Alpha-gal Syndrome (Red Meat Allergy) with Gary Falcetano | Foodie Pharmacology with Dr. Cassandra Quave

This Foodie Pharmacology podcast is part of a special two-part series sponsored by ThermoFisher Scientific Incorporated. The views and opinions in this podcast are those of the presenters and represent the synthesis of science. Hello, fellow foodies and welcome back. This is Dr. Cassandra Cueve and you're listening to Foodie Pharmacology, The Science Podcast, where the food curious. This week on the show, we are taking a closer look at a very unusual allergy. We're going to be talking about alpha-gal syndrome. Alpha-gal is an emerging and often under-recognized food allergy that has an unusual trigger, a tick bite. In the U.S., the Lone Star tick is the main culprit. So, the expert we have on this show today is Gary Falsetano. He's a senior manager of Global Medical and Scientific Affairs of allergy at ThermoFisher Scientific. He's a seasoned clinician, educator, and medical communications leader, and has spent his career advancing education in asthma, allergies, and immunologic disorders. He has experienced expanding emergency medicine, primary care, military service, and over two decades in medical publishing. Thanks so much for coming on this show, Gary. It's great to see you again. Thanks so much. It's great to see you. I'm looking forward to our next conversation today. Yeah. Well, we learned so much about pollen food allergy syndrome with you last time. I had to get you a pet caught to talk about this night and air of an allergy. I mean, this literally makes me really freak out because I can't imagine a life in which I could be allergic to more meat. I love my steak. So maybe you can tell us a bit more about what is alpha-gal syndrome and why has it been getting some more attention lately? Yeah, absolutely. As you said, it is a bit of a nightmare-ish. It's almost something you could see in a science fiction movie, right? So very unusual allergy is actually caused, as you mentioned, by the bite of a tick. The alpha-gal actually stands for galactose alpha-13 galactose. So we're going to call it alpha-gal. Sometimes we just call it AGS for alpha-gal syndrome, but it's really unusual allergy. It's really the first one of its kind to be traced back to an insect bite, right? We know we can have allergic reactions to wasps and bees, and those are actually reactions to the venom that is injected, right? So it's an immediate reaction. This is not a reaction to what's being injected or transferred the alpha-gal molecule. It's actually the body building up antibodies to that molecule, and then you having a reaction when you ingest or you come in contact with mammalian products. And I guess everybody thinks of red meat. We think of steaks, but the pork industry has been a long time trying to tell us pork was the other white meat. It is a red meat, right? So it's lamb, so it's rabbit. So is any mammal, right? Any live bearer, you know, animal is a mammal, and you can have a reaction to that. There are also many products, so milk, cheeses, all contain mammalian, obviously from mammals, and they contain alpha-gal as well. There's even, you know, different products, different medical products that are made from mammals. So all of those put us at risk for having reactions if we have alpha-gal syndrome. So it's basically forced to be in food. Fish are okay, poultry is okay, right? So, you know, turkey, chicken, all forms of fish, shellfish, etc., all safe. Right of that, yeah, most of our other things that we think of as our, you know, typical American diet, you know, are an issue. And so how big of a problem is this syndrome? Is it restricted to certain regions of the U.S. or are we starting to see it in more areas? Yeah, so initially this was a real problem in the southeastern United States. So the main tick, as you mentioned, that's been implicated as the vector for this is the Lone Star tick or Ambulioma Maricano. And the Lone Star tick is predominantly located in the southeastern United States. What we've been seeing though is a spread for various reasons, you know, climate warming is one thing, the expansion of some of its hosts. So the prime host for the tick is the whitetail deer population. That population expanding into ever increasing more suburban areas, you know, not just in rural areas, you know, we were even seeing in some urban areas, right, the expansion of that. So we're seeing this now, not being a southeastern issue, but a real problem in the northeast, Long Island, New York is a hotspot, Martha's Vineyard, you know, off the coast of Massachusetts, another hotspot. We'd now seen cases though identified in Maine, in Northern Michigan, and as far west as even the Pacific Northwest. And those are actually through really good investigational efforts have actually been traced back to other than the Lone Star tick. So there's the black-legged tick or deer-tick in the northeast that was identified as the vector for a case in Maine. There was another case that was pretty conclusively identified in the Pacific Northwest, the western black-legged tick or deer-tick out there. When you look at all the, you know, the most common areas for these ticks, you're talking about now most of the country has a possibility of, you