The first peer-reviewed study of farmers and ranchers living with alpha-gal syndrome (AGS), a tickborne allergy to red meat, has been published in the Journal of Agromedicine.
More than 200 farmers and ranchers across 26 states were surveyed on their experiences with tick bites, AGS awareness, symptoms and obtaining a diagnosis. Key findings included:
- On average, individuals had three healthcare provider visits prior to diagnosis though some reported more than 10 visits.
- The most common medical providers that diagnosed individuals with AGS were general practitioners and allergists.
- Individuals were uniquely grouped into one of four AGS symptom classes and symptoms can differ by sex.
“The purpose of this survey was to understand how this emerging allergy was impacting the farming and ranching community members with AGS by asking them questions about their work, their physical health and their mental health,” said researcher Shaun Cross, Ph.D., assistant professor in the University of Nebraska Medical Center College of Public Health. “We received great feedback and are excited to share this information across a series of publications and stories.”
The article is open-access at this link, https://doi.org/10.1080/1059924X.2026.2729161
The Journal of Agromedicine has been edited since 2004 by scientists and staff of the National Farm Medicine Center, Marshfield Clinic Research Institute, and receives philanthropic support through the Auction of Champions. The journal is published by Taylor and Francis.
AGS is spreading
In the United States, AGS is spread primarily through the bite of the lone star tick. In recent years the lone star tick has pushed out of its traditional range in the southeast United States and into areas previously too cold for them. Most of the survey respondents lived in Missouri and Oklahoma.
Alpha-gal syndrome affects nearly half a million Americans, according to estimates from the Centers for Disease Control and Prevention. For farmers and ranchers who are in close contact with livestock every day, the allergy can be especially challenging.
Cross said the research team heard from people who’ve had to hire more help, stop raising livestock or leave farming altogether.
“The idea of a person shuttering down a farm that’s been in their family for generations because of this new diagnosis, I can only imagine what that feels like,” Cross said. “That has to be devastating for these farms.”
Difficult to diagnose
The study also highlighted significant diagnostic hurdles faced by this high-risk occupational group, with participants reporting an average of nearly three medical provider visits before receiving an accurate diagnosis.
“Three medical visits are costly and frustrating for the patient who is experiencing these symptoms,” Cross said. “It is also a burden for farmers and ranchers in rural areas who have to drive far for medical treatment and lack access to medical specialists. Furthermore, time away from the operation is often difficult for farmers and ranchers.”
The study identified four distinct symptom clusters, with the most frequently reported symptoms including abdominal cramping, diarrhea, itchy skin, and nausea. Notably, women more often reported gastrointestinal discomfort, while men were more likely to fall into the mild symptom category.
“This report contributes to the evolving AGS literature because even in a sample of 201, we provide evidence that the symptoms cluster in a pattern among those afflicted,” Cross said. “We showed that diagnosis is easier when the symptom pattern looks like an allergy.”
National attention
Already this work has received national attention as Cross was invited to present results of the study at the first National Convening on a National Strategy for Alpha-gal Syndrome, hosted by Food Allergy Research and Education (FARE), Oct. 27-28, in Washington, D.C. Cross emphasized the importance of recognizing the broader impacts of AGS in occupational health, particularly within rural and agricultural communities.
“Farmers and ranchers are at an increased risk of exposure to ticks from working outdoors,” Cross said. “It’s crucial that healthcare providers, especially those in rural areas, are better equipped to recognize AGS symptoms and understand the unique occupational implications for these individuals.
Alpha-gal is a molecule (galactose-α-1,3-galactose) that is naturally produced in the bodies of most mammals but not in people. It is also found in the saliva of some ticks, most commonly the lone star tick. When a tick bites, it can transfer alpha-gal from its saliva into a person’s body. The body’s natural defenses, or immune system, can identify alpha-gal as a threat and trigger an allergic reaction. Symptoms can range from mild to severe, and some may be life-threatening. Symptoms occur after people eat mammalian meat such as beef, pork, or venison or are exposed to other products made from mammals, including dairy and medications. Because of this, AGS is also sometimes known as red meat allergy or tick bite meat allergy.
More than 110,000 suspected cases of AGS were identified in the United States between 2010 and 2022. However, cases of AGS are not nationally notifiable to CDC. The actual number of AGS cases in the United States is not known, but as many as 450,000 people may be affected. For more information on AGS, visit the CDC web page.
