Lyme disease, science, and society: Camp Other

Friday, April 8, 2011

18 Tick bite you? Stick to eating fish and poultry; avoid red meat?

I say the above not just because there have been health benefits from cutting back on your consumption of red meat - but because in the past couple of years, a number of people who have been bitten by ticks have developed a delayed anaphylactic allergic reaction to red meat. Now there is further evidence that there is a connection between tick bites and this reaction.

Anaphylaxis is the most serious form of allergic reaction a person can get, and it can be fatal. Typical symptoms include swelling of the tongue and throat, itching, hives, trouble breathing, low blood pressure, and shortly thereafter - an inability to breathe at all.

People with severe allergic reactions to food - such as peanuts - are advised to carry a medical device called an epinephrine pen (commercial name, Epipen). The "pen" is a portable injection device with a small cartridge of epinephrine and a preservative in it which is injected into the side of a person's leg at a 90 degree angle and held there for 10 seconds before removal. This injection is not the end of treatment - it is only meant to help until EMTs or paramedics arrive; an ambulance must be called if someone has an anaphylactic reaction.

So, when I say this is serious - it is. People have died from anaphylactic reactions. Having Epipens on hand is critical if you know you have this condition. Your odds of survival are greatly improved if you have them and use them early in the onset of serious symptoms.

If I seem to be pretty concerned about this issue, I am - I know a number of people with serious allergies, including one with a peanut allergy - and they have to carry these pens and avoid certain restaurants all the time.

Weird thing about this anaphylactic response in people who have had tick bites is that everyone who had the reaction used to have no problem eating red meat prior to the bites - and also, the anaphylactic response doesn't turn up until 3 to 6 hours after consuming the red meat. Usually an anaphylactic response shows up 5 to 30 minutes after consuming the wrong food - and is a reaction to protein in the food. In this case - even though it's meat that is the trigger - a carbohydrate is the source of the reaction.


The research states it is mostly people who have been bitten by the Lone Star tick who develop this allergic reaction. But since you might not know which kind of tick bit you, you might want to avoid beef, lamb, and pork in your diet - and maybe even cow's milk - just to be on the safe side. Besides... Fish, turkey, and chicken are usually leaner sources of protein and have less saturated fat anyway - it's good for you.

Source publication:
The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. The Journal of Allergy and Clinical Immunology. (In Press) Scott P. Commins, MD, PhD, Hayley R. James, BS, Libby A. Kelly, MD, Shawna L. Pochan, CNM, MPH, Lisa J. Workman, BA, Matthew S. Perzanowski, PhD, MPH, Katherine M. Kocan, PhD, John V. Fahy, MD, Lucy W. Nganga, MD, Eva Ronmark, PhD, Philip J. Cooper, MB BS, PhD, Thomas A.E. Platts-Mills, FRS.

Abstract source: http://www.jacionline.org/article/S0091-6749(11)00344-7/abstract

Newspaper article from 2010 on patients in southeast US: http://www.roanoke.com/news/roanoke/wb/253939

What's interesting is that Dr. Commins did research on IgE antibodies and anaphylaxis caused by carbohydrates present in red meat and thought there might be a relationship to tick bites when he did this earlier research.

To quote from this previous publication,
"Initial attempts to clarify the possible causes of development of IgE antibodies to α-gal included investigation of parasitic infections as an inciting event. Sera from patients with documented helminth infections, however, do not consistently contain IgE antibodies to α-gal (data not shown). Interestingly, more than 80% of the patients in the present cohort report being bitten by ticks before having symptoms; a similar scenario has been recently described in a group of Australian patients.31Therefore the implications of IgE antibodies to α-gal might extend well beyond the southeastern United States, and we are pursuing the possibility that bites from ticks or tick larvae of the genus Amblyomma are responsible for triggering the production of IgE antibodies to α-gal."

The interesting part for me, too, is that he mentions that a similar scenario has been described in a group of Australian patients.  When you think "Lyme disease", most people think the eastern coast of the United States. Most people don't think of people on the west coast - let alone Australia - getting ill from tickborne infections. But it happens, and I suspect it happens more frequently than most people are aware.

There has been a lot of controversy downunder as to whether or not one can get any sort of tickborne infection from ticks in Australia. The common belief held by many for a long time was that outside of tick paralysis, ticks in Australia don't carry diseases like ticks do in the northern hemisphere.

That's changing.

A lot of discussion about Lyme disease in Australia was spurred by the July 2010 death of Karl McManus, an actor on the set of the TV show, Home and Away. Karl was bitten by a tick in Australia in 2007 while filming outdoors on the set and went on to develop a flu-like illness followed by many symptoms of neuroborreliosis. More information on Lyme disease and other tickborne infections in Australia can be found at the Karl McManus Foundation web site.

Due to stories such as Karl's and of a number of Australians who state they have had symptoms of tickborne infections - even though they have not traveled outside Australia - it is clear more needs to be done to investigate the situation. More research is needed there to show how extensive tickborne infection is in Australia, and a greater awareness about the symptoms of tickborne infections outside of tick paralysis (fairly well known by Australians and supposedly completely reversible if the tick is removed right away) is needed by the Australian public and doctors.

There are five kinds of hard-bodied Ixodes ticks - as well as other ticks - that could spread infection in the country. Note that there are no Lone Star ticks in Australia - so what is causing the serious allergic reaction mentioned above? So far, I only found limited research available and accessible online referring to the citation source below [31] which is The Association between Ixodes Holocyclus Tick Bite Reactions and Red Meat Allergy by Sheryl van Nunen, Kate O’Connor, Suran Fernando, Lesley Clarke, and Richard X Boyle, which was published as part of a poster session at the Australasian Society of Clinical Immunology & Allergy's 18th Annual Scientific Meeting in 2007 in Western Australia.

If any of my readers from Australia know more about this session or anyone has more information about this, please let me know in comments.

Earlier research, in full text:
Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1,3-galactose. The Journal of Allergy and Clinical Immunology. Volume 123, Issue 2 , Pages 426-433.e2, February 2009. Scott P. Commins, MD, PhD, Shama M. Satinover, MS, Jacob Hosen, BS, Jonathan Mozena, MD, Larry Borish, MD, Barrett D. Lewis, MD, Judith A. Woodfolk, MBChB, PhD, Thomas A.E. Platts-Mills, MD, PhD

Read entire publication for free: http://www.jacionline.org/article/S0091-6749(08)01931-3/fulltext

18 comments:

  1. Thanks CO, yet another fine article. I don't know how you do it. How can you have Lyme and think so clearly? Your site is ripe with extraordinary research. Bravo!
    I started to get brown spots all over my torso about 3 years ago. Dermatologist diagnosed me with Mastocytosis. Could this type of histamine reaction be similar to the anaphylactic scenario? In the first few years of having Lyme there were many strange skin issues. Mild ACA and tiny circular blood blisters on hands and feet. As well as adult on-set allergies. It is amazing to me when I look at all the destructive things happening to me. One of the patient studies you referred to in the past gave me a eureka moment! Hidradenitis suppurativa was another diagnosis early on. Then I read about other lyme patients having this same issue. It blew my mind! The things I read on your site give me the fuel of understanding the landscape of this disease. Thank you! -Jess

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  2. Hi Jess,

    Thanks for stopping by and for the compliment.

    How do I do it? The power of Mepron and Zithromax, maybe? You should have seen me before I started this blog... I couldn't have written out of a paper bag.

    I still have some cognitive problems involving memory and executive function and those have only somewhat improved. (Examples: I can't leave a jug of water to fill under a tap and come back to it - I'll simply forget. Same goes with putting the stovetop on - I almost totally ruined a pot that way. Do I need assisted living at this point to make sure I don't burn the house down? Hope not.)

    I also spend a lot of time putting an entry together and it's not uncommon for it to eat most of my day to write one. It takes time, but it has helped distract me from pain.

    I'm sorry you have been suffering with Lyme disease and all the strange symptoms that can crop up with it. Regarding your mastocytosis, I'd have to research it for you before giving you a well-reasoned response. In my own experience and that of others I have spoken with, I can say that allergies often increase along with symptoms - and as symptoms improve, the allergies generally improve as well.

    I'm glad my research has been helping you piece together the puzzle. That's what I'm trying to do here as well - and I hope that my efforts will help others, too.