know, acquiring alpha-gal from a tick bite. Wow. And so, what's the timeline look like from the point of exposure? Let's say that I'm on a hike in nature, I have a ticker and move it. How long is the waiting period before symptoms might arise? Is it pretty immediate? Is it, you know, take a bit longer? Yeah, so that's a great question. What we're typically seeing is anywhere from three, four weeks up to 12 weeks. So one to three months in that area, after a tick bite, you start developing these alpha-gal antibodies and can start having reactions after that period of time. One of the other things that's a little bit different, you know, when we think about Lyme disease going back to those deer ticks, you know, the conventional thought is it ticks about 24 hours of the tick being attached to actually transmit the infectious, you know, organisms. That's not the case. Now, what we're seeing with alpha-gal is, you know, if the tick is long enough to, on you long enough to be embedded and cause any erythema or redness or itching, that's long enough to be sensitized with alpha-gal. So it can be as short as 15 or 20 minutes. And what does symptoms look like for this allergy? We know that, like, different allergies have different types of symptomologies. So after you've built up antibodies to alpha-gal, and you can assume a product that triggers those antibodies, what are some of the symptoms that someone might experience? Yeah. So it's a broad constellation of symptoms, but very similar to what you would expect with a food allergy. We've discussed that, I think, on the last episode, you know, it can be anywhere from, you know, hives to difficulty breathing, to swelling, lip swelling, tongue swelling. So all the typical things you think about with anaphylaxis. But what we're seeing with alpha-gal is there's other phenotypes of alpha-gal syndrome, which is why it's a syndrome. So pure GI issues, severe abdominal cramping, diarrhea, vomiting, you know, symptoms that look more like food poisoning than an allergy can definitely be related to alpha-gal syndrome. And we've just seen a recent clinical practice guideline come out from our colleagues in American Gastroanalogical Association that, you know, really discuss, you know, that alpha-gal should be in the differential when you have those kind of presenting GI complaints that you can't really isolate to anything else, things like irritable bowel syndrome, you know, we need to keep it high in the differential, especially if you're in an area where alpha-gal is more prevalent. And is this something that physicians are well equipped to pick up on? Like if you come in and maybe you don't even know that you had a tick exposure, I don't know like how obvious it is that someone might pick a month later or I'm having diarrhea and a month ago I had a tick bite. So how hard is this for physicians to diagnose? Yeah, it's not easy. And so, you know, what we didn't mention so far is the unusual nature, you know, typically with the food allergy, we eat a food that we're allergic to, you know, we're exposed to it. It's just that one of those symptoms within 10 minutes, 30 minutes, an hour, typically no longer than two hours after eating a food. With alpha gal it's delayed mammalian meat allergies. So typically you don't see symptoms You know, it's usually greater than two four anywhere from four to six even eight hours after ingesting the food Yeah, so that makes it difficult right because you know when people show up to an emergency room with these symptoms They say, you know, well what have you been in contact with in the last few hours and it's typically nothing right it was a meal that I ate six or eight hours ago There was a term that we used to use when when alpha gal was first identified it was called midnight anaphylaxis So you would have a meal, you know, it's six p.m. And then at midnight begin having symptoms that would awaken you from sleep Again, it's not just anaphylaxis though and we can see as I mentioned the GI symptoms But also chronic urticaria or hives so you know, I've spoken to many Allergist and especially in the southeast were was so prevalent initially that said, you know a lot of their chronic hive Patients once they tested them for alpha gal sensitization. They saw the sensitization. They pulled the red meat out of their diet. The hives result That's incredible. So so Is there a treatment for this allergy or is it basically that you have to undergo a more restricted diet? As a lead image it yeah, so so there is no specific treatment for it It's so it requires the complete elimination of mammalian products from the diet There is there is some good news though This typically what we've seen in a lot of patients is it will resolve if you don't have further tick bites So the your levels of antibodies will decrease over time and we've seen patients Quite a number actually that are able to reintroduce the mammalian meats into their diet after a period of time without the tick bites That said additional tick bites cause your levels of antibodies to go up even higher and can cause an increase in symptoms or more severe symptoms. So You know kind of double-ed So when I'm thinking about I'm going to talk a bit about the immunology aspect here does maybe we can explore a bit more around the