "I ate dinner, I went to bed, I woke up in the middle of the night and I had this rash, my stomach hurt," those should be our kind of red flags to say, "Okay, we need to look at this a little differently."

Host: How about when we talk about symptoms, what about kids, especially younger kids that are often prone to tick bites? They're not necessarily, of course, as aware or informed about avoiding them. How does it affect younger people as compared with adults?

Laci Rascher, APRN-FPA: Probably a little more challenging just as it is in treating all children. They are not the most reliable historians. They don't know what they ate, when they ate it, if they've ever had a tick bite. Sometimes they present with other caregivers that may not know the answers to those questions as well.

And just in general, kids are rashy. So when we see them and they have these outbreaks, it's not necessarily the first thing on our minds. And sometimes it may take a few repeated exposures before that truly comes out, and we just hope they don't get to the anaphylactic piece to make that diagnoses.

Host: Understood. So, what are the main misconceptions you run into with patients and maybe even other health professionals about alpha-gal syndrome, and how can we address these in terms of routine consultations?

Laci Rascher, APRN-FPA: I think as clinicians, a lot of times we like data. So, we like positive tests. And remembering that just because a blood serum test is positive doesn't necessarily correlate to an actual reaction is an important piece. This alpha-gal has been in the news over the summer, over the spring, as people are being more exposed to the tick bites. So, we had kind of an influx in people coming in. They're worried about it. They're stressed about it. So, you kind of just have to educate thoroughly test when appropriate, correlate that with the clinical data. And then, sometimes we even do a trial where we withhold those products to see if they truly improve.

So, you have them restrain from all meat-containing products, those listed in-depth, you know, lists for them to avoid. And if their symptoms improve over the next one to two weeks, that correlates with a likeliness, and then they get a referral to allergy.

Host: So picking up on one thing you mentioned there, you're saying that 2026 has been a bad or maybe worse than usual year in terms of tick bites?

Laci Rascher, APRN-FPA: I think over the last few years, we've just kind of seen the number of tick bites gradually increase. And the more data that's out there, sometimes the more confusing it can be for patients. But encouraging them, you know, wear the long sleeve clothing with the pants tucked in, the appropriate insecticides. Prevention is our best goal here. A little bit of reassurance that typically one bite isn't the cause of this. It's usually recurrent or multiple bites over a period of time that it builds up in the system.

Host: Yeah. It's a great point that it's not just one but multiple bites that can bring it on. Couple of other questions for you. How about promising treatments that are in development for this, like the alpha-gal epitope and also some others? What's the epitope?

Laci Rascher, APRN-FPA: Yeah. They're doing some studies on some immunizations and some treatment. They're all, as far as I understand it, very early in the development. But we do typically see these symptoms improve with withdrawing and then can do a gradual reintroduction of these products. So, it's not necessarily that you'll have to avoid this forever.

But we want to make sure that you're prepared in case of the worst case scenario with an anaphylactic reaction, that you have an EpiPen on hand, you know how to use it, you know to go to the ER if you have to use it so you can be monitored in case an additional dose is needed.

Host: Now, of course, an EpiPen would be reactionary right after a reaction to a reaction, if you will. But there are also in the works vaccines targeting tick bites, right?

Laci Rascher, APRN-FPA: Yes. Yes, there are. How far into the making? I can't speak to that. I'm not privy to enough. I know it's in the works. I know it's early stages, and just like everything, they vet it thoroughly before they roll it out. But I know they are in the studies and working through some of that

Host: That would be a major breakthrough to say the least, wouldn't it?

Laci Rascher, APRN-FPA: Absolutely. I work in a walk-in setting. We get people who bring us in their tick bites. We remove some tics ourselves. We do tend to send them off for some testing, most specifically appropriate identification of what type of tick. And then, in some instances, they'll reflux that to see if there's Lyme. But as of now, there's no testing that we do on the tick for the alpha-gal.

Host: In summary, if not addressed, alpha-gal syndrome could be life-threatening too, right?

Laci Rascher, APRN-FPA: Yes. Like typical reactions, the more exposures you get, the more severe the reaction tends to be. A lot of times, in food allergies when you are exposed to it the first or second time, you don't tend to react. It's usually that third or fourth exposure where you have that big breakout. With the alpha-gal, you have reactions, but they can be a little more minimal, and you can brush it off until it's big enough to kind of grab your attention. And then, you say, "Okay, what's going on here?"

Host: Well, we trust you're now more familiar with alpha-gal syndrome. Laci, keep up all your good work fighting this and all the other things that you and yours do, and thanks so much again.

Laci Rascher, APRN-FPA: Thank you for having me.

Host: Absolutely. And for more information, please visit kirbyhealth.org/services/primary-care. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of the Kirby Connections Health podcast.