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Don't Skip The Bug Spray: Alpha-gal Cases Are Climbing
By Gail EllisOklahoma State UniversityOklahoma State University Extension specialists say residents should remain diligent in preventing tick bites as the alpha-gal allergy emerges as a serious health in Oklahoma and the southeastern United States.
Tick bites are rare during the cooler months, but the pests are considered a year-round threat in states with mild winter temperatures.
12 years of mysterious illness
Sand Springs, Oklahoma, resident Stephanie McAllister developed a mysterious cough in 2008 that baffled medical specialists. She coughed constantly, but every X-ray was clear and every test declared normal. The pulmonologist she visited mentioned a chronic cough is usually an indicator of some kind of allergy, but no diagnosis was determined. Doctors suggested several serious medical ailments as the probable cause, including bulimia or anxiety. McAllister felt like she was going crazy, but deep down she knew none of these were the problem.
"I started having brain fogginess and joint pain in my arms and legs, but all of the tests ran for arthritis came back normal," she said.
In 2019, while hiking around Keystone Lake near her home, McAllister was bit by a tick and began vomiting five or six times a day. Again, every test doctors administered came back normal.
"I started Googling symptoms and reading articles," she said. "I went to three different doctors and asked them to do an alpha-gal test, and they all said it was too rare, that there was no way I had it."
Frustrated with 12 exhausting years of unexplained illness, McAllister started eating a vegan diet. Her symptoms disappeared, and she suspected alpha-gal was the culprit. In 2020, she found an urgent care that reluctantly ran the simple alpha-gal blood test, and the result was positive.
"It was a relief to know," McAllister said. "I had it for so long, and I was just thankful I knew what to do to feel better."
Today, she consumes chicken and seafood, but her avoidance of red meat is more complicated than it sounds.
"I have to be really careful with anything that's processed because beef and pork aren't listed on allergy labels," she said. "Any box, can or bag that lists natural flavors as an ingredient could have beef or pork in it. I know if I eat it, I'm going to feel terrible for the next three days."
High risk in northeast Oklahoma
A report from the Centers for Disease Control in July 2023 illustrates the geographic distribution of suspected alpha-gal syndrome cases from 2017 to 2022. The northeast and central regions of Oklahoma report some of the highest rates of alpha-gal in the country.
"Mammals have the alpha-gal compound, but humans don't," said Janice Hermann, OSU Extension nutrition specialist. "When a tick feeds on a mammal and bites a human, it can cause the human to have an allergic reaction to alpha-gal."
Meat from beef, pork and venison contain the compound and can enact a severe allergic reaction. In some cases, even milk, gelatin or beef broth can heighten alpha-gal syndrome.
Hermann explained the allergy is difficult to identify because of its delayed reaction.
"Food allergy symptoms usually occur rapidly whereas alpha-gal syndrome may not show symptoms until 2 to 6 hours after consuming the product," Hermann said. A lot of times, people don't associate it with the fact they consumed meat."
The CDC lists the following symptoms of an alpha-gal allergic reaction:
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Health issues had consumed Stillwater resident Ryane Draper's life for two years,
"I had extreme fatigue. I felt like someone was drugging me every day," Draper said. "I had terrible joint inflammation, constant digestive issues, stomach pains, bloating, and I was also reactive to dairy."
After a significant reaction to a meal with pork, she visited a doctor who had diagnosed a previous patient with alpha-gal. The doctor ran the same blood test on Draper, confirming the allergy in 2020.
"I'm able to consume a little bit of milk and ice cream here and there, but if I eat too much, I can feel it almost immediately," Draper said. "If cutting out certain foods works, that's what I'm going to do."
For those who have alpha-gal syndrome, some can trace the allergy to a specific tick bite. Others were never aware of a tick on their body. Bruce Noden, associate professor of medical and veterinary entomology in the OSU Department of Entomology and Plant Pathology, has personal experience with the health condition. His son was diagnosed shortly after high school.
"He got into a bunch of seed ticks out at Lake McMurtry and wound up in the hospital with anaphylaxis," Noden said. "He calls me at 11:30 at night and says, 'Dad, I can't breathe.'"
His son is one of the lucky alpha-gal victims whose symptoms eventually faded.
"We ate fish and chicken for two years in our house, and when he tried to reintroduce red meat, he came out of it," Noden said.
Alpha-gal goes global
The lone star tick variety is the most common carrier of the alpha-gal compound, inoculating a salivary protein.
"We're recognizing it more and seeing it in areas where lone star ticks are prevalent," Noden said. "The lone star tick is invading New England, and we're seeing alpha-gal cases rise there. Wherever the lone star tick is present, we have a problem."
He described the lone star tick as ubiquitous; while most other varieties feed on different hosts during different stages of their development, the lone star tick will feed on anything regardless of its stage.
Another confusing characteristic of the alpha-gal compound is human variability. Noden's international veterinary medicine colleagues in other areas of the world, such as Spain, have discovered people can show high levels of the alpha-gal antibody in their system but not exhibit allergic reactions to red meat.
"It seems there's something else going on here," he said. "We've simplified the allergy to a tick bite, but what else in the bite causes the reaction, and why is the reaction coming from lone star ticks?"
As an emerging illness, physicians are more aware of the possibility of alpha-gal when a patient shows symptoms. Dr. Lora Cotton, a primary care physician at OSU Family Medicine-Health Care Center, said the unusual symptoms are not typically associated with an allergy and can change every time a reaction occurs.
"It's probably underdiagnosed because of the variability in presentation of symptoms," Cotton said. "We're not able to pinpoint a cause right away. We mark off the common things, and when we don't find a diagnosis, that's when we should consider testing for the alpha-gal allergy."
Cotton said the blood test that reports antibodies to the alpha-gal sugar molecule is readily available. Patients can ask for the test if they suspect a tick bite.
There is no direct treatment for the allergy, and those who experience serious anaphylactic reactions should carry an EpiPen. Cotton said that although symptoms can fade over time, alpha-gal can be reactivated if a person is re-exposed to tick bites.
OSU Extension's nutrition and entomology specialists say the most effective way to prevent tick bites in tall grass or wooded areas is to spray skin with an insect repellant that contains DEET. Wear pants, tall socks and boots that impede pests from crawling onto bare skin, and always complete frequent and thorough tick checks.
Alpha-gal awareness
For residents such as McAllister in Sand Springs, the long journey of suffering from and finally receiving an alpha-gal diagnosis has changed the way she prepares for any time spent in the great outdoors.
"Now I do not go out in the woods without bug spray, and our two dogs and three cats have flea and tick medicine at all times," she said.
A native Oklahoman, McAllister was never afraid of ticks, but her experience has uncovered the scary, life-threatening side effects of an encounter.
"If I get another bite, it could make my symptoms worse," she said. "Some people still don't think it's a real thing. I believe there are a lot of people walking around with the symptoms who have no idea they have it."
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There Are Actually 4 Types Of Pneumonia. These Are The Differences.
In recent weeks, the news of American gymnast Mary Lou Retton's hospitalization for a rare type of pneumonia raises the question of what the major risks are for developing the condition.
Pneumonia is the world's leading cause of death for children under the age of five, and the leading cause of hospitalization for adults in the United States, with over one million admissions per year; about 40,000 Americans die from the disease annually. Pneumonia, which can range from mild to life-threatening, is caused by inflammation within the tiny air sacs in the lungs. It can lead to deadly consequences—including a lack of oxygen and blood infections—if left untreated.
National Geographic spoke with several experts to gain a better understanding of the various types of pneumonia, and the risks of contracting different forms of the disease.
How is it diagnosed?Pneumonia is an infection of the lower airways, specifically the tiny air sacs, called alveoli, which serves as the exchange point for delivering oxygen to the blood, and removing carbon dioxide. This infection can be triggered by various factors that initiate in the upper airway and then travel into the deeper parts of the lungs.
Some of the common symptoms for pneumonia include cough, shortness of breath, chest pain, and general fatigue. To diagnose pneumonia, a doctor will use a stethoscope to check a patient's breathing, listening for a characteristic crackling sound, similar to the sound of crumpling paper, says Tianshi David Wu, a pulmonologist at Baylor College of Medicine. "That's all that's needed to diagnose pneumonia," Wu says, adding that if a doctor is still unsure, they can also order an X-ray of the lungs, which will confirm the diagnosis.