antibodies themselves Are these antibodies something that everyone would have a reaction to or is this only a certain cohort of the population that's a higher risk of generating these antibodies And then I want to get into measurement but let's let's start with just the basic biology like how why is it that certain people form these antibodies? Yeah, so you know, I think you've you've got a Nobel winning question right where you know We see this with with all kinds of allergy right? If some people develop allergy and others don't You know typically we see patients who have or people that have a predisposition to allergy tend to develop right? We call it the allergic March, you know, we discuss this when we talked about a topic dermatitis before So you know, we tend to see more food allergy more other allergies in those patients that are predisposed for various reasons both You know genetically and you know for you know again Even reasons we don't understand that's not typically the case with alpha gal though alpha gal's a little bit different You know in speaking with with some of the the initial researchers We thought this was actually more of a disease of people who were not a topic It patient, you know, we would see 50 67-year-old Men especially who you know were outdoorsmen and kind of you know in the woods all the time go through their whole life without any allergy without any You know respiratory allergies without any food allergies and develop alpha gal syndrome after the tick bites Now that you know, it's becoming more prevalent. We're seeing it's about 50 50 We see patients who have an atopic, you know, disposition Developing along with their other allergies and also patients who are really not atopic but but now are with with alpha gal Wow Okay, and so these antibody is the body basically will produce supply Exposure to other Signals in the diet But at an a normal stentiest state if you eliminate these foods from the diet Do is the risk of the antibody production completely eliminated or can what happens With that process maybe a little bit more about how the antibody Yeah, yeah, so the antibodies are typically made in response to the tick bite So they're not made in response to ingestion of the the foods the the foods cause of reaction But they're not causing the antibodies Um, you know going back again to our previous episode will we talked about sensitization through the skin and how important it is to have intact skin so that you don't get future food allergy Um, it really kind of goes with this right because the tick is biting you through the skin causing a TH2 Then reaction development of the ige antibodies and then when you're exposed to mammalian meats seeing those reactions of the future Got it Okay, so we know that there is a biomarker like these antibodies could serve as a biomarker signal for the allergy How do we detect that or are there tools to detect this if you go to your doctor and say you know I think I might have this based on these symptoms and because of my exposure to ticks in the outdoors Are there ways that they can actually confirm whether or not you have alpha-gal syndrome? Yeah, absolutely. So there's a specific ige antibody test Um, just called an alpha-gal assay right alpha-gal antibody assay and it's the same as any other specific ige test for a food or a pollen or a venom So it's it's performed in the same way using the same technology Um, interestingly the um what is used for the antigen is actually bovine thyroglobulin Which is highly decorated with alpha-gal so it makes it a very good assay a very Very sensitive assay It's important to know just like all all other you know laboratory tests We want to have a pre-test probability, right? So we don't want to just screen people for these antibodies because you know Just like in in other food allergies we can have antibodies present and not have Symptoms right you must have antibodies to have symptoms, but you don't have to have symptoms if you have antibodies So it's important to test patients who you have a suspicion, right? They have symptoms that are consistent. So you know anyone who's in a tick endemic area Who you know potentially has been been bitten by a tick and then is having that whole constellation of allergic symptoms That you can't really pin down to anything. That's the the perfect patient to then be testing Um, you know, you did I wanted to get back to you said, you know how well known is this and I can tell you that it's Becoming a lot more you know, um, you know Um, you know, the awareness has increased quite a bit over the last few years But a morbidity more mortality weekly report which is put out by the CDC Um, paper just from just two years ago Actually demonstrated that 42% of clinician survey had never heard of alpha-gal syndrome And of those that had heard it. I think it was around 35% We're not confident in how to diagnose or manage it Now hopefully over the last two years, you know between media between a lot of educational efforts being done by the allergy organizations being done by ourselves I you know, hopefully that is that is improved greatly, but it's still something that you know If if patients are you know highly suspicious of this they may need to educate their clinicians as well I mean, it sounds