Worst Fear: Alpha-gal Syndrome

The idea of spending five months walking with a heavy pack on, sleeping outside in all types of weather, and foregoing the comforts of home can sound scary. It definitely does scare me on occasion when I think about it. But, like, it scares me in a good way. Like, an I believe this will be challenging but I can handle it, kind of way. There are other things about the trail that scare me in a different way.

I am a very risk averse person by nature. I’ve never been on a roller coaster, I’ve never scuba dived. I’ve only been outside the continental United States twice (once to Montreal and once to Puerto Rico). The reason I never take risks is because I always play out the absolute worst thing that can possibly happen over and over in my head until I’m convinced it will. Do I want to stand on the edge of this moderately high building? No, because the exact second I decide to stand there I will get hit by a minor vortex that lifts me over the edge and drops me onto a giant pile of broken concrete and rusty safety razors and horse dung. The very fact that nothing like this has ever happened to me just reinforces the idea that my abundance of caution is the reason why.

I have several very specific fears about things that may happen to me on the Appalachian Trail. They range from the plausible to the irrationally unlikely. But rest assured that wherever on that continuum they lie, I remain equally concerned about them. Perhaps writing them out here in my blog will help to allay my fears. For my first specific fear I have something that is very real and even likely to occur. Fortunately, it is also easily preventable with care and discipline.

My first fear (that is first chronologically, not first in terms of the amount of heebie-jeebies it gives me) is alpha-gal syndrome. Alpha-gal syndrome is an allergic disease caused by a tick bite. Being bitten causes you to develop an allergic reaction to galactose-α-1,3-galactose (also known as alpha-gal). That carbohydrate is found in the meat of most mammals, which means once you get it you will no longer be able to eat beef, pork, or most other meat. Alpha-gal is not found in humans, so Soylent Green would still be okay to eat. In the worst cases, people with the syndrome are not able to consume dairy like milk or yogurt either.

The idea of an allergic reaction to alpha-gal is not unknown. What is scary is the idea of becoming allergic to the molecule after you eat it and it circulates in the bloodstream. Alpha-gal is the main reason why pig organs are rejected during transplantation into people. Our antibodies attack the carbohydrate and cause the organs to fail. Fortunately, scientists are engineering xenotransplants which lack that molecule.

Unfortunately, that does not matter with alpha-gal syndrome. When the tick bites you it can take up to several months to develop the reaction. The exact mechanism is not clear. The same tick could bite two people and one can get the syndrome and the other won’t. Once you have it, a few hours after you eat red meat the allergic reaction begins. No more steak or ice cream or hot dogs, for the rest of your life.

Which specific ticks can cause this? Way too many. Lone star tick, blacklegged tick, and western blacklegged tick are all known or suspected to cause it. Where is the lone star tick located? Why, the eastern United States of course. Isn’t that where the Appalachian Trail is? No shit. When are they most active? April to September. Well, fuck my life.

As horrific as this is, it can be easily prevented. Permethrin is a miracle compound. Our Army uniforms were impregnated with it and I can proudly say I never got a tick bite despite sleeping on exposed ground many, many times across the southeastern United States. It is also critical to frequently check yourself and each other for ticks when you have a chance. They like to hide in your underarms and between your legs, just like many perverts you encounter.

There are not many things worse than getting alpha-gal syndrome as far as I’m concerned. As scary as it is, practicing good hygiene and insect prevention is the key to making sure it does not happen to me. There are more than a few other scenarios I will go over in the coming months that are in some ways even more scary than this. I can’t wait to tell you all about them.