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  3. Yes, CO you are helping a lot of people! I'm sure you know how difficult it is finding unbiased sites out there. So many angry, sad ranting Lymies. I prefer to armor myself with science. Since it seems most doctors know so little. (I live in Canada) I diagnosed myself, positive IGENX and pay a private Doctor for treatment. The dozen MDs that refused to treat me crushed my view of the health care system. Canada is dysfunctional on a massive level.
    So now I am my own student Doctor. And you are Professor Other!
    Many Thanks -Jess

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  4. *Serum interleukin-6 reflects disease severity and osteoporosis in mastocytosis patients.(pubmed)
    *Interleukin-6 is expressed at high levels in the CNS in Lyme neuroborreliosis. (pubmed)
    *Response of soluble IL-2 receptor, interleukin-2 and interleukin-6 in patients with positive and negative Borrelia burgdorferi serology.(pubmed)
    *Interleukin-6 Promotes Anti-OspA Borreliacidal Antibody Production In Vitro (http://www.asm.org/)

    Just thought I'd throw in some interesting connections. IL-6 and all it's friends seem to be more fuel to the fire! -Jess

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  5. Jess,

    It is difficult to find sites that simply report on scientific research geared towards Lyme disease and other tickborne infections alone - there are tons of aggregate sites for science reporting and lots of research sites - but they aren't geared towards tickborne infection alone.

    Every Lyme disease advocacy site I've seen so far has posted at least some measure of studies to support their claims - most of which are promoted via ILADS site. There isn't a genuine standalone site so far as I can see which is neither ILADS, patient advocacy, or IDSA-panel-associated which approaches scientific discussion of Lyme disease and tickborne infections as a vehicle for education and helping patients understand these diseases and complications associated with them.

    I would like to see a change in this - how to bring it about remains to be seen. From here and comments elsewhere, I encourage others with science backgrounds to begin writing more about these topics.

    I'm sorry you were the one who had to diagnose yourself, get the tests from Igenex, and see a private doctor. I've been following the plight of Canadians - if you pay for single payer coverage, you should be getting paid coverage for Lyme disease treatment and not have to resort to out of pocket payment for it. This is, of course, the same complaint that Americans have towards their insurance companies.

    While many people in the US have been afraid of the gov't taking over health care, my viewpoint of it is at least everything else health related will be taken care of if I happen to lose insurance. Naturally I want diagnosis, testing, and treatment for tickborne illnesses to be covered too, but I support preventative treatment and care for everyone and would petition and protest to have Lyme disease treatment be part of any healthcare plan - insurance or government supplied.

    Healthcare systems around the world have their failings. None of them are perfect, but I think that relative to other industrial first world countries, the US gets the least bang for tons of buck. This needs to change, regardless of who is running the system. We should be getting red carpet treatment for what we pay into the system.

    But sad to say, when it comes to early diagnosis and treatment, people are falling through the cracks everywhere. I've seen it in Europe (check out Joanne's blog in the links to the right - Looking at Lyme Disease) and in Australia (see Lyme Green Australia blog to the right), where it's even more controversial to have a Lyme disease diagnosis. Clearly more research is needed to determine what is going on here and why so many people are showing similar symptoms.

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  6. Jess,

    Thank you for sharing your insights on IL-6. Keep reading, there's more to learn related to this out there. I'm glad you're taking the time to do some of your own research!

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  7. Pieces if the puzzle right? Is there a line between hypochondriac and curious? It eases me to discover things about my body and put to rest the fear of dying! Or at least reasoning my way out of pain with the distraction of science. Symptoms of Lyme and Bartonella are complicated like listening to a dyslexic Swahili wildebeest. Screeching and searching for relief. All the connecting factors of this Th1 infection seem to be endless and obvious all at once. Hard facts as opposed to the IDSA (hogwash) guidelines is the only way to go. Don't you think? I question all authority and always will. We humans are to easily lemmings. ;-)
    -Jess

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  8. Jess,

    I'm a geek. I am by nature curious, so my wanting to know more about something is my nature - being sick with the subject of my geekery is just extra motivation for me. As for hypochondria, I did take on a therapist for a while to have someone to rant to and spare my buddies from it - and my therapist's opinion was that my illness is not in my head - I'm just sick and any depression I have is from dealing with it. So, I don't concern myself with the hypochondriac label. If someone else wants to call me that, I have a few professionals I can refer them to for their official diagnosis of my condition.

    More information is useful if it sets your mind at ease. The sign that you are "losing it" is when more information does not help and you begin second guessing everything. In my opinion, this is when it's good to reduce anxiety in one's life by playing Portal and talking to friends and just stopping what the Buddhists call the "monkey mind" from running the show.

    At least that's my take on it?

    Did you see the recent research finding Bartonella in ticks? I haven't posted about it yet; I wonder what Gary Wormser thinks about it.

    Yes, it's important to look at hard facts - and also not get too married to your "pet theory". It's possible in the future that we will all find out immune dysregulation plays a much bigger role in chronic symptoms than the Lyme community has been saying all along, and persistent infection plays a smaller role in this. I think one is necessary for the other to occur, but this is speculation and more research really is needed.