like the perfect word question. I like this. I just have midnight anaphylaxis That's a incredible um, okay, so let's say so you need to not only have the antibodies, but also clinical symptom history to really mirror it getting this test done and we have specific IDE Test alpha-gal assays that clinicians can order let's say that you've got the diagnosis and now you're told eliminate these mammalian products from your diet So that would include all the dairy your beef your So this is where it's um, it's more nuanced, right? So every patient is individual and and and what we often see You know, just like in food allergy some patients need exposure to a high amount of the food in order to to demonstrate a reaction The same is true with alpha-gal so different foods have different levels of alpha-gal in Um, when we think about the meats organ meats have the highest Really lean cuts of muscle things like filet have a lower amount So there are patients that only react to say liver, you know Um, or awful and they don't react to a lean cut of of meat the other the other thing that's that we're seeing is is Mort the fattier cuts are also generally more reactive um The levels just keep going down when we talk about other mammalian products So milk has much lower level of alpha-gal but there are some people patients that can't tolerate There are many patients that can that are diagnosed with alpha-gal so it's very individualized and that's where you really need to work with your clinician Work with a dietitian to really figure out kind of what's best for you know for the individual That's that's really that's a really great point around variations and levels Well, I'm also wondering Geary are there other kind of surprising sources of alpha-gal in other food products Let's say if you're awarding organ meats, you're not eating beef liver, and you're really cognizant of that, but are there other kind of hidden sources that we might be exposed to either in our supplements or in other food sources? Yeah, absolutely. Again, gelatin because it's made from mammals can certainly contain alpha and small amounts, but again, highly sensitive people that with alpha allergy can react to gelatin. So certainly any of the gel caps, right, and any of the supplements, medications can potentially be an issue. Other hidden areas, we see this term natural flavoring in a lot of foods, and a lot of times that is actually a million product. So there is legislation right now before Congress, because Congress kind of directs the FDA on food labeling, and right now we have what we call the big nine of foods that are required to have disclosures on all food labels. So things like milk, egg, wheat, soy, fish, shellfish. Within the last few years, we added sesame to that, so in other words, the big eight, it became the big nine several years ago. There is now legislation before Congress, because alpha gal looks like it's going to be the 10 most prevalent allergen in the country to actually add that to the preventative labeling. So hopefully we'll be able to see those disclosures that will make life a little bit easier for patients. Yeah, that's that's a really good point. I'm speaking with someone recently about about supplements and capsules and they spoke about sometimes a challenge of buying vegan, vegan capsules, the gel, the gel capsules being being a million. That's really interesting. Okay, it kind of speaks to ulcers and the challenges with pre-prepared meals and processed foods in that we don't always have clear again what's in them. I've I've been struggling with with airline meals lately because I feel like they put my particular poison which we talked about last time with bell peppers on like literally every dish. It's like I was on a flight recently to Europe and it was on I looked at four meals and they put it on every single one of them. The only way you could tell is if you actually opened and looked at it because there was no disclosure of all the ingredients in the dish. They list the major allergens but not not some of these other things. I would love it if we could get to a place where we just have with the QR code because you all the ingredients on every thing that we're not there yet. But yeah. No, and it makes, as you said, it makes travel. It makes dining out, you know, really challenging for those with food allergies, especially when you're not part of the big nine. Right. Yeah, yeah, it's a great point. So okay, we spoke about capsules, about flavoring. Are there any other medical products or other products that we should be aware of that might have triggers for alpha gal surgery? Yeah, I mean, so certain vaccines have some a million products in them. There are typically alternatives for those vaccines that are that are mammal-free. Heparin, so it's one that's made. Yeah, that's so that's made from from pigs. And Heparin in typically in low doses for most patients. So the kind of the subcutaneous epinephrine that you get if you're in the hospital, you need to have, you know, DVT prophylaxis, right? You know, blood pressure, blood pressure, blood pressure, blood pressure, blood pressure, blood pressure. And so the, you know, typically the subcutaneous lower doses are not typically an issue for alpha gal patients, but there are, you know, times