This year marks a 50th anniversary few of us are celebrating — the identification of a new illness (which has probably been around for thousands of years) — Lyme disease.
This illness, caused by a spirochete (a wiggly spiral shaped bacteria) called Borrelia Burgdorfi, is known by its tell-tale, “bulls-eye rash,” erythema chronicum migrans (ECM.) But half of the people who are infected with this bacteria may get a different looking rash, or none at all.
The first sign of Lyme disease is often a flu like illness, or if untreated — secondary disease resulting in arthritis, or more delayed cardiac or neurologic complications likes Bell’s Palsy. Despite treatment with antibiotics, 10% of adults may go on to develop post-treatment Lyme disease that can cause a debilitating mix of fatigue, malaise, joint pain, insomnia, and other symptoms similar to chronic fatigue syndrome, or long COVID.
Lyme disease is recognized as the most common vector-borne disease in the United States, affecting a half million people a year. When a black-legged tick (formerly called a deer tick), which is carrying the B. Burgdorf, latches onto a person, it may transmit this bacteria, which causes Lyme disease.
Lyme disease is most common in the spring, when the young ticks (called nymphs) are most active, and the fall, when the adults are most active. Nymphs are often missed, since they are the size of poppy seeds, but the adults have a characteristic black shield and a hard reddish-brown body.
As a pediatrician, I often had to remove ticks from struggling little patients when parents were unsuccessful. I got used to reassuring parents that the angry red reactions some kids got at the site of the tick was not ECM but a normal inflammatory response. As someone who loves the outdoors, I’ve had many of these reactions that lasted days or even weeks.
My hunch that this immune response might actually help prevent Lyme disease may be born out by recent research: After an effective recombinant monoclonal antibody vaccine, approved in 1998, was withdrawn in 2002 because of poor sales, ongoing research has concentrated on developing a vaccine directed not against the spirochete, but against the tick — evoking just this kind of inflammatory response.
Then there are the other diseases which may be spread by the black-legged tick. They are much less common than Lyme disease but growing in prevalence. They include anaplasmosis and ehrlichiosis, both caused by bacteria, and babesiosis, caused by a parasite. They all cause flu-like symptoms and are treatable with appropriate medications. All three are especially dangerous for the elderly and immunocompromised. Finally in the rogue’s gallery of black-legged tick-borne illness are viruses like the rare but deadly Powassan virus, which causes a flu syndrome but may also lead to seizures, and even death.
There are two other common human ticks: One, well known to dog owners is a plain brown tick with a soft body called, unsurprisingly, the American Dog Tick. It’s usually benign but may rarely transmit a very serious illness — Rocky Mountain spotted fever, mostly in southeastern states (not in the Rockies).
The tick which has become most notorious in the last year is the Lone Star tick. This critter has spread far from its home base of Texas, to become, in some areas of New England (like Rhode Island, and Martha’s Vineyard) the dominant tick species. The adult male has a speckled brown back resembling a tortoise shell, and the female is red with a tiny central spot.
Lone star ticks can be aggressive, swarming like bees. This tick has gained notoriety after reports emerged of people developing anaphylaxis — wheezing, vomiting, hives, hypotension, and even death — several hours after eating a hamburger or other meat. The illness was traced to sensitization to a sugar present in beef, pork, lamb and dairy products, caused by the bite of a lone star tick. It was first identified in 2010 and given the name alpha gal syndrome, named for the sugar called galactose-alpha – 1,3 galactose, present both in non-primate mammalian meat and lone star tick saliva.
Cases have burgeoned in the last decade, with the number of suspected cases reaching 450,000. Allergist Margaret Shannon, of Pioneer Valley Allergy Associates, has seen several cases, and says she routinely tests anyone with anaphylaxis of unknown cause for alpha gal. The allergic reaction may fade over time and is treatable by an expensive monthly injection of a monoclonal antibody called Xolair. In the meantime, any person with alpha gal must carry an epinephrine auto injector in case of a meat or dairy exposure.
Alpha gal presents an ironic situation. The meteoric rise in tick populations and tick-borne illnesses is in large part due to climate change. Warmer temperatures have led to northerly spread of ticks like lone star. Milder winters mean more ticks can survive the winter. And suburban development, with broken patches of forests and fewer predators, has led to more deer which carry ticks. (If there are deer on your property, you’re four times more likely to have ticks).
The production of beef is a major contributor to climate change, responsible for nearly 15% of all greenhouse gas emissions. This led to two philosophers, in a 2025 article in the journal Bioethics to propose that ticks carrying causing alpha gal are “beneficial bloodsuckers,” causing people to stop eating (or raising) cattle. This may be an extreme position, but gives one pause, especially considering that Health and Human Services Secretary Robert F. Kennedy Jr.’s obsession with red meat as the top food on his new jiggered food pyramid — leading to beef consumption in the U.S. rising by 10% in the last year.
In the meantime, it is best to treat oneself, and your children with tick precautions as outlined in an excellent review in the May/June issue of Consumer Reports. Doctors now prescribe one dose of doxycycline for adults and kids with ticks embedded for over 24 hours or for unknown periods. But this does not prevent the severe allergic reaction spread by lone star ticks. For now, only avoiding ticks will prevent alpha gal, or becoming a vegan who still eats fish or chicken.
Dr. David Gottsegen of Belchertown is a pediatrician who focuses on the interrelationship between mind, body and spirit.