562:
589:. They had previously hypothesized that a fungal infection or parasite could lead to the allergy. They discovered that these individuals had IgE antibodies in their blood that were specifically targeted to the portion of cetuximab which contained the alpha-gal carbohydrate. When Platts-Mills was bitten by a tick and developed alpha-gal allergies, his team concluded that a link existed between tick bites and the allergy. They found that the IgE antibody response to the mammalian oligosaccharide epitope
350:
374:
239:. They discovered that these individuals had IgE antibodies in their blood that were specifically targeted to the portion of cetuximab which contained the alpha-gal carbohydrate. When Platts-Mills was bitten by a tick and developed alpha-gal allergies, his team came to the conclusion that a link existed between tick bites and the allergy. They found that the IgE antibody response to the mammalian oligosaccharide epitope
470:. Immediate hypersensitivities and reactions, specifically concentrated in the southern part of the United States, can be seen from the alpha-gal components of this anti-cancer drug. Increasing evidence now suggests reactions to certain substances with traces of alpha-gal used in the preparation of certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics and pain medications.
598:
most prevalent, allergy rates are 32% higher than elsewhere. However, as physicians are not required to report the number of patients with alpha-gal allergy, the true number of affected individuals is unknown. Arkansas was the first state to make alpha-gal syndrome a reportable condition in the United States. Alpha-gal has also been shown to exist in the saliva of
444:
meat with the same alpha-gal causes an allergic reaction. Symptoms of the allergy reaction are caused by too many IgE antibodies attacking the allergen – the alpha-gal. Other types of ticks are suspected of causing similar problems. Only a small percentage of children and adults will acquire a red meat allergy after receiving a bite from a lone star tick.
613:
In 2021, University of
Tennessee entomologist Becky Trout Fryxell reported that more cases of Alpha-Gal syndrome are occurring from those who encounter the Lone Star tick: " likes to feed on dogs, deer, and seems to always find people as well," said Fryxell. "It has the ability to transmit a lot of
552:
Debate exists around the best method of tick removal. Low-quality evidence favors mechanical techniques over chemical treatments such as gasoline, petroleum jelly, or clear fingernail polish. Mechanical techniques involve pulling with forceps or commercial devices. Pulling is slightly favored over
486:
A blood test for the specific antigen, IgE, to the alpha-gal carbohydrate, is commonly used for diagnosis in clinical practice. Typically, a level of 1% for IgE specific for alpha-gal out of total IgE in the body has been identified in patients with alpha-gal syndrome. Traditional skin-prick allergy
357:
There have been cases where gastrointestinal symptoms arise without pruritus, hives, or other skin involvement. This presentation is not typical of food allergies, which can make initial suspicion of alpha-gal syndrome less likely. In 70% of cases, the reaction is accompanied by respiratory distress
333:
A typical allergic reaction to alpha-gal has a delayed onset, occurring 3–8 hours after consuming mammalian meat products. However, there have been some instances of onset of symptoms occurring within 2 hours. After the delayed onset, the allergic response is like most food allergies, and especially
443:
contains alpha-gal, and that saliva is injected into the bloodstream. Researchers still do not know which specific component of tick saliva causes the reaction. The immune system then releases a flood of IgE antibodies to fight this foreign sugar. After this reaction, the future intake of mammalian
361:
It is worth noting that symptoms and overall reactions can vary greatly between individuals with alpha-gal syndrome. It has been found that other factors, including exercise and alcohol consumption, can potentially affect an individual's symptoms and overall reactivity to alpha-gal. Increased risk
597:
As of
November 2019, Australia has the highest rate of mammalian meat allergy and tick anaphylaxis worldwide. In the US, the allergy most often occurs in the central and southern regions, which corresponds to the distribution of the Lone Star tick. In the Southern United States, where the tick is
499:
There is no cure for alpha-gal; the main form of management is abstaining from mammalian meat, including lamb, beef, pork, and other mammalian products if necessary. These products have been found to have the highest risk of reaction, whereas dairy products present a much lower risk. Avoidance of
199:
meat. The condition results from past exposure to certain tick bites. It was first reported in 2002. Symptoms of the allergy vary greatly between individuals and include rash, hives, nausea or vomiting, difficulty breathing, drop in blood pressure, dizziness or faintness, diarrhea, severe stomach
621:, when 25 patients reported having allergic reactions to red meat after being bitten by ticks. She later concluded that the relatively sudden rise in cases was the result of a local fox baiting program that began in 2003. Foxes were introduced to Australia and had decimated the local indigenous
320:
Alpha-gal allergy has been reported in 17 countries on all six continents where humans are bitten by ticks, particularly the United States and
Australia. Alpha-gal allergies are the first known food allergies that present the possibility of delayed anaphylaxis. They are also the first known
2634:
Chung, Christine H.; Mirakhur, Beloo; Chan, Emily; Le, Quynh-Thu; Berlin, Jordan; Morse, Michael; Murphy, Barbara A.; Satinover, Shama M.; Hosen, Jacob; Mauro, David; Slebos, Robbert J.; Zhou, Qinwei; Gold, Diane; Hatley, Tina; Hicklin, Daniel J.; Platts-Mills, Thomas A.E. (13 March 2008).
512:
In addition to avoiding triggers, such as mammalian meat, treatment is aimed at alleviating symptoms and is highly dependent on severity. If an allergic individual who only experiences relatively mild symptoms consumes food containing alpha-gal, then treatment with over-the-counter
640:
approved the genetic modification of pigs so they do not produce alpha-gal sugars. Pigs developed with the trademarked name GalSafe may be able to be eaten safely by people with alpha-gal allergy. They may also produce alpha-gal-safe drugs, and their organs can also be used for
548:
and avoiding areas inhabited by ticks. Other recommendations are to conduct tick checks after coming inside, remove outdoor clothing articles and run them in a dryer on high heat to kill undetected ticks. Taking a shower or bath promptly can aid in detecting ticks on the skin.
503:
Unlike most food allergies, in some people, the alpha-gal allergy may recede over time as long as another tick does not bite the person. It has been found that with avoidance of further tick bites, levels of serum IgE decline. The recovery period can take 8 months to 5 years.
316:
naturally do not contain alpha-gal. Increasing evidence now suggests reactions to certain substances with traces of alpha-gal used in the preparation of certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics and pain medications.
517:
may be acceptable. In cases where more severe reactions—like anaphylaxis—are observed, admission to a hospital for emergency treatment is necessary. In these situations, treatment is the same as for any anaphylactic reaction, and necessitates epinephrine administration.
482:
Diagnosis begins with initial suspicion of alpha-gal syndrome following a thorough review of an individual's medical history and clinical symptoms. Regarding laboratory testing, diagnosis tends to be difficult, and no specific test is recommended over others.
215:
on exposure to the carbohydrate. Anti-gal is a human natural antibody that interacts specifically with the mammalian carbohydrate structure gal alpha 1-3Gal beta 1-4GlcNAc-R (the alpha-galactosyl epitope). The alpha-gal molecule is found in all mammals except
473:
Anaphylactic transfusion reactions have been reported in patients with presumed alpha-gal syndrome who had type O blood and received group B plasma or platelets. The B blood group antigen is antigenically similar to
Galactose-alpha-1,3-Galactose.
447:
A 2012 preliminary study found unexpectedly high rates of alpha-gal allergy in the western and north-central parts of the United States. This suggests that unknown tick species may spread the allergy. The study found alpha-gal allergy cases in
625:
population, hence the fox baiting program. However, an unforeseen effect of the subsequent rise in the bandicoot population was the rise in ticks, as bandicoots are a major host for ticks, thus the number of humans suffering tick bites.
490:
In certain instances in which a person does not present with the typical symptoms and history of alpha-gal syndrome but is found to have elevated alpha-gal IgE levels, improvement with avoidance of red meat can be diagnostic, as well.
633:; hence misidentification can occur. Pork–cat syndrome usually elicits an immediate allergic response, while a true alpha-gal allergy typically features a delayed allergic reaction of 3 to 8 hours after ingestion of the allergen.
923:
1300:
Cabezas-Cruz, Alejandro; Hodžić, Adnan; Román-Carrasco, Patricia; Mateos-Hernández, Lourdes; Duscher, Georg
Gerhard; Sinha, Deepak Kumar; Hemmer, Wolfgang; Swoboda, Ines; Estrada-Peña, AgustĂn; de la Fuente, JosĂ© (2019-05-31).
593:
was associated with both the immediate-onset anaphylaxis during first exposure to intravenous cetuximab and the delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products, such as beef or pork.
243:
was associated with both the immediate-onset anaphylaxis during first exposure to intravenous cetuximab and the delayed-onset anaphylaxis 3 to 6 hours after ingestion of mammalian food products, such as beef or pork.
