A healthy 47-year-old New Jersey man went camping with his family, ate a steak for dinner and woke four hours later in excruciating pain.
Two weeks later, he ate a hamburger at a barbecue. Within hours, he was unconscious on his bathroom floor. Despite two hours of resuscitation efforts, the man — a commercial airline pilot — died.
The cause was eventually traced to something seemingly unrelated to either meal: a tick bite.
The victim had alpha-gal syndrome, also known as AGS, a potentially life-threatening allergy associated with the bite of the lone star tick. Often called a “red meat allergy,” the condition can cause a delayed reaction hours after a person eats beef, pork, lamb or other products containing a carbohydrate called alpha-gal.
And it is not just an obscure condition affecting people somewhere else.
One municipality in Central New Jersey that tracks AGS is Princeton. The town had had some five confirmed cases of alpha-gal syndrome in 2026, according to statistics provided by Health Department Director Jeffrey Grosser to Princeton Nature Notes. No confirmed cases were reported in Princeton in 2025. In June, the Department issued a separate notice warning residents about AGS and urging them to protect themselves against lone star tick bites. Rutgers researchers have also documented the northward expansion of the aggressive tick in New Jersey.
That makes the strange story of alpha-gal syndrome particularly relevant in Central Jersey, where a bite encountered while hiking, gardening, mowing the lawn or simply spending time in a backyard can potentially change what a person is able to eat.
The New Jersey man’s fatal case illustrates how difficult the allergy can be to recognize.
Two summers ago, the man and his family took a camping trip, and by all indications, he was healthy. After a day of play, the family ate a late dinner at 10 p.m. According to a case study published in 2025 in The Journal of Allergy and Clinical Immunology, while they usually dined on chicken, that night they enjoyed a beef steak. Subsequently, “the man awoke at 2 a.m. with abdominal discomfort, which became so severe that he was writhing in pain, having diarrhea and vomiting. After 2 hours, his condition improved, and he went back to sleep. In the morning, he felt well enough to walk 5 miles and then ate breakfast.”
The man and his wife talked about consulting a physician but decided there wasn’t much to tell a doctor about the event. Privately, according to the study, he told one of his sons: “I thought I was going to die.”
Fast-forward two weeks. The family returned home to New Jersey (their hometown was never publicly disclosed). The husband and wife attended a 3 p.m. barbecue, where he ate a hamburger and enjoyed a beer. Returning home, he mowed the lawn. He experienced no indigestion or other stomach ailments.
His wife went out at 7 p.m., thinking he was fine. At 7:20 p.m., the man went to the bathroom. Ten minutes later, his son was on the phone with his mother, letting her know that his father was getting sick again. By 7:37 p.m., the man’s son was calling 911. When the paramedics arrived, he was unconscious on the bathroom floor. EMTs started resuscitation measures, which, according to the study, “lasted for two hours which included transferring the patient to hospital, but at 10:22 PM, he was declared dead.”
On Nov. 13, 2025, news outlets across the country announced the “first fatality” from a “red meat allergy” caused by a tick bite. The New Jersey resident had died from an undiagnosed case of alpha-gal syndrome.
Many people refer to AGS as a “red meat” allergy, but it’s not that simple. In fact, the story of alpha-gal syndrome from discovery to diagnosis is mind-boggling.
Enter Thomas Platts-Mills. A Brit by birth and training, he is a professor of medicine and microbiology at the University of Virginia School of Medicine. In 2004, a new cancer drug called cetuximab was being used to treat colorectal cancer. In an interview, Dr. Platts-Mills noted patients living in Virginia, North Carolina, Tennessee, Arkansas, southern Missouri and eastern Oklahoma were having bad allergic reactions to the drug. Colleagues in those states reached out to Platts-Mills for help.
They discovered the use of cetuximab was causing the body to create antibodies to fight the drug. Researchers ultimately concluded patients exhibiting allergic reactions were allergic to the drug’s gelatin caps, which contained the carbohydrate molecule galactose-α-1,3-galactose, called alpha-gal for short.
If you remember your high school science, every carbohydrate (-tose) needs an enzyme (-tase) to convert the carbohydrate to energy. Humans, however, no longer have a corresponding -tase to break down galactose-α-1,3-galactose. According to Jeff Wilson, M.D., an assistant professor of medicine in the Division of Asthma, Allergy and Clinical Immunology at the University of Virginia School of Medicine who works with Dr. Platts-Mills, “because of a few mutations over the past ~20 some million years … humans don’t intrinsically synthesize alpha-gal.” But our bodies also aren’t normally bothered by alpha-gal molecules.
Platts-Mills and his researchers identified the states where the cetuximab patients lived. Then, one researcher looked at what other ailments existed in those areas. He discovered Rocky Mountain spotted fever was a common diagnosis. And Rocky Mountain spotted fever comes from the bite of a very specific tick.
Enter the culprit: the lone star tick. We know tick bites leave behind pathogens causing illnesses like Lyme disease. But the lone star tick has a cameo role in that, along with the ability to transmit disease, it can leave behind material that can trigger an immune response to alpha-gal.
