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Letters to the editor for March 8, 2021

Letters to the editor for March 8, 2021

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Uptick of alpha gal disease

The problem of alpha gal tick-borne disease is described in a Feb. 4, 2021, New England Journal of Medicine article as “…an increasingly recognized public health issue.”

The classic presentation as an allergic reaction to red meat often is not the predominant symptom. Gastrointestinal symptoms of abdominal pain, with or without diarrhea, may be related to alpha gal. Four recent cases this winter brought to my attention presented as generalized muscle and joint pains (1), weak spells where the individual fell out (2), and joint pains with an abnormal blood test for autoimmune disease (1).

With warming weather, we can expect more cases locally and as the doctor in the NEJM article points out, “…symptoms and signs may be more insidious, and cases that involve predominantly gastrointestinal symptoms, presyncope, or syncope (spells) may be particularly hard to recognize.” In three of these cases the patient was told there was no need to test for alpha gal, but when the patient persisted, the alpha gal IgE blood test was positive.

Global warming contributes to the expanding territory for tick exposure and increasing number of deer will result in more cases. The alpha gal IgE test is not part of the “tick panel” of tests and must be requested separately. Central Virginia has been an epicenter for alpha gal tick-borne disease becoming a greatly underdiagnosed national public health issue.

JEFFREY W. WILSON, MD.

Lynchburg

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