    To stop being a lemming means to question everything. The IDSA. The researchers. Other people on support groups. ILADS. Me. Fox News. CBS News. PBS. BBC. I could go on and on, but you get my drift: Question everything.

    You do have to start with something or some works to base your discussions on, though, and your own hypotheses. Choose wisely.

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  9. Oh, and to add to the above? Immune dysregulation is different from an autoimmune disorder. Either way, I think the infection has to get the ball rolling, and persistent infection can run concurrent with dysregulation.

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  10. Interesting that you said that, dysregulation. The only treatment readily available to me is the Marshall Protocol. It made sense. These pathogens survive and reproduce by disrupting the Vitamin D Nuclear Receptor, an evolutionarily consistent mechanism for survival, which leads to the development of chronic inflammatory diseases. Bacterial pathogens persist and reproduce by disabling the innate immune response.The innate immune response is the body's first line of defense against and non-specific way for responding to bacterial pathogens. Located in the nucleus of a variety of cells, the Vitamin D nuclear receptor (VDR) plays a crucial, often under-appreciated, role in the innate immune response.
    Blah Blah Blah...
    Or at least I hope so. One year of treatment so far and I have seen much improvement. Choosing a Lyme treatment is like playing russian roulette. I question my decision most days. IV treatment of antibiotics scares the hell out of me and doesn't seem to have huge success. It's all a guessing game. Who really knows for sure? I start low dose pulsed antibiotics next week. If there is Herxing I will consider it to be working.
    Or winning the lottery if I get my health back.
    Which came first the dysregulation or autoimmune disorder? Chicken or egg. Hard to say.
    I have no real "pet theory" It's almost more about faith right now. There are no definitive answers anywhere that I can find. Conclusions and studies that vary greatly. Truth is suppressed. Medicine has lost it's magic for me. Quagmire.
    Have I chosen wisely? Time will tell. Thats all i've got.
    -Jess

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  11. Jess,

    Curious - why is it the Marshall Protocol is the only treatment you can try? Is it because of lack of access to a doctor in Canada, or some other reason?

    I know some patients leave Canada and get diagnosed and treated in the US, and a number of Canadians have been holding protests and writing to their provincial health boards to address this issue so they can get tested (accurately! not like the BC fiasco) and treated in their own country.

    Blah, Blah, Blah, indeed. I haven't touched upon discussion of the Marshall Protocol here - as I've said on the site before, I've been focused on looking at what evidence there is to support the more conventional approaches first as well as to find evidence of how well the current antibiotics prescribed for treatment do or don't work. There is plenty of material to write about if I just focus on that. Years' worth.

    I do want to focus on alternative treatments more as I go along, but also don't want to make claims about whether they work or not based on testimony. In taking the time to research the medical and scientific hypotheses behind them, I have to find substantial supporting documents which were not written by Marshall or his immediate associates and refer to them, plus any citations related to those references. Then I have to try to find conflicts of interest - this part is harder, and I will in all likelihood not be able to uncover them all.

    It takes a while to do all this - so generally my research on any one protocol is a long term project. When I post here about any one abstract and it happens to relate to another paper I've already written about, it's a bonus because I have research to readily fall back on and link. But that's just one paper I'm talking about and analyzing - not an entire protocol which can be connected to many papers.

    Analysis of the 2006 Lyme disease panel guidelines is something I am still not done with, and the guidelines are different from other papers because a good portion of them reference clinical trials in the body of the paper - and also the guidelines have a lot of related citations. To really do them justice, I want to know what other professionals in the field have to say about them and why - plus look at each of those citations for their value. So I have not done as thorough a job on discussing and questioning the guidelines as I'd like, and that's just one paper.

    (more)

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  12. The guidelines are different from other papers, though, in that they do constitute a treatment protocol - so that complicates research for it.

    For example, if the guidelines recommend 30 days of IV Rocephin for treating neurborreliosis, is that reasonable? How do we know it is? Does it have a high enough MBC for that duration for all patients and all strains of Bb? Is there evidence that runs counter to evidence stating it is high enough?

    If there is treatment failure in a portion of the patients, how do we know what the cause is? Is it because of the patient's inability to mop up the remaining spirochetes post-abx? Is it because some patients have a genetic defect that affects their immune system (not autoimmune - something else)? Is it because the kind of Bb they have is, in fact, harder to beat?