when we give high dose Heparin IV things in like cardiac procedures. And those can potentially be a problem. So again, having that discussion with your surgical team before is very important. That's great. So I guess, I guess one question. We spoke about alpha gal in the US. Is this something that's really global in nature or is this something that's really restricted to our specific tick species? Yeah, unfortunately, we're not unique. Shortly after it was identified here. So it was first identified here in the early 2000s. There have been reports of these kind of delayed red meat reactions even before that in the 1990s. But it really became identified. And we found it, you know, the correlation and the true cause in the early 2000. Shortly after it was identified here, it was identified in Australia. We've seen it in Europe. We've seen it in the Asia-Pacific countries. So right now there is an continent on Earth except Antarctica where it hasn't been found. So yeah. And again, the tick's to survive. We'll see with climate change. I was going to say, you know, right now, I think they're okay. So if you're at the polar or the Antarctic research station, I think you're it's different ticks in different parts of the world. But it's, you know, the exoes ticks, which is part of the the black leg tick here in the US. There are other exoes of varieties of ticks around the world. And they seem between the Ambulioma, which is the lone star tick here, and other Ambulioma species around the world and the exoes, they seem to be the two main carriers throughout the world. Yeah. And I believe that that that photo that we keep showing that that is and I don't want to get it incorrect. It's either the male or the female of the lone star tick. So the whatever the opposite is, we'll not have that yellow dot. So don't be fooled if it doesn't have the dot. Okay, take it to now. Well, and I think it's interesting, you know, too. It's it's about time of exposure is important with any with any text. But it can be a much shorter time link that you have exposure to actually develop the syndrome. Yeah. That's why prevention here is even more important. You know, with with Lyme disease, we talk a lot about tick checks, right? And, you know, after you've been hiking, do a thorough tick tick check, remove them quickly. You know, we talk about how to do that, right? With with AlphaGal, it's really about preventing the tick by to begin with. So it's about, you know, the, the whole long pants and the socks and, you know, and really, you know, maybe, maybe interim checks, right? Along your hikes or your outdoor activities to make sure that they're, you're not getting any attached. I just recently moved to the northeast. And I can certainly a lot more AlphaGal, where I am now, then where I was in Florida. And I can tell you I'm pretty, pretty paranoid about it. Because I do like an occasional stick. And you know, you just reminded me too. I don't remember if we discussed co factors the last time you spoke. No, I don't think we're good. Let's let's get into that. Yeah. So with a lot of food allergies, they can be enhanced or actually occur only in conjunction with with co factors. So there's a week dependent exercise and do stand up for access, where you have a weed allergy, but you don't have symptoms unless you exercise within a couple hours after eating weed. So exercise as a co factor. Alcohol is another big co factor. So people, again, we'll have reactions only if they have an alcoholic beverage in conjunction with whatever there are a glass of red wine. My steak is that's exactly where I was going. Though alcohol is one of the biggest co factors, along with exercise for precipitating AlphaGal syndrome. So yeah, there are people that could have the state potentially, especially the lean cut and be okay, but they have a, you know, a rib eye and a glass of wine. And they end up in the emergency department. And you know, it's in speaking of that, it's just like any other food allergy. Once it's been identified, obviously we need to do strict avoidance, but you also want to make sure you have emergency up in effort that you act quickly that you utilize the up in effort and, you know, as soon as you're starting to see symptoms, just like any other. That that was the next question I have is about the level of severity, like can you experience the influx is from this from this syndrome and you're saying yes. Yeah, absolutely. So there was just recently. The first really published case, although we know there have been other deaths. There was a recent published case from New Jersey, actually, with a gentleman who had had some previous GI symptoms pretty severe to not attribute it to anything allergic. And then had an anaphylaxis and died. So yeah, it absolutely can be fatal. Well, all this talk about ticks has me thinking of my upcoming field research. I'm doing this summer. I'm going to Mongolia to collect plants and ride horseback now with horses and then we're in Mongolia. There are issues of ticks. So I've taken my oral typhoid vaccines. I'm all set there. And then I'm also doing the series of tick warrants at the lightest vaccine. Right. Because around livestock, you can also have, you know, ticks maybe it'd be helpful. We talk to them about, you know, tick