Alpha-gal survey finds three visits before diagnosis

By Amara Osei

A peer-reviewed survey of 201 farmers and ranchers with alpha-gal syndrome (AGS) found that participants averaged nearly three healthcare-provider visits before diagnosis, and some reported more than 10.

The Journal of Agromedicine article is the first peer-reviewed study focused on U.S. farmers and ranchers living with AGS, a tickborne allergy to red meat. Researchers surveyed more than 200 people across 26 states about tick bites, AGS awareness, symptoms, diagnosis, work, physical health, and mental health. The stated purpose was to understand how the emerging allergy affects members of the farming and ranching community. Most respondents lived in Missouri and Oklahoma.

What did the survey find?

• General practitioners and allergists were the medical providers most commonly credited with diagnosing AGS.
• Researchers placed participants into four AGS symptom classes, with patterns differing by sex. Women more often reported gastrointestinal discomfort; men were more likely to fall into the mild-symptom category.
• The most frequently reported symptoms were abdominal cramping, diarrhea, itchy skin, and nausea.

Shaun Cross, Ph.D., assistant professor in the University of Nebraska Medical Center College of Public Health, framed the results:

“This report contributes to the evolving AGS literature because even in a sample of 201, we provide evidence that the symptoms cluster in a pattern among those afflicted,” Cross said. “We showed that diagnosis is easier when the symptom pattern looks like an allergy.”

Cross described the average delay as costly and frustrating. He also cited long travel distances for rural care, limited access to medical specialists, and difficulty taking time away from a farm, which can compound the burden before an accurate diagnosis.

Scientists and staff of the National Farm Medicine Center and Marshfield Clinic Research Institute have edited the Journal of Agromedicine since 2004. The journal receives philanthropic support through the Auction of Champions and is published by Taylor and Francis. The open-access study carries DOI 10.1080/1059924X.2026.2729161.

How does alpha-gal trigger illness?

Alpha-gal, or galactose-α-1,3-galactose, occurs naturally in most mammals but not in people. Some ticks carry alpha-gal in their saliva, most commonly the lone star tick. A bite can transfer it into the body, where the immune system may identify it as a threat and trigger an allergic reaction.

AGS can follow ingestion of mammalian meat such as beef, pork, or venison, or exposure to other mammalian products, including dairy and medications. Symptoms range from mild to severe, and some can be life-threatening. The condition is also known as red meat allergy or tick bite meat allergy.

The lone star tick is the primary tick that spreads AGS in the United States. In recent years, it has pushed beyond its traditional Southeast range into areas previously too cold. That expansion raises concern for farmers and ranchers who encounter ticks repeatedly while working outdoors.

How large is the public-health burden?

CDC estimates indicate that as many as 450,000 Americans—nearly half a million—may have AGS. The agency identified more than 110,000 suspected cases in the United States from 2010 through 2022. Because AGS is not nationally notifiable to CDC, the actual number of cases remains unknown.

Cross presented the results at the first National Convening on a National Strategy for Alpha-gal Syndrome, hosted by Food Allergy Research and Education (FARE), Oct. 27-28 in Washington, D.C. He said rural healthcare providers need better recognition of AGS symptoms and occupational implications because farmers and ranchers face increased tick exposure while working outdoors.

What happens to farm work?

Participants reported three operational consequences: hiring more help, stopping livestock production, and leaving farming altogether.

“The idea of a person shuttering down a farm that’s been in their family for generations because of this new diagnosis, I can only imagine what that feels like,” Cross said. “That has to be devastating for these farms.”

The findings connect occupational tick exposure with delayed diagnosis and, in some cases, withdrawal from farm work. The release did not provide counts or percentages for the three reported work outcomes, so they should not be read as prevalence estimates.

What does this mean for veterinary medicine?

• Companion animals: The survey enrolled humans and did not examine dogs, cats, or other companion animals. It evaluated no companion-animal diagnostic test, medication, or vaccine, so the results do not support treatment or safety recommendations for pets.
• Food animals: The study did not report disease, reproductive harm, mortality, or animal-level production effects in food animals. Its livestock findings concern human labor and farm decisions after an AGS diagnosis. The human survey tested no veterinary drug or vaccine, and the source describes no action by the FDA Center for Veterinary Medicine (CVM), European Medicines Agency (EMA), or USDA.
• Public health: The immediate implications center on occupational medicine: earlier recognition in rural clinics, access to specialists, time away from work, and surveillance. Non-notifiability leaves the true U.S. burden uncertain despite more than 110,000 suspected cases identified from 2010 through 2022.

What happens next?

Cross said the team received strong feedback and plans to share the work through a series of publications and stories. The next measure of progress is shorter time to diagnosis in rural clinics, where distance to specialists, competing farm duties, and incomplete awareness of AGS continue to delay recognition.