    And so, here I am, having taken only one line out of the guidelines and it has spawned multiple lines of inquiry. This is how it is, doing this analysis. And why it's so time consuming, because in order to do this right, I have to look into each question. And do so when I am freakin' sick, which slows down the process.

    It's much easier for me to write at length about a short paper or abstract with one basic premise behind it than a long paper that is multipurpose. The risk of dealing with the long paper is that I can get bogged down in dealing with each of the questions in my line of inquiry while my short term focus can easily go towards knocking out another post on something which requires less research, discussion, and commentary.

    Does that make sense?

    I'm not sure how to overcome this state of affairs. I think it comes with the territory of dealing with fatigue and illness. It does make my own notes look like they were written by a grad student with insomnia and ADHD - not a good mix.

    (more)

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  13. Jess,

    You said,

    "Choosing a Lyme treatment is like playing russian roulette. I question my decision most days. IV treatment of antibiotics scares the hell out of me and doesn't seem to have huge success. It's all a guessing game. Who really knows for sure? I start low dose pulsed antibiotics next week. If there is Herxing I will consider it to be working."

    I understand where you're coming from, and I am not entirely sure how one navigates being in the situation we're in - I think we all manage to find our own way.

    Part of the problem is we are not a "clinically homogenous population" to study, and that has been an issue all along in getting the right answers as to what an effective treatment strategy is.

    When you get bitten by that tick, whether you remember it or not, it's not always clear what it has infected you with. We don't have tests for everything it can carry, though with proteomics research, I am hopeful we will design better tests and treatments in the future and catch more infections early.

    Now? Now this isn't the situation, we know the tests are not that accurate especially in early infection - and those we do have do not catch all pathogenic strains.

    So is my treatment going to be the same as yours if we have different pathogens? Part of it may overlap - part of it may not. That's already a given.

    My first assumption when I went into all of this is to try the scientifically supported as much as possible first, and part of my motivation was practical and insurance-motivated.

    My insurer would cover a lot - in fact most - of my oral antibiotics. I could never get them to cover IV. But since I'm in the US, I knew that with not working if things continued, I'd eventually run out of insurance. So my goal has been to take advantage of it while I have it, and do this as long as I can - and as long as it makes a measurable difference.

    I had a great deal of functionality restored to me using antibiotics for nearly two years after I was bitten and was even able to go back to work full time for a while because of the meds. I could not have done that before then or off antibiotics - once I stopped, all my symptoms would return - often within 72-96 hours. So I know they have worked to treat my condition, however the medical profession would choose to define it (chronic Lyme or post-Lyme).

    I noted that once my Babesia was treated, it took much longer for my symptoms to return while off antibiotics and antiprotozoal meds. I suspect that Babesia played a big role in my illness and I hope it is not going to relapse. (Even the most conservative ID docs know it can relapse, especially in those who are immune deficient.)

    (more)

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  14. I know that there are some doctors out there who have their patients on many different herbs and supplements daily. I have no evidence that this approach helps - and when I compare how I'm doing to how others are doing based on their self-reporting of symptoms - what I see is that they are often doing no better than I am on my more conservative regimen and are stressing about when and how to take all this stuff.

    I decided I didn't want to stress and just accept that getting better on what I am doing takes time. So I haven't changed my own protocol and approach in any way - and despite it all, have made some gains in cognitive functioning and reduction in pain. It isn't all better - I can't work yet. But it is noticeable.

    I think a lot of what underlies my approach is attitude: I think some infections take not only a long time to fight, but it takes a long time for the body to return to normal even when one is done fighting the infection. Even once I stop taking all medications related to Lyme disease and coinfections and fatigue, I suspect there will still be residual fatigue and damage done to my body. I don't think at that point anything more than extra sleep, healthy lifestyle, and time are going to help - my body has the ability to heal itself for the most part, it just needs a big block of stress-free time to do so.

    How would you define your process for determining what is worth trying, and when to stop?