prevention. Because this may be something that a lot of people, if you're not enough, I feel like a lot of centers, not doors, people are aware of these that maybe not everyone is. And so you mentioned long pants and socks. Like what, what are some of the tips for tricks you have? And then I'll share what I'm doing to get ready for this in Mongolia. Yeah, I mean, you know, they've we've heard for years about kind of tucking your pants in your socks and looking pretty ridiculous, right. But, but you know what, if it means being able to have that state, you know, or, or they're not be worried about any of my medications, right? It's, I think, you know, I'll look a little ridiculous. So that's one pre-methering to treat clothing. thing, I think is one of the biggest recommendations, right? It doesn't go on your skin, but it goes on the clothing. Again, just, you know, I think there's a little bit controversy around deep and percentages of deep and how effective it is. But you know, I would say anybody who's spending any time out of doors, I would really kind of research kind of the best techniques and of course, of course it's always, you know, we talk about medicine, shared decision-making, so what you're willing to do, what you're able to do, you know, how far you want to go for prevention, but you know, anything you can do to really prevent them from initially attaching, I think is going to be very beneficial. No, I mean, that's 100% like I've pre-streated my clothing with permethrine. It's so easy. For those of you that have never done this, this basically binds the insect repellent, I could arrested an insect aside to the clothing itself and so you let it kind of dry outside and then it lasts for several weeks on your clothing if you're going out and then wearing the socks over. I'll be wearing writing boots in my leg, my abs and my calves will be covered, but when I'm not, I'll be wearing socks over the pants and I also treated the socks and just what we're doing a physical check, you know, like you said, right early, whenever you're taking all, you know, clothes in the day really checking to make sure that you don't have any tics that you do to carefully remove them with the, you know, the right way. The right way, right? And you can, you can look up the right way, but you know, it's not about squeezing the body. It's about using a fine tweezers and pulling them out from the head and yeah. Yeah. And there's definitely some checking to it because I like my steak and red wine. I am not a vegan girl yet, but I do like vegetables as well, but you know, I grew up and it's nice to have the balance, right? And hopefully we can avoid, yeah, more people. So, you know, right now the latest statistics are somewhere, they're estimated around a half a million people in the U.S. are effected. Exactly. Worldwide or in the U.S.? That's just U.S. Oh my goodness. Yeah. They said we're seeing definite increases, there's some hot spots, Sweden is a hot spot globally Australia is a hot spot more and more in Asia as well, but Sweden and Australia seem to be, you know, two of the areas that it's really increasing as well as across the U.S. And you know, for clinicians that are listening, even if you're in an area that has very low prevalence of alpha-gal, I think it's important, you know, you're going to Mongolia, you know, people travel, people spend, you know, weeks in the Southeast, right? Where it's just so prevalent. So you know, taking a travel history, I think, is important, you know, when we're working through symptoms, especially non-descript symptoms, you know, there's this concept term, we call idiopathic anaphylaxis, and idiopathic just means we don't know what caused it, but the other way to look at it is, we just haven't figured out what caused it yet, right? It's not like it came out of the air, something caused it. And in certain areas where, you know, the ticks are prevalent, alpha-gal is prevalent. A lot of these idiopathic anaphylaxis have now been resolved as being alpha-gal, and just we didn't realize it'd be. Wow, just because it was underdiagnosed, basically, yeah. Exactly. Exactly. Exactly. So this is really, I mean, I mentioned tick-borne cephalitis, we've talked about Lyme disease. There are all other kinds of infectious diseases that can also be transmitted through insects, like ticks. Very important to keep in mind. Gary, can you, I know you mentioned it earlier on the top of the episode that I'd like to just dive in a little bit more, like what is it about the tick that leads to this antibody reaction? Because it's not an infectious agent, it's just, is it through, do they release a kind of venom? Like, what starts this whole process? Yeah, I mean, so in the process of attaching the tick, expels contents, right? Just stomach contents and any coagulants, part of that is actually this alpha-gal molecule. And the interesting thing, the reason why we develop allergy is that all mammals have alpha-gal except humans and world primates. So it's kind of, you know, through evolution, we've lost the alpha-gal, and that's why we're able to become sensitized. It's not self anymore, where other mammals, because if you want to, you know, why wouldn't it, the deer develop it, they're vegans, right? But, you know, other mammals that are meat eaters, right? Why wouldn't they develop alpha-gal, and that's because it hasn't been bred out of them? Wow. That makes a lot of sense. Well, are there any other, we've got a few minutes here to wrap up. We've covered pollen food allergy syndrome on our last episode, fascinating ties to seasonal allergies and environmental exposures like tick, tick bites in alpha-gal. Are there any other kind of leading food allergies that you see are becoming a bigger problem or we're just perhaps more aware of, or things that folks should commit, just have on their radar? Yeah, I think, as our diets become more and more diverse, we tend to see, you know, more and more kind of unusual food allergies develop, you know, we're seeing more in the way of legume allergies, we're seeing more in the way of just kind of other, more, you know, what we think of as healthier ways of eating, right? And when we get exposed to these different plants, so, you know, we'll definitely see more of that, but, you know, we've seen more sesame allergy as we've developed a more Mediterranean diet and Middle Eastern diet, right? So on the food side, I think that's, you know, interesting. On the non-food side, though, since we're talking about insects here with alpha-gal, phenom allergy is something I never want to miss an opportunity to talk about one of our most successful things in allergy is the ability to treat someone who's venom allergic, so insect venom allergic, so bees, wasps, with immunotherapy. It is highly successful treatment, more successful, anything else we do in allergy and it's not well known, even by primary care clinicians, I don't think they appreciate just how effective it is. So, you know, what I would say is we now have allergy components. We've talked about that alpha-gal is an allergy component that we test for. We have allergy components in stinging insects as well and it helps allergists be more precise in their diagnosis and be able to guide their venom, immunotherapy, even better and be more efficient with it. I would say anyone who's had a systemic reaction, a severe reaction to an insect sting, they want to just not just get an epinephrine device and kind of go on your way, but you really want to pursue that with an allergist potential immunotherapy because it is really disease-modifying. It can stop you from having future reactions. Wow, so this is not a, so the epinephrine pens we take in the emergency situation where you have any reaction, it's like a bee venom or wasp venom, but the immunotherapy is something you would take before you have such reaction to kind of remediate the disease. Yeah, so it's immune-modifying, right? So it's a series of injections, small amounts, gradually increasing, you know, more frequent initially and then, you know, monthly and then, you know, less, but it's a three to five year course of immunotherapy when you're done, almost all patients are protected from future reactions from that insect. So it's a really amazing success story that not enough people know about. That's incredible. Wow. Science in medicine continues to, to just amaze me with the ways that we're progressing, incredible. I've been in that scenario where I was scared to death away. One of my sons when he was very young was stung in the head by 12 wasps and required trips to the ER and all sorts of monitoring and medication and I wasn't aware that there was no option for this because that's something I'm always worried about if he has another exposure like that. Yeah, and it's, you know, it's hard to say sometimes it's just a toxic reaction, right? Yeah. To that amount of venom. Exactly. As opposed to allergic reaction, but an allergist can help you work through that for sure. Incredible. Wow. Great. I will definitely be wearing my socks outside of my pants and looking like a big dork, but that's okay. I want to maintain my ability to eat that steak and that was so fine because my meal, but sure. It's a classic theory and it's exciting to hear that clinicians also have the scientific tools available to them. If there is a suspicion of potential alpha-gal at play based on patient symptoms and it is, it uses no very convenient blood. It's again, it's available in all the national laboratories, many regional laboratories. So it's easy to ascertain. It's not a difficult assessment. Fantastic. It is just like a simple blood test, basically, just a simple blood draw. Yep. Great. Fantastic. Wow. Well, thank you so much for sharing this with us. I mean, this is really helpful. You know, displays some of the mystery around Alfred Gal and what leads to it and how it's diagnosed. So this was been really informational. As always, I love speaking with you about food allergy. So thanks. It's always a pleasure. Thanks for inviting me. Awesome. All right. Well, you've been listening to the Foodie Pharmacology, the science podcast for the food curious recorded you today on Restream. 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We're in season eight so many more episodes, amazing shows to come up on this season and we're excited to continue sharing the science of food with you. Alright, see healthy out there and see you next time. We'd once again like to thank Thermo Fisher Scientific Incorporated for their sponsorship of this episode.