Health Advisory

Summary

• As of September 24th, 2025, cases of alpha-gal syndrome (also known as the “red meat allergy”) are reportable in Virginia.
• Alpha-gal syndrome (AGS) is a serious, potentially life-threatening allergy to alpha-gal that occurs after a tick bite. Alpha-gal is a molecule found in most mammals, but not in people. People with AGS can experience an allergic reaction after eating red meat or other products containing alpha-gal.
• Physicians and persons in charge of medical care facilities are now required to report suspected or confirmed cases of AGS to the Fairfax County Health Department (FCHD) as outlined in 12VAC5-90-90(A, C, E). Additionally, directors of laboratories are now required to report alpha-gal-specific IgE test results with a value of ≥0.1k IU/ml or >0.1 kU/L as outlined in 12VAC5-90-80(B) and 12VAC5-90-90(B).

Suggested Actions

• Providers should report AGS cases within three days of suspected or confirmed diagnosis via the Virginia Department of Health Confidential Morbidity Report or directly to the FCHD by calling 703-246-2433, TTY 711 or emailing hdcd@fairfaxcounty.gov. When reporting, clinicians need to provide the patient’s name, date of birth, race, sex, residential address, AGS-related laboratory results (if available), and the reporter’s information.
• Directors of laboratories should report AGS laboratory results (per the AGS values above) within three days of suspected or confirmed diagnosis to the FCHD or through automatic triggering of electronic laboratory reports (ELR). Means of laboratory reporting include ELR sent via HL7 2.5.1 or flat file standard to VDH through our state health information exchange (preferred), telephone, fax, or mail. Information on ELR onboarding can be found here: https://www.vdh.virginia.gov/meaningful-use/submissionofreportablelabresults/. If your facility is already sending ELR, please start to include reportable AGS results in your feed starting 9/24/2025. When reporting, laboratories should include specimen source, lab method and result, patient’s name, date of birth, race, sex, residential address, phone number of the provider, and the medical facility where the patient was examined and order initiated.

Additional Information

• The carbohydrate galactose-α-1,3-galactose (alpha-gal) is found in most mammals but not in primates. Humans may develop specific immunoglobulin-E (IgE) antibodies to alpha-gal following exposure to alpha-gal in the saliva when bit by a lone star tick (Amblyomma americanum) or, potentially, by a blacklegged tick (Ixodes scapularis). When sensitized individuals ingest mammalian (red) meat which contains alpha-gal, they develop a systemic allergic reaction, alpha-gal syndrome. AGS also occurs following exposure to dairy products, though this is less common than reactions to red meat. Eating non-mammalian meat (e.g., chicken, fish) does not induce an allergic reaction because those meats do not contain alpha-gal.
• A minority of patients with AGS may have reactions to alpha-gal in gelatin and medications or vaccines that contain gelatin. Patients should be monitored closely for any signs of an allergic reaction after receiving these products.
• AGS symptoms vary from mild to severe. The onset of allergic reaction is delayed compared to other food allergies, usually presenting 2-6 hours after consuming meat or dairy products. Possible signs and symptoms include hives, nausea/vomiting, severe abdominal pain, diarrhea, cough, shortness of breath, difficulty breathing, a drop in blood pressure, swelling of the lips/throat/tongue or eye lids, dizziness/fainting, or anaphylactic reactions.
• AGS is thought to be predominantly spread by the lone star tick (Amblyomma americanum) but there is also evidence for potential spread via the blacklegged tick (Ixodes scapularis). Patients with AGS may or may not remember a tick bite and tick exposure should not be required to warrant testing a patient that has compatible clinical illness.
• The main diagnostic test for AGS is a blood test looking for IgE antibodies specific to alpha-gal (alpha-gal sIgE). The LOINC Code is 73837-7 Galactose-alpha-1,3-galactose (Alpha-Gal) IgE Ab [Units/volume] in Serum. Serology is preferred to an allergy skin test.
• Positive alpha-gal specific IgE tests may occur in people who do not have AGS, particularly in regions with lone star ticks. When determining a diagnosis, compatible clinical illness should be considered.
• AGS is managed through diet and avoiding tick exposure. The Centers for Disease Control and Prevention offers free continuing education credits for the interactive web-based training module, Understanding and Managing AGS for Healthcare Providers.
• A list of all reportable diseases in Virginia can be found at the following link: https://www.fairfaxcounty.gov/health/diseases-conditions/reporting and is also attached to the end of this Health Advisory.
• For additional information on AGS, please visit https://www.cdc.gov/alpha-gal-syndrome/index.html. For questions on reporting, please call FCHD at 703-246-2433 or emailing hdcd@fairfaxcounty.gov.