Dr. Tick on the Lone Star Plague of 2017
After a weird winter, weather-wise, tick are out in mindboggling numbers. And with a tick-borne meat allergy on the rise, it's time for a talk with one of the East Coast's foremost experts
Erin McGintee has the strong jaw and easy smile of a college jock, which may give her clients confidence after they’ve had a traumatic encounter with a local tick. She is in fact, Dr. Tick, the not-so-sexy sobriquet she earned as the go-to specialist for people with the red-meat allergy, which is transmitted by the lone star tick. As Dr. Tick, she is encyclopedic on all the various nasty outcomes a human can suffer from a tick bite, and is a bit contrarian on the treatment of Lyme disease. “As much as Lyme disease is a big, big problem out here,” she says, “I think it probably gets over-diagnosed due to the fact that we need to have this low threshold for treating if we have any suspicion.”
According to some ecologists, this is not the year to get complacent about tick-borne Lyme disease. Based on the reliable correlation between the mouse population and Lyme infections, 2017 should be an especially risky year. Since an off-the-charts infestation of mice was reported in the Hudson River Valley the previous year, and as many as 100 ticks can hitch a ride on one mouse, it’s not alarmist to say that we may be looking at a Lyme plague this year.
“There’s no place in the Northeast that has close to as big of a tick problem as we have,” McGintee says. “The North and the South Forks are the perfect breeding ground — Tick Central. We’re at the end of an island, and there are no natural predators for the deer that often carry them, so their population is out of control.” The three species to look out for are the blacklegged, or deer tick, the American dog tick, and the lone star tick whose name comes from the white mark found on adult females, and not from any fondness for Aggie football or Willie Nelson. Both nymph and adult blacklegged ticks carry Borrelia burgdorferi, the bacterium that transmits Lyme disease. Is it a myth that the small ones are the most dangerous? Dr. Tick clarifies.
“It is true that the smaller the tick you find on your body, the higher the chance it carries Lyme disease. The tick has to be on your body for a long time for you to contract Lyme disease, and the smaller ticks are harder to detect.”
What is confusing is that the Lyme carrier is called a deer tick; their hosts are typically meadow mice. Lyme hogs the spotlight from the other tick-borne diseases you can catch out here, including ehrlichiosis, Rocky Mountain spotted fever, and babesiosis. In 2015, the Suffolk County Human Tick and Vector-borne Diseases Task Force reported 231 cases of Lyme disease, followed by 197 cases of babesiosis, 114 cases of ehrlichiosis, and 8 cases of Rocky Mountain spotted fever.
When you look at the symptoms of a Lyme infection untreated with a course of the antibiotic doxycyline, it’s easy to see why Lyme gets all the attention. Arthritis, Bell’s palsy, heart palpitations, meningitis, and short-term memory problems are often chronic, lifetime ailments, versus the passing migraines, diarrhea, confusion, fatigue, and nausea that can accompany the other tick-borne infections.
Erin McGintee has lived in East Hