This story was featured in the Winter/Spring 2026 issue of Appalachia Journal.
James Mason and his wife, Dayle, enjoy a sunny hike on the Baldface Circle Trail. Hours later, Dayle’s mysterious allergic reaction would lead them back to the bite of a tick several months earlier. Photo by Jim Nourse.
We rose early, while it was cool, for our nine-mile hike. We wanted to beat the heat and thunderstorms forecast for late that afternoon. My wife, Dayle, and I were camped at a small quiet White Mountain National Forest campground near Basin Pond in isolated Evans Notch on the New Hampshire/Maine border.
We planned to cover the Baldface Circle Trail, one of our favorites. Although it attracts fewer people than flock to the White Mountains’ higher 4,000-footers, the route reaches spectacular exposed ridges after one scrambles up and around granite slabs that reach 3,610 feet, before it swings north to more views.
High above the valley, limited cell service finally came in, and we checked our weather app, which confirmed a 60-percent chance of late-afternoon thunderstorms. In the hot and muggy air, we saw no sign (yet) of building clouds, but we didn’t linger on the ridge. We relished the three-mile stretch above treeline, admiring the views on every side: the Carter Range and the Presidentials to the west and Maine’s Caribou-Speckled Mountain Wilderness to the east. In the light breeze, we talked about our seven grandchildren and noticed a few alpine wildflowers.
The open ridge ended as we descended the Bicknell Ridge Trail, and I thought how nice it would be to cook juicy burgers over the open fire back at camp. We had reduced our red meat intake in recent years, but I was looking forward to this treat.
Just as we arrived back at camp around 4 p.m., the heat and humidity gave way to the cold front and an intense, fast-moving storm that brought thunder and lightning bolts and drenched us for ten minutes. We were glad to be safely off the exposed ridge and cooked and enjoyed the scrumptious meal, sitting around the crackling fire until darkness nudged us in for the night. Tomorrow would be an easier hike, Blueberry Mountain.
Startled from my sound sleep at around 9:30 p.m., I heard Dayle in a calm but assertive voice: “I have a problem.” She had awakened to severe itching in her hands and feet. It soon progressed to her torso and whole body. Clearly out of sorts, she exclaimed, “I’m itching all over from the inside out—it’s making me crazy!” I thought, What the heck? As a longtime emergency medical technician, I knew right away this was a systemic allergic reaction—but, what was the invading allergen? Perhaps something she ate? But that was hours ago, and she hadn’t eaten anything she hadn’t consumed in the past. This had never happened before.
At its worst, an allergic reaction can swell the face and throat, restricting breathing. When that happens, the sufferer needs immediate intervention—an EpiPen, which I did not have. I anxiously dug into my backpack to find my medical survival kit and pulled out a foil packet of eight Benadryl tablets. Dayle took two with warm water to speed absorption. We hoped this would provide relief, but it certainly would not be immediate. The itching continued to intensify and she described feeling faint and queasy. “I think I’m going to pass out.”
Slightly frazzled, I helped her lie down and elevated her feet. This quickly eased her lightheadedness, she said, and her pale face soon returned to normal color. OK, what next? There was no cell service at our campground, it was late, and many miles of narrow, winding road separated us from a hospital. After about an hour into this drama and two more Benadryl tablets, her symptoms did not appear worse. Even so, I was figuring my next steps: where to find cell service to call an ambulance, whether a campground neighbor had an EpiPen, or should we get in the truck and head toward civilization now?
By midnight, her itching had mostly subsided, and the Benadryl-induced drowsiness made it easier to sleep. She dozed off, and I did too. We were up at 7 a.m., but not to hike Blueberry Mountain. We drove home to west-central New Hampshire, eager to seek medical advice. What was Dayle suddenly so allergic to? Her doctor asked lots of questions and suggested possibilities, but presented no clear answer, other than to “pay attention” and be prepared in case it happens again.
Well, that was not very reassuring.
About four weeks later, several hours after eating dinner, Dayle was in agony again with the same intense itching and hives. This time, we had eaten steak from the grill. Because we didn’t eat meat much, this episode helped to confirm that red meat was likely the cause. I searched online and discovered a meat allergy called alpha-gal syndrome (AGS). It’s caused by a sugar molecule found in all mammalian meat, including beef, pork, and venison. This carbohydrate is carried and transmitted by the lone star tick (Amblyomma Americanum), named for the single white splotch on the female tick’s back. The ticks acquire it by biting animals, often deer, and they pass it on by biting humans. Once this sugar molecule gets into humans’ bloodstreams, it can trigger allergic reactions to mammalian meat.
This happened nearly seven years ago. At the time, the lone star tick was predominantly found in the South and Mid-Atlantic states. Officials had not yet realized that the lone star tick had migrated north, transported primarily by deer, into northern New England. Back then, cases of AGS had rarely been seen in New Hampshire. This illness was simply not on our doctor’s radar. More recently, lone star ticks have been located in an even wider range of natural and domesticated environments than blacklegged (deer) ticks, making it more challenging to avoid.
In response to Dayle’s pointed inquiry about the possibility of AGS, her primary care physician identified and ordered a definitive blood test that proved positive for her alpha-galactose (a sugar molecule) antibodies.
Typically, allergic reactions to food such as shellfish or peanuts occur within minutes of ingesting. But experts on this disease, Drs. Scott Commins and Jessica Macdougall, have suggested AGS may take two to six hours to trigger a response from the body’s immune system. This delayed reaction makes it more challenging to pinpoint the cause. Symptoms may include mild to
severe itching, hives, low blood pressure, vomiting, and in worst cases, a lifethreatening anaphylactic emergency. To further complicate the AGS diagnosis, some individuals experience cardiovascular symptoms, whereas others have nausea and gastrointestinal distress without itching. The researchers also found that an allergic reaction may not occur for weeks or even months after the initial tick bite. These scientists speculate that AGS is the leading cause of adult-onset food allergies in high-prevalence areas. Similarly, the Centers for Disease Control and Prevention reports that the number of alpha-gal cases is rising significantly, and that other tick species can also transmit the sugar.
The information I’ll share now is based on my own extensive research. It is not intended to diagnose. I recommend contacting your healthcare professionals for particular situations, and that other tick species can also transmit the sugar.
Through our firsthand experience and associated research, it has become clear that this allergen exists not only in red meat but also in many other foods, and even medications that contain mammalian products. The anticoagulant drug heparin is one of these. Cow’s milk, gelatin, and many vitamin supplements also contain alpha-galactose and are capable of triggering an allergic or hypersensitive immune response. Even worse, carrageenan, which is extracted from red seaweed and used as a thickener and binder in many food products and medications, has been identified as a culprit for many with AGS. To be safe, Dayle now carries an oral antihistamine and an EpiPen with her everywhere. We know several others in our small New Hampshire town who have also been diagnosed with this life-altering condition. They can no longer eat red meat. One man suffers gastrointestinal symptoms similar to irritable bowel syndrome.
Unlike Lyme disease, anaplasmosis, and other tick-borne infections that can be managed using antibiotics, there is no treatment for AGS except to avoid red meat, beef, pork, lamb, dairy products, and other products containing alpha-gal. We continue to discover surprising places this allergen can be lurking: soaps, shampoo, sunscreen, and even ice cream. Ugh! In an effort to help others, AGS sufferers have developed websites, such as alphagalinformation.org to offer guidance and list products that could trigger an anaphylactic reaction in those afflicted.
Ticks are small, sometimes tiny, eight-legged parasites that feed on blood. Simply put, ticks go through four life stages: egg, larva, nymph, and adult. After hatching from eggs, ticks must ingest blood at every stage to survive. They usually acquire pathogens and this alpha-galactose carbohydrate early in life when they feed on non-primate mammals, like rabbits, mice or deer. Ticks don’t fly or jump. Instead, they use a passive behavior called “questing,” where they perch, front legs extended, ready to ambush a blood host. Ticks typically quest on vegetation like tall grass, shrubs,
and leaf litter, where they can easily come in contact with passing animals.
Only the female lone star tick has a telltale white dot. Photo by USDA.
I first observed this questing instinct one spring about 25 years ago in Utah. We were climbing Mount Nebo, planning to tent one night on the snow and ski from the summit on day two. While hiking up an overgrown trail we noticed (and tried to avoid) a dozen or so ticks questing atop individual blackberry canes that protruded well above the six inches of newly fallen snow. Research biologists claim that ticks survive well in cold and snowy environments because they contain naturally inherent “antifreeze”-like characteristics.
Ticks are drawn to certain stimuli: movement, exhaled carbon dioxide, and body heat. When a host brushes against a questing tick, its barbed front legs grab onto the host—it then crawls to a suitable location on the skin. Some ticks will attach quickly but others will wander, looking for places like the ear, or other areas where the skin is thinner. Regardless of where a tick attaches, it is capable of releasing saliva with anesthetic properties, so the victim is less able to sense it embedding. Once embedded, ticks begin feeding on blood and in turn, can inject infected saliva into the host.
If you’re an avid outdoors person or hiker, you are likely tired of yet another reminder to avoid ticks. However, as the tick populations continue to increase in volume and become more diverse, it’s not just Lyme disease we should look to dodge. Other serious life-threatening tick-borne illnesses have become prevalent throughout the eastern United States. The only sure way to avoid these illnesses is to prevent a tick from biting you. If you work or recreate in the outdoors, it’s a challenge to avoid ticks altogether, but the U.S. Department of Agriculture offers a few helpful recommendations, and I have added a few ideas of my own.
How to Avoid Ticks and Tick Bites
- Treat clothing with pyrethrum and use DEET-containing repellants.
- Wear light-colored clothing to improve your chances of spotting a tick.
- Tuck pants into socks and wear pre-treated “tick gaiters.”
- Stay on trails; avoid sitting on the ground; avoid contact with grass and brush.
- Do frequent tick checks, especially before entering your living space.
- Check backpacks and clothing for “hitchhiker” ticks.
- Shower and conduct thorough tick checks using full-length mirrors.
- Use fingertips to carefully palpate the entire scalp for any adherent ticks.
- If a tick is found wandering on you, carefully catch it, fold it inside clear tape, or submerge it in ethyl rubbing alcohol.
I use the “tape method” to securely capture the tiny and elusive crawling tick before it can escape. Once it’s stuck to the clear tape, fold the tape over to encase it. If you do find a tick attached to the skin, do not panic, but remove the tick as soon as possible. Do not wait to seek medical attention to remove the tick. Delaying tick removal to get help from a healthcare provider could increase your risk of contracting a tickborne illness.
The CDC recommends following these steps to remove a tick that has attached to the skin:
- Grasp the tick as close to the skin’s surface as possible using clean, fine-tipped tweezers. If fine-tipped “tick removal” tweezers are not available, use regular tweezers or your fingers to grasp the tick. Grasp the tick close to the skin’s surface to avoid squeezing the tick’s body.
- Pull tick away from the skin with steady, even pressure. Patiently wait for the tick to release. Don’t twist, jerk, or pull too hard. This can cause the tick’s mouthparts to break off and remain in the skin. If this happens, your body will naturally push the mouthparts out over time as your skin heals.
- Dispose of the live tick by taking one of these steps: Place it in a sealed container; wrap it tightly in tape; or put it in alcohol. Do not crush the tick with your fingers.
- After removing the tick, thoroughly clean the bite area and your hands with soap and water, rubbing alcohol, or hand sanitizer.
- If you find a tick attached to you, there may be other ticks on your body. Do a careful check to look for other ticks and promptly remove them.
Beyond this advice, I like to take a close-up photo of the tick that was detected and removed during its blood meal, and save the tick (inside folded tape, of course) to document the find for future identification and potentially determine a diagnosis and treatment options. Especially important: Keep any ticks from reaching your hair, where they’re nearly impossible to discover. If you have dealt with finding and removing ticks before, you know what I am talking about.
If you may have been bitten by a tick and develop the symptoms in the following list, within a few days or weeks, or even months in the case of AGS, see your healthcare provider. Your doctor will be interested in knowing the history of the bite: your geographical location, the size and color of the tick, how long the tick was likely attached, and whether it was engorged (enlarged with blood meal). This information will help to determine a course of treatment. Commercial labs will analyze captured ticks. Some of those labs claim to test for as many as ten different tickborne illnesses and give results in two to five days. That sounds great, but I have never used such a lab, and the CDC recommends against relying on such testing, instead suggesting that you consult your healthcare provider as soon as symptoms present. Alphagal symptoms can range broadly and often manifest differently from person to person. In most cases early diagnosis and treatment are key to avoiding serious long-term health consequences.
Apparently, there is hope for the meat allergy victim: For the last few years Dayle’s allergist has recommended biannual blood tests to assess the level of alpha-galactose antibodies present in the blood. When the antibody count goes down, as it can over time, it may be possible to once again enjoy a juicy burger over the campfire without an allergic reaction. Until then, for the sake of well being and convenience we stick to poultry and fish.
Considering our preferred outdoor activities, we’re not likely to stay home watching television to avoid ticks and their associated illnesses. For us, it’s just another precaution—like applying sunscreen, staying hydrated, and having all the gear required to survive a night out if necessary. We’re often managing risks and making important safety decisions in the wilderness, such as evaluating the weather before traversing an exposed ridge or sizing up our options when confronted with a precarious river crossing. Yes, the expanding tick populations and their many associated illnesses are clearly a threat—but a risk worth managing to be outside enjoying our yards, the woods, and hiking mountains. All tick-borne diseases are preventable—avoid being bitten. But, if you do find a tick that has attached to your skin, properly remove it as soon as possible and pay attention to any symptoms that could develop related to that bite. So, go take on the backcountry challenges—enjoy nature and the exhilaration experienced getting to the top, but be “tick wise” and be responsible when you venture out.
James Mason wrote the popular essay “Day Four” for the Winter/Spring 2023 issue. He is a custom furniture builder, skier, hiker, and Appalachian Trail maintainer. He lives in Lyme, New Hampshire, with his wife, Dayle. Jim has served on the Dartmouth Outing Club’s Safety/Risk Management Advisory Committee since it was formed in 1980 and is currently the safety officer of the Upper Valley Wilderness Response Team. Learn more at uvwrt.org.