Four types of pneumonia?The four main types of pneumonia that are characterized based on the cause: bacterial, viral, fungal, and hospital-acquired.
For the most part, "there's no way to tell if a pneumonia is being caused by a bacterium, a virus, or a fungi just by examination," Wu says. "Most pneumonias don't ultimately get a diagnosis" of what is causing it. Instead, doctors will treat pneumonia based on a patient's symptoms and their medical history, using this information to determine the best course of treatment.
Bacterial pneumonia, which is the most common type, is caused by bacteria, which means that it is easily treated with an antibiotic. For many patients, treating pneumonia with an antibiotic will help resolve their symptoms, and help them start to feel better within days of starting treatment. "The earlier the treatment, the better," Wu says. There is also a vaccine that protects against the most prominent bacterial strain that causes pneumonia, and is approved for certain groups, including patients over the age of 65 and those with certain pre-existing conditions.
Viral pneumonia, which is less common, is caused by a virus, such as influenza, SARS-CoV-2—‑the virus that causes COVID-19—or RSV, a respiratory virus that usually causes mild, cold-like symptoms. Many of these viral infections begin in the upper airways, then travel down into the lungs.
A viral infection can also lead to bacterial pneumonia by weakening a patient's immune system, leaving them vulnerable to a secondary infection. Although no virus can be treated with an antibiotic, there are vaccines that can help prevent infection: the yearly flu shot, COVID vaccine, and for those who are eligible, the new RSV vaccine.
Fungal pneumonias are rare, and usually found in patients with pre-existing conditions, such as a compromised immune system. Fungal pneumonias tend to affect people with autoimmune disorders, patients who are undergoing chemotherapy, or other chronic conditions that can affect a person's immune system, says Lucas Kimmig, a pulmonologist at University of Chicago Medicine. Fungal pneumonias require a different treatment strategy and can often be more serious, due to both the complications of pneumonia, as well as the patient's other underlying conditions.
Hospital-acquired pneumonias are considered a separate category because a hospital environment often exposes patients to a different set of bacteria, including strains that are more likely to be resistant to antibiotics. A case of pneumonia that was acquired in a hospital setting can affect how doctors treat the condition. "They're at risk for some different bugs that we don't usually see in the outpatient setting," Kimmig says. "That affects the antibiotic choice."
Why is pneumonia so serious?The risk of pneumonia is that, if left untreated, it can cause serious complications, and can spread to other parts of the body.
"If there is a bacteria or a virus that infects the lungs, there's really no way to get it out," says Jason Turowski, a pulmonologist at the Cleveland Clinic. "That infection can rage and rage."
The primary risk of pneumonia is that it can damage the lungs, affecting a person's ability to get the oxygen they need. This damage usually happens because inflammation can cause a buildup of inflammatory cells in the tiny sacs of the lung that prevents oxygen from getting delivered, and carbon dioxide from getting released. "It's causing an injury that doesn't enable you to get the vital oxygen you need and to release the carbon dioxide your body's making," Turowski says.
The secondary risk is that the infection can spread to other parts of the body, such as the space between the lung and the chest wall, or into the bloodstream. When this infection starts to spread to other parts of the body, this can turn into a condition called sepsis, which is an out-of-control, systemic response to an infection. Sepsis can quickly grow into a life-threatening condition that often results in death.
Who is most at risk for developing pneumonia?The people who are at the highest risk for developing serious complications from pneumonia include children under the age of five, adults over the age of 65, and people with pre-existing conditions, such as heart and lung disease, or a weakened immune system due to chemotherapy or organ transplantation.
Other risk factors include having uncontrolled diabetes or smoking or drinking heavily.
"Most forms of pneumonia end up being mild and self-limiting," Wu says. "If it is severe enough to be hospitalized, there are probably other things going on."
Warning signs pneumonia is worseningFor patients who have been diagnosed with pneumonia, and are recovering at home, some of the major warning signs that they may need to seek out additional medical care include a worsening in their condition, even after treatment, whether it's a fever that won't go away, chest pain or shortness of breath that won't resolve, or rapid breathing, which can indicate a failure to get enough oxygen.
"It's important to always contact your doctor when something feels different," Turowski says. "When we're involved early, we can guide you, and if we get a follow up call, that I'm getting worse, then we can help get things ready for you in the hospital."
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