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  15. Yes, I live in Vancouver *(accurately! not like the BC fiasco) hahaha.
    Four mind numbing years searching, dozens of doctors calling me psychosomatic, denial of +++IGENX tests, refusal to treat in any way.
    Blah blah blah.
    I could go to Seattle but the 3 main LDMDs have mixed reviews and major$$$. Met with many MP patients who have tried all therapies and progress the most with the MP. The proof is in the person.
    So it seems, and I have met many who say it saved their lives. There happens to be an MD MP specialist who lives in the Van. So my choice was imminent, antibiotics not available. I like the concept of the protocol. Making my immune system reset and work in tandem with antibiotics. Who the f**k knows.
    As you say all this reading and info hoarding whilst sick is making us crazy in a cornucopia of ways.
    We all have the same dilemma. What to do when there is no steadfast rule? Grasp into the universe and wish upon a star?
    With all therapies there are risks. I question mine. But I do get results.
    So I keep going, and yes blindly trusting that it will work. The science makes sense to my feeble mind and my body is acting accordingly. I Don't need science driven papers but it would be nice. The issue, like you say is needing more research. I agree. But the information needed is splayed and dense. I like the fact that your writing and research is varied and not protocol driven. Neutral approach is best. One day maybe I'll read some of your words about The MP + or -. Either way your responses would be well researched and concise.
    -Jess

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  16. Didn't see your last post...
    I agree about all the herbal supplements. The MP does not allow much of that sort of thing. To keep the herxing obvious. Diet and no sun are the main things. I take Angiotensin Receptor blocker, magnesium and sublingual B12. Thats it so far. Last month I started to feel my head pop out into normality! The next year of antibiotics will tell.
    Yes Attitude and the reality that our bodies can only do so much. And yes there will be residual damage. I have do delusions.
    I suppose trial and error are my only defining factors.
    Like you I prefer some reasonable science behind my decisions.
    When to stop... When it's broke. What to trust? My body.
    I have been able to work this last 6 months! I work in a crazy stressful profession so that says a lot. But yes the dreaded word.. stress. How does one lead a stress free life? A contributing factor to Lyme? Oh Yes, may I have another sir? Life is a barrage of questions for those of us attempting to treat ourselves. Good Luck right? :-)
    -Jess

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  17. We have got to get more information on this Tick/Red Meat problem. I almost died in the hospital 3 times before anyone could tell me why.. Just flipping a hamburger then putting a crab cake on same grill put me out 4 hours later. Can anyone tell me where there might be help or research for this. Erika

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  18. Erika,

    That is very scary, and I am very sorry to hear of what must have been the most difficult experience in your life. Three times is a lot. I hope you are getting post-treatment counseling to deal with the effects of this experience. If not, seek out help - this is tough stuff to manage alone.

    There isn't a lot known about this allergic reaction yet and more research is required. For one thing, it is unlike other allergies because it is an allergy to a carbohydrate when by definition allergies are to a protein. This is unusual, and will require more research to determine how it happens and what - if anything - can be done to treat it in the future.

    Unfortunately, right now there is no cure for it - if it is an anaphylactic reaction, I don't think you can be desensitized to it. There is research that has been done on peanut allergy desensitization for anaphylaxis that looks promising, but it may not be the same for red meat. It's also not research that has been finalized so that all doctors can use this procedure even with peanuts - and peanuts are a very common allergen.

    The only thing one can do is practice avoidance and strict adherence to avoiding cross-contamination.

    This does mean, sadly, exactly this:

    Never cook your food on a grill red meat has been cooked on earlier. You are best scrubbing down that grill or using one on which red meat has never been cooked.

    It means entirely avoiding restaurants that use red meat in the kitchen, so fish and chip shops, rotisserie chicken places with no red meat offerings, and vegetarian restaurants are your safest bets for eating out.

    (I have friends who go through similar issues with peanuts, and they have to avoid almost all Asian cuisine because of peanut sauces - especially Thai. And they also avoid any place with peanut butter sandwiches or crushed peanuts on sundaes for the kids.)

    Otherwise, eat at home and keep red meat out of your own kitchen - stick with chicken, turkey, and fish and hopefully that will be okay if you must have animal protein. Just make sure when you go shopping to read the ingredients list on packages and pay particular attention to sauces, soups, gravies, seasonings, and boullion cubes to make sure no red meat ingredient is included.

    If you haven't done so already, I advise consulting an allergist and getting a rolling prescription for Epipens, as they need to be regularly replaced even if you do not use them. Read the package insert carefully and have those near and dear to you practice using the fake practice Epipen on you so they know what to do if you have an accidental exposure.

    To learn more about anaphylaxis and food allergies in general, I recommend this site: http://www.foodallergy.org/

    Outside of this advice, I recommend you contact Dr. Luis Matos in Roanoke, Virginia (see above link to southeast US cases) and ask him your questions as he has seen a number of patients with this problem. He may have better advice to give than I have and know about more current research on this issue than I do.

    I wish you good health and wish you no more experiences that take your breath away. Please keep us posted on what you learn from Dr. Matos, because there are others who visit this blog in search of information on this allergy, too. Thank you.

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