The lone star tick gets its name from the female tick, which bears one white spot on her back, not from the Lone Star State of Texas. These ticks cover a wide area of the Eastern and Southern U.S. According to researchers at Rutgers University, the tick was first described in 1754. They were plentiful at the time, but by the 1800s, due to habitat destruction and deer hunting, the population in New Jersey declined.
But the lone star ticks are back, and their range has been expanding northward in New Jersey.
Rutgers researchers have documented that expansion through statewide tick surveillance, and the university continues to collect ticks submitted by residents through its NJTicks4Science program. Lone star ticks can be found in wooded areas, along forest edges and in suburban environments, putting people at risk even when they are not hiking deep in the woods.
In New Jersey, lone star ticks like the woodlands, the coast and even your backyard. They are known to be aggressive in their search for blood. Call them tiny Draculas.
Platts-Mills and his research team eventually determined the lone star tick could trigger sensitization to alpha-gal. Thus, those patients who were allergic to cetuximab likely had alpha-gal antibodies in their systems before treatment started.
Lone star ticks need blood meals to reproduce and grow. The ticks dine on mammals like deer, foxes, mice and your dog — any non-primate mammal. Since those mammals have alpha-gal in their systems, the lone star tick ingests the alpha-gal carbohydrate molecules from the blood of those mammals.
Depending on what you eat, you, too, consume alpha-gal molecules. The molecules are found in red meats (beef, lamb and pork), but the molecules are also found in consumables that might surprise you. Gelatins used to make medical capsules contain alpha-gal, as do gummy candies. If your french fries, for example, are cooked in lard, tallow or suet, you will ingest alpha-gal. Foods made with beef broth, beef bouillon or beef stock also contain alpha-gal. Chicken, turkey and fish do not contain alpha-gal.
When the lone star tick dines on you, it can potentially trigger the production of alpha-gal-specific IgE antibodies. The human body usually generates IgE antibodies to fight parasites and some allergens. IgE antibodies aren’t the ones that rush to protect us from bacterial or viral infections, for example. Once the alpha-gal-specific IgE antibodies exist in the body, they can mount a response during the digestion of red meat or other products containing alpha-gal. That immune response can cause an allergic reaction.
It’s as though the lone star tick bite trains the body to recognize and defend against alpha-gal.
The allergic reaction is not immediate. In fact, it typically happens somewhere between three and six hours after ingesting food containing alpha-gal molecules. The allergic reaction can be intensified if a person consumes alcohol with a meal. Researchers think the delayed reaction is connected to the time it takes to digest food.
The first reactive sign can be hives. There can also be swelling of the lips. Next, the gastrointestinal tract can go into overdrive, causing vomiting, cramping and diarrhea. Potentially, as in the case of the New Jersey airline pilot, a person can die. Many people diagnosed with AGS carry epinephrine auto-injectors.
New Jersey has conducted statewide surveillance for alpha-gal syndrome since 2022 in an effort to determine where cases are occurring and improve awareness among health care providers and the public.
Reported cases, however, may not represent everyone living with the condition. Because AGS can produce symptoms hours after a meal, the connection between a reaction, something a person ate and an earlier tick bite can be difficult to recognize.
The bite of the lone star tick apparently does not leave behind a characteristic rash. Researchers report the bite of the lone star tick can cause itching at the site for a week or so. And should that itching occur, it may be associated with subsequently developing alpha-gal syndrome.
The only treatment for AGS is to avoid eating products containing alpha-gal. Over time, some people see a lessening of symptoms, but researchers don’t know why. Some people, once bitten, have no problems. Dr. Wilson advises people diagnosed with AGS to try to avoid subsequent lone star tick bites.
“The higher the levels of alpha-gal IgE [antibodies]–such as is apt to happen with recurrent tick bites–the more likely someone is to develop allergic reactions to red meat,” Dr. Wilson wrote in an email. “But, not everyone who makes a high alpha-gal IgE develops red meat allergy and some with relatively modest levels of alpha-gal IgE can still react to red meat.”
This is when academics say: More research is needed.
For Central Jersey residents, avoiding the lone star tick does not necessarily mean avoiding the wilderness. Exposure can happen much closer to home.
To avoid bites, wear tick repellent when you mow the lawn, work in the garden or walk in wild areas. Staying on well-groomed paths is advised. The Centers for Disease Control and Prevention notes that the lone star tick “is widely distributed in the Northeast, South, and Midwest United States.” So don’t let your guard down while traveling or vacationing.
Consumer Reports evaluates tick repellents. The University of Rhode Island’s TickEncounter website has tips on its TickSmart prevention page; it also has a page providing photos to help people identify various ticks. Insect Shield is a company that sells clothing treated with permethrin, an insecticide. The company also treats personal clothing. The most comprehensive site about AGS is called Alpha-gal Information. The site is run by those managing AGS in their own lives and is heavily sourced with research articles.
Learn more:
Lone Star Tick Surveillance: cdc.gov/ticks/data-research/facts-stats/lone-star-tick-surveillance.html
Alpha-gal Information: alphagalinformation.org
University of Rhode Island TickEncounter: web.uri.edu/tickencounter
Insect Shield: insectshield.com