2062:
1367:
Mabelane (2018). "Predictive values of alpha-gal IgE levels and alpha-gal IgE:total IgE ratio and oral food challenge proven meat allergy in a population with a high prevalence of reported red meat allergy".
487:
tests for allergy to meat may give a false-negative answer and are not generally considered reliable. Skin and basophil activation tests with cetuximab are the most sensitive, but high costs limit their use.
1695:
Gilstad CW, Conry-Cantilena K, Zarpak R, Eder AF (October 2023). "An outbreak of anaphylactic transfusion reactions to group B plasma and platelets and its possible relationship to Alpha-Gal syndrome".
2700:
651:
New
American guidelines published in 2023 recommended physicians to suspect alpha-gal syndrome in cases with abdominal pain and GI symptoms, but without traditional allergy symptoms like hives.
2390:
1496:
2693:
1850:
Unal D, Coskun R, Demir S, Gelincik A, Colakoglu B, Buyukozturk S (2017). "Successful beef desensitization in 2 adult patients with a delayed-type reaction to red meat".
1758:
Bircher AJ, Hofmeier KS, Link S, Heijnen I (February 2017). "Food allergy to the carbohydrate galactose-alpha-1,3-galactose (alpha-gal): four case reports and a review".
432:. Alpha-gal is not naturally present in apes, Old World monkeys, or humans, but is in all other mammals. If a tick feeds on another mammal, the alpha-gal remains in its
1139:"A peculiar cause of anaphylaxis: no more steak? The journey to discovery of a newly recognized allergy to galactose-alpha-1,3-galactose found in mammalian meat"
2686:
365:
The severity of symptoms and overall reaction to alpha-gal have been found to correlate with the amount of alpha-gal carbohydrate in the ingested food or drug.
362:
has also been discovered in those without type B or type AB blood, as the type B blood antigen is similar to alpha-gal and may confer some level of immunity.
2211:
2915:
358:
and is particularly harmful to those with asthma. However, not every exposure to alpha-gal results in allergic reaction for some people with the allergy.
1606:
462:
derived from porcine tissue may also contain alpha-gal. Alpha gal is found on the fragment-antigen binding (Fab) fragment of the recombinant monoclonal
284:
to avoid triggering an allergic reaction. Some afflicted individuals are so hypersensitive to alpha-gal that the allergy can cross-react with mammalian
1414:
Crispell, Gary; Commins, Scott P.; Archer-Hartman, Stephanie A.; Choudhary, Shailesh; Dharmarajan, Guha; Azadi, Parastoo; Karim, Shahid (17 May 2019).
2286:
648:
For those undergoing surgery, possible triggering agents include porcine-derived heart valves, insulin, heparin, thrombin, and surgifoam powder.
2013:
1731:
Krishna N, Krishna S, Krishna R (November 2017). "P112 Correlation between clinical findings and laboratory tests for alpha gal sensitivity".
2969:
1994:
585:
Platts-Mills, Tina Hatley
Merritt, and Scott Commins were attempting to discover why some people were reacting negatively to the cancer drug
2885:
2414:
2391:"FDA Approves First-of-its-Kind Intentional Genomic Alteration in Line of Domestic Pigs for Both Human Food, Potential Therapeutic Uses"
688:
2760:
2523:
2038:
235:
In 2006, researchers Thomas Platts-Mills and Scott
Commins attempted to discover why some people were allergic to the cancer drug
2151:
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2233:
2820:
2312:
2180:
1959:
Huygelen V, Borra V, De Buck E, Vandekerckhove P (August 2017). "Effective methods for tick removal: A systematic review".
452:, where no ticks identified with the allergies live. Human factors were suggested, but no specific examples were provided.
590:
272:) in Australia, which can transfer this carbohydrate to a victim, have been implicated in the development of this delayed
240:
204:
2799:
1912:"Personal protection measures to prevent tick bites in the United States: Knowledge gaps, challenges, and opportunities"
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561:
2830:
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Galili U (1993). "Evolution and pathophysiology of the human natural anti-alpha-galactosyl IgG (anti-Gal) antibody".
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2203:
614:
pathogens too. And it's also associated with a tick meat allergy, which unfortunately is becoming pretty common."
439:
The tick injects the alpha-gal into a person's skin with its bite. Recent research has shown that saliva from the
417:
3164:
2789:
2784:
1416:"Discovery of Alpha-Gal-Containing Antigens in North American Tick Species Believed to Induce Red Meat Allergy"
1087:"A novel Australian tick Ixodes (Endopalpiger) australiensis inducing mammalian meat allergy after tick bite"
816:"Delayed anaphylaxis to red meat in patients with IgE specific for galactose alpha-1,3-galactose (alpha-gal)"
500:
dairy is not generally recommended as most afflicted individuals do not have reactions to dairy consumption.
3195:
2925:
2900:
1471:
280:"). Healthcare providers recommend avoiding food products containing beef, pork, lamb, venison, rabbit, and
3060:
2905:
2257:
527:
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195:), is a type of acquired allergy characterized by a delayed onset of symptoms (3–8 hours) after ingesting
1607:"What Does a Red Meat Allergy Have to Do With Anesthesia? Perioperative Management of Alpha-Gal Syndrome"
665:
630:
574:
The allergy was first formally identified as originating from tick bites in the United States in 2002 by
570:, the species of hard-bodied tick most likely to be responsible in Australia for instances of the allergy
3053:
3031:
2910:
2591:"Tick bite-induced alpha-gal syndrome and immunologic responses in an alpha-gal deficient murine model"
2063:"Mammalian meat allergy: People on the northern beaches becoming allergic to red meat after tick bites"
349:
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3024:
3017:
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2890:
2152:"Meat Allergy: Alpha-Gal Reaction From Lone-Star Ticks More Common In Central, Southern U.S. Regions"
440:
257:
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617:
Van Nunen, an immunologist specialising in allergies, had been practicing in a tick-prone area of
2709:
2371:
1783:
1646:
Miller MJ, Lee P, Lee BG, Flegel WA, West-Mitchell K, Conry-Cantilena K, De Giorgi V (May 2024).
1393:
891:
428:
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and even some dairy products. Individuals with an alpha-gal allergy do not need to become strict
63:
1231:
765:"Current and Future Strategies for the Diagnosis and Treatment of the Alpha-Gal Syndrome (AGS)"
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946:"Anaphylaxis syndromes related to a new mammalian cross-reactive carbohydrate determinant"
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1936:
1911:
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Tick bites can be prevented by treating clothing and gear with products containing 0.5%
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1558:"Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose"
2320:
2188:
1927:
1886:
1623:
1102:
725:
346:. Anaphylactic reactions are seen in approximately 60% of afflicted individuals.
17:
3043:
2812:
1497:
Ticks! Ick! The latest science on the red meat allergy caused by some tick bites
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2848:
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1995:"NIAID Scientists Link Cases of Unexplained Anaphylaxis to Red Meat Allergy"
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Anaphylaxis is a potential life-threatening reaction to the allergy
560:
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Alpha-gal allergies develop after a person has been bitten by the
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728:. US Centers for Disease Control and Prevention. 2020-10-06
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have been performed on patients with an alpha-gal allergy.
466:
antibody used in the immunotherapy treatment of metastatic
1288:
Mammalian meat and milk (cow and goat) contain alpha-gal.
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Berg EA, Platts-Mills TA, Commins SP (February 2014).
2438:
DErcole FJ, Dhandha VH, Levi ML, et al. (2019).
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859:
758:
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Alpha-gal allergy is a reaction to the carbohydrate
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207:("alpha-gal"), whereby the body is overloaded with
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148:
138:
130:
122:
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62:
52:
40:
35:
2204:"Entomologist warns about tickborne meat allergy"
2550:Frontiers in Cellular and Infection Microbiology
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458:derived from porcine intestine and replacement
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8:
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1191:"Tick bite leads to curious meat allergy"
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1110:
1033:
1031:
1029:
1027:
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422:in Japan, or a currently unknown tick in
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720:
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1182:
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1624:10.1213/ANE.0000000000003460
1193:. Milwaukee Journal Sentinel
1103:10.5415/apallergy.2018.8.e31
638:Food and Drug Administration
48:Mammalian meat allergy (MMA)
2831:Relapsing fever borreliosis
2780:Spotted fever rickettsiosis
2334:Dolgin, Elie (2021-04-01).
1513:"Acquired Red Meat Allergy"
693:first aired 8 November 2016
534:Prevention and tick removal
3212:
2608:10.3389/fimmu.2023.1336883
2494:10.1016/j.jaip.2019.09.017
2352:10.1038/s41587-021-00885-9
2208:WVLT TV News, Knoxville TN
2105:10.1016/j.anai.2013.11.014
1864:10.1016/j.jaip.2016.12.008
1745:10.1016/j.anai.2017.08.136
962:10.1016/j.jaci.2009.08.026
537:
380:, a vector for the allergy
300:- including red meat from
2821:Baggio–Yoshinari syndrome
2563:10.3389/fcimb.2021.680264
1155:10.1007/s11606-012-2144-z
832:10.1007/s11882-012-0315-y
419:Haemaphysalis longicornis
325:, rather than a protein.
46:Acquired red meat allergy
3165:Rhipicephalus sanguineus
2790:American tick bite fever
2785:Pacific Coast tick fever
2444:J Clin Anesth Pain Manag
1611:Anesthesia and Analgesia
1433:10.3389/fimmu.2019.01056
1320:10.3389/fimmu.2019.01210
1266:10.4102/phcfm.v11i1.1901
1020:Platts-Mills et al. 2020
44:Alpha-gal syndrome (AGS)
2926:Tick-borne encephalitis
2901:Kyasanur Forest disease
2595:Frontiers in Immunology
1420:Frontiers in Immunology
1307:Frontiers in Immunology
930:. pp. HEALTH, E01.
578:, and independently by
152:Avoidance of tick bites
3061:Dermacentor variabilis
2906:Omsk hemorrhagic fever
1213:"'Alpha-Gal' Syndrome"
582:in Australia in 2007.
571:
381:
354:
189:mammalian meat allergy
3054:Dermacentor andersoni
3032:Amblyomma triguttatum
2911:Powassan encephalitis
2522:(December 11, 2018).
1910:Eisen L (July 2022).
1772:10.1684/ejd.2016.2908
1219:. Cornell University.
564:
376:
352:
251:species, such as the
3147:Ornithodoros moubata
3133:Ornithodoros gurneyi
3025:Amblyomma cajennense
3018:Amblyomma americanum
2936:Protozoan infections
2921:Tete orthobunyavirus
2891:Heartland bandavirus
2761:Human monocytotropic
2726:Bacterial infections
2653:10.1056/NEJMoa074943
2340:Nature Biotechnology
1916:Ticks Tick Borne Dis
1574:10.1056/NEJMoa074943
1091:Asia Pacific Allergy
726:"Alpha-gal syndrome"
378:Amblyomma americanum
258:Amblyomma americanum
247:Bites from specific
3140:Ornithodoros hermsi
2881:Colorado tick fever
2710:Tick-borne diseases
2317:The Washington Post
2185:The Washington Post
1042:. Food Safety News.
928:The Washington Post
782:10.2147/JAA.S265660
643:xenotransplantation
607:Amblyomma maculatum
576:Thomas Platts-Mills
369:Cause and mechanism
262:in the US, and the
58:Allergy, immunology
2757:Human granulocytic
2138:The Canberra Times
2018:The New York Times
1973:10.1111/jebm.12257
1885:CDC (2020-07-01).
880:10.1007/bf00201098
636:In 2020, the U.S.
572:
429:Amblyomma hebraeum
382:
355:
177:Alpha-gal syndrome
36:Alpha-gal syndrome
3178:
3177:
3174:
3173:
3111:Ixodes scapularis
3090:Ixodes holocyclus
2999:Species and bites
2978:
2977:
2965:Alpha-gal allergy
2857:
2856:
2748:Boutonneuse fever
2323:on June 25, 2018.
1710:10.1111/trf.17521
1704:(10): 1997–2000.
1664:10.1111/trf.17811
1382:10.1111/pai.12969
666:Pork–cat syndrome
631:pork–cat syndrome
601:Ixodes scapularis
567:Ixodes holocyclus
274:allergic response
269:Ixodes holocyclus
226:Old World monkeys
185:alpha-gal allergy
183:), also known as
174:
173:
140:Diagnostic method
30:Medical condition
18:Alpha-gal allergy
16:(Redirected from
3203:
3097:Ixodes pacificus
3083:Ixodes cornuatus
3003:
2990:Tick infestation
2863:Viral infections
2731:
2722:
2712:and infestations
2703:
2696:
2689:
2680:
2674:
2664:
2630:
2620:
2610:
2585:
2575:
2565:
2540:
2538:
2536:
2515:
2505:
2462:
2461:
2459:
2457:10.36959/377/330
2435:
2429:
2428:
2426:
2425:
2419:NYU Langone News
2411:
2405:
2404:
2402:
2401:
2386:
2380:
2379:
2331:
2325:
2324:
2308:
2302:
2301:
2299:
2298:
2283:
2277:
2276:
2274:
2273:
2264:. Archived from
2254:
2248:
2247:
2245:
2244:
2229:
2223:
2222:
2220:
2219:
2199:
2193:
2192:
2191:on July 2, 2018.
2176:
2170:
2169:
2167:
2165:
2148:
2142:
2141:
2133:
2127:
2126:
2116:
2084:
2078:
2077:
2075:
2074:
2059:
2053:
2052:
2050:
2049:
2034:
2028:
2027:
2025:
2024:
2009:
2003:
2002:
1991:
1985:
1984:
1961:J Evid Based Med
1956:
1950:
1949:
1939:
1907:
1901:
1900:
1898:
1897:
1882:
1876:
1875:
1847:
1841:
1840:
1830:
1798:
1792:
1791:
1755:
1749:
1748:
1728:
1722:
1721:
1692:
1686:
1685:
1675:
1643:
1637:
1636:
1626:
1602:
1596:
1595:
1585:
1553:
1547:
1546:
1538:
1527:
1526:
1524:
1523:
1508:
1499:
1494:
1485:
1484:
1483:
1481:
1467:
1456:
1455:
1445:
1435:
1411:
1402:
1401:
1364:
1358:
1357:
1349:
1343:
1342:
1332:
1322:
1297:
1291:
1290:
1277:
1245:
1236:
1235:
1227:
1221:
1220:
1209:
1203:
1202:
1200:
1198:
1186:
1177:
1176:
1166:
1134:
1125:
1124:
1114:
1082:
1073:
1072:
1070:
1069:
1055:
1044:
1043:
1035:
1022:
1017:
984:
983:
973:
941:
932:
931:
919:
900:
899:
863:
854:
853:
843:
811:
805:
804:
794:
784:
760:
737:
736:
734:
733:
722:
695:
682:
580:Sheryl van Nunen
528:desensitizations
434:alimentary tract
394:castor bean tick
209:immunoglobulin E
33:
21:
3211:
3210:
3206:
3205:
3204:
3202:
3201:
3200:
3181:
3180:
3179:
3170:
3152:
3116:
3066:
3037:
2994:
2974:
2948:
2930:
2853:
2835:
2807:
2713:
2707:
2677:
2647:(11): 1109–17.
2633:
2588:
2543:
2534:
2532:
2518:
2475:
2471:
2469:Further reading
2466:
2465:
2437:
2436:
2432:
2423:
2421:
2413:
2412:
2408:
2399:
2397:
2388:
2387:
2383:
2333:
2332:
2328:
2310:
2309:
2305:
2296:
2294:
2285:
2284:
2280:
2271:
2269:
2256:
2255:
2251:
2242:
2240:
2231:
2230:
2226:
2217:
2215:
2201:
2200:
2196:
2178:
2177:
2173:
2163:
2161:
2150:
2149:
2145:
2135:
2134:
2130:
2086:
2085:
2081:
2072:
2070:
2067:www.news.com.au
2061:
2060:
2056:
2047:
2045:
2036:
2035:
2031:
2022:
2020:
2011:
2010:
2006:
1993:
1992:
1988:
1958:
1957:
1953:
1909:
1908:
1904:
1895:
1893:
1884:
1883:
1879:
1849:
1848:
1844:
1800:
1799:
1795:
1757:
1756:
1752:
1730:
1729:
1725:
1694:
1693:
1689:
1645:
1644:
1640:
1604:
1603:
1599:
1568:(11): 1109–17.
1555:
1554:
1550:
1540:
1539:
1530:
1521:
1519:
1510:
1509:
1502:
1495:
1488:
1479:
1477:
1469:
1468:
1459:
1413:
1412:
1405:
1366:
1365:
1361:
1351:
1350:
1346:
1299:
1298:
1294:
1247:
1246:
1239:
1229:
1228:
1224:
1211:
1210:
1206:
1196:
1194:
1188:
1187:
1180:
1136:
1135:
1128:
1084:
1083:
1076:
1067:
1065:
1057:
1056:
1047:
1037:
1036:
1025:
1018:
987:
943:
942:
935:
921:
920:
903:
874:(2–3): 155–71.
