Alpha-gal syndrome, the tick-borne allergy to mammalian food products, can turn a night out to dinner into a night at the hospital. With rates of the condition soaring on the Vineyard, both food service workers and customers are figuring out how to keep restaurant dining safe.
On Monday, Island tick and health experts met with chefs and restaurateurs at Oak Bluffs town hall to discuss best practices for protecting a community susceptible to alpha-gal while preserving an enjoyable restaurant experience.
Panelists included tick epidemiologist Lea Hamner, tick biologist Patrick Roden-Reynolds, dietician Josh Levy, Oak Bluffs health agent Alexa Arieta and a slate of Island food service professionals.
When Ms. Hamner asked the audience Monday if they knew someone with alpha-gal, several hands shot up.
“I think everyone can probably attest it’s getting closer and closer and closer to home, no matter who you are on this Island,” she said.
With so little known about the syndrome, experts are still trying to figure out how to treat people who live with it. But its relationship to food, Ms. Hamner said, is relatively well understood. She called reactivity to red meat the “common denominator” of alpha-gal symptoms, but noted reactions to dairy are also common.
Even so, she said a defining trait of the allergy is that it’s “consistently inconsistent.” Some people are only reactive to red meat, but can consume dairy products without an issue. Meanwhile, others can react to just the fumes of red meat or dairy cooking, or even carrageenan, a sugar from seaweed used as a thickener or stabilizer.
And while biting into a hamburger or a piece of steak will more than likely result in symptoms for alpha-gal sufferers, the nature of those symptoms can vary wildly. One patient could experience minor digestive discomfort, while another could go into anaphylaxis.
For food service professionals, alpha-gal’s wide variety of presentations means extra vigilance and communication with customers is necessary to keep their kitchens safe.
Charlie Granquist, the chef at Slough Farm, said he’s worked hard to find ways to eliminate alpha-gal allergens from the meals he cooks for farm staff and the Island community. He estimated that around half of the farmers he regularly cooks for have alpha-gal.
Though he’s been watching alpha-gal trend up for a long time, he said its severity was fully impressed upon him when his wife went into anaphylactic shock after eating a burger.
“I was starting to get complacent,” he said.
He and others also stressed that keeping equipment clean and washing cookware between uses is key to avoid cross-contamination. While Mr. Granquist used to cook with cast iron pans seasoned with baked-on layers of oil and fat, he’s swapped those out for stainless steel pans that can be thoroughly scrubbed between uses.
Additionally, Mr. Granquist is turning to alpha-gal-friendly substitutes for tried-and-true cooking staples and non-mammalian roads to complex flavors. Nuts, for example, can add thickness and depth to sauces, and mushrooms, fish sauce and miso can lend layers of umami to a dish.
Though a range of reactions to mammalian food products is possible, Mr. Granquist said best practice is to treat it as seriously as peanuts and shellfish allergies.
“When you get a peanut allergy coming into the kitchen, you take it seriously,” he said. “You mark it on your ticket and you follow that ticket all the way through the kitchen.”
Some chefs mark their menus to indicate which dishes can be made safely for customers living with alpha-gal. While there’s currently no Island-wide standard, common markers on Vineyard menus include AGF, meaning “alpha-gal friendly,” and AGS, which stands for “alpha-gal safe.”
But the best tool overall to fight alpha-gal, said Mr. Roden-Reynolds and Ms. Hamner, is tick bite prevention. When spending time outside, make sure clothing provides adequate coverage and treat them with permethrin, the synthetic tick repellent. A service called Insect Shield, which offers discounts for Islanders, treats clothes with permethrin that stays in the fibers for 70 washes.
While the rise of alpha-gal may feel like uncharted territory for Islanders, other communities — particularly in the southeastern U.S. — have confronted it before. Ms. Hamner said it will be important to learn from those communities moving forward and perhaps even adopt some of their strategies.
“We’re not alone, even though it feels very acute,” she said.