865:
864:
857:
813:
812:
808:
762:
761:
740:
731:
729:
724:
723:
698:
683:
679:
674:
661:Poultry allergy
657:
559:
542:
536:
524:
522:Desensitization
510:
497:
480:
392:, the European
371:
331:
169:desensitization
161:Anti-histamines
47:
45:
31:
28:
23:
22:
15:
12:
11:
5:
3209:
3207:
3199:
3198:
3196:Food allergies
3193:
3183:
3182:
3176:
3175:
3172:
3171:
3169:
3168:
3160:
3158:
3154:
3153:
3151:
3150:
3143:
3136:
3128:
3126:
3118:
3117:
3115:
3114:
3107:
3104:Ixodes ricinus
3100:
3093:
3086:
3078:
3076:
3068:
3067:
3065:
3064:
3057:
3049:
3047:
3039:
3038:
3036:
3035:
3028:
3021:
3013:
3011:
3000:
2996:
2995:
2993:
2992:
2986:
2984:
2980:
2979:
2976:
2975:
2973:
2972:
2967:
2962:
2960:Tick paralysis
2956:
2954:
2953:Other diseases
2950:
2949:
2947:
2946:
2940:
2938:
2932:
2931:
2929:
2928:
2923:
2918:
2913:
2908:
2903:
2898:
2893:
2888:
2883:
2878:
2873:
2867:
2865:
2859:
2858:
2855:
2854:
2852:
2851:
2845:
2843:
2837:
2836:
2834:
2833:
2828:
2823:
2817:
2815:
2809:
2808:
2806:
2805:
2804:
2803:
2797:
2795:rickettsialpox
2792:
2787:
2777:
2772:
2750:
2745:
2739:
2737:
2728:
2719:
2715:
2714:
2708:
2706:
2705:
2698:
2691:
2683:
2676:
2675:
2631:
2586:
2541:
2520:McKenna, Maryn
2516:
2472:
2470:
2467:
2464:
2463:
2430:
2406:
2381:
2346:(4): 397–400.
2326:
2303:
2278:
2249:
2224:
2194:
2171:
2143:
2128:
2079:
2054:
2029:
2004:
1986:
1967:(3): 177–188.
1951:
1902:
1877:
1842:
1813:(7): 667–677.
1793:
1750:
1723:
1687:
1658:(5): 949–951.
1638:
1597:
1548:
1543:Healthy Living
1528:
1500:
1486:
1457:
1403:
1359:
1344:
1292:
1237:
1222:
1204:
1178:
1126:
1074:
1045:
1023:
985:
933:
901:
855:
806:
738:
696:
676:
675:
673:
670:
669:
668:
663:
656:
653:
558:
555:
538:Main article:
535:
532:
523:
520:
515:antihistamines
509:
506:
496:
493:
479:
476:
456:Blood thinners
441:lone star tick
398:paralysis tick
386:lone star tick
370:
367:
330:
327:
264:paralysis tick
253:Lone Star tick
172:
171:
158:
154:
153:
150:
146:
145:
142:
136:
135:
132:
128:
127:
124:
120:
119:
116:
112:
111:
69:Abdominal pain
66:
60:
59:
56:
50:
49:
42:
38:
37:
29:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3208:
3197:
3194:
3192:
3189:
3188:
3186:
3167:
3166:
3162:
3161:
3159:
3155:
3149:
3148:
3144:
3142:
3141:
3137:
3135:
3134:
3130:
3129:
3127:
3125:
3124:
3119:
3113:
3112:
3108:
3106:
3105:
3101:
3099:
3098:
3094:
3092:
3091:
3087:
3085:
3084:
3080:
3079:
3077:
3075:
3074:
3069:
3063:
3062:
3058:
3056:
3055:
3051:
3050:
3048:
3046:
3045:
3040:
3034:
3033:
3029:
3027:
3026:
3022:
3020:
3019:
3015:
3014:
3012:
3010:
3009:
3004:
3001:
2997:
2991:
2988:
2987:
2985:
2981:
2971:
2968:
2966:
2963:
2961:
2958:
2957:
2955:
2951:
2945:
2942:
2941:
2939:
2937:
2933:
2927:
2924:
2922:
2919:
2917:
2914:
2912:
2909:
2907:
2904:
2902:
2899:
2897:
2894:
2892:
2889:
2887:
2884:
2882:
2879:
2877:
2876:Bourbon virus
2874:
2872:
2869:
2868:
2866:
2864:
2860:
2850:
2847:
2846:
2844:
2842:
2841:Thiotrichales
2838:
2832:
2829:
2827:
2824:
2822:
2819:
2818:
2816:
2814:
2810:
2801:
2798:
2796:
2793:
2791:
2788:
2786:
2783:
2782:
2781:
2778:
2776:
2773:
2770:
2768:
2762:
2758:
2754:
2751:
2749:
2746:
2744:
2741:
2740:
2738:
2736:
2735:Rickettsiales
2732:
2729:
2727:
2723:
2720:
2716:
2711:
2704:
2699:
2697:
2692:
2690:
2685:
2684:
2681:
2672:
2668:
2663:
2658:
2654:
2650:
2646:
2642:
2638:
2632:
2628:
2624:
2619:
2614:
2609:
2604:
2600:
2596:
2592:
2587:
2583:
2579:
2574:
2569:
2564:
2559:
2555:
2551:
2547:
2542:
2531:
2530:
2525:
2521:
2517:
2513:
2509:
2504:
2499:
2495:
2491:
2487:
2483:
2479:
2474:
2473:
2468:
2458:
2453:
2449:
2445:
2441:
2434:
2431:
2420:
2416:
2410:
2407:
2396:
2392:
2385:
2382:
2377:
2373:
2369:
2365:
2361:
2357:
2353:
2349:
2345:
2341:
2337:
2330:
2327:
2322:
2318:
2314:
2307:
2304:
2292:
2288:
2282:
2279:
2268:on 2019-03-27
2267:
2263:
2259:
2253:
2250:
2239:
2235:
2228:
2225:
2213:
2209:
2205:
2198:
2195:
2190:
2186:
2182:
2175:
2172:
2159:
2158:
2153:
2147:
2144:
2139:
2132:
2129:
2124:
2120:
2115:
2110:
2106:
2102:
2099:(2): 97–101.
2098:
2094:
2090:
2083:
2080:
2068:
2064:
2058:
2055:
2044:
2040:
2033:
2030:
2019:
2015:
2008:
2005:
2000:
1996:
1990:
1987:
1982:
1978:
1974:
1970:
1966:
1962:
1955:
1952:
1947:
1943:
1938:
1933:
1929:
1925:
1922:(4): 101944.
1921:
1917:
1913:
1906:
1903:
1892:
1888:
1881:
1878:
1873:
1869:
1865:
1861:
1857:
1853:
1846:
1843:
1838:
1834:
1829:
1824:
1820:
1816:
1812:
1808:
1804:
1797:
1794:
1789:
1785:
1781:
1777:
1773:
1769:
1765:
1761:
1754:
1751:
1746:
1742:
1738:
1734:
1727:
1724:
1719:
1715:
1711:
1707:
1703:
1699:
1691:
1688:
1683:
1679:
1674:
1669:
1665:
1661:
1657:
1653:
1649:
1642:
1639:
1634:
1630:
1625:
1620:
1617:(5): 1242–8.
1616:
1612:
1608:
1601:
1598:
1593:
1589:
1584:
1579:
1575:
1571:
1567:
1563:
1559:
1552:
1549:
1544:
1537:
1535:
1533:
1529:
1518:
1514:
1507:
1505:
1501:
1498:
1493:
1491:
1487:
1475:
1474:
1466:
1464:
1462:
1458:
1453:
1449:
1444:
1439:
1434:
1429:
1425:
1421:
1417:
1410:
1408:
1404:
1399:
1395:
1391:
1387:
1383:
1379:
1375:
1371:
1363:
1360:
1355:
1348:
1345:
1340:
1336:
1331:
1326:
1321:
1316:
1312:
1308:
1304:
1296:
1293:
1289:
1285:
1281:
1276:
1271:
1267:
1263:
1259:
1255:
1251:
1244:
1242:
1238:
1233:
1226:
1223:
1218:
1214:
1208:
1205:
1192:
1185:
1183:
1179:
1174:
1170:
1165:
1160:
1156:
1152:
1148:
1144:
1140:
1133:
1131:
1127:
1122:
1118:
1113:
1108:
1104:
1100:
1096:
1092:
1088:
1081:
1079:
1075:
1064:
1060:
1054:
1052:
1050:
1046:
1041:
1034:
1032:
1030:
1028:
1024:
1021:
1016:
1014:
1012:
1010:
1008:
1006:
1004:
1002:
1000:
998:
996:
994:
992:
990:
986:
981:
977:
972:
967:
963:
959:
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2243:2019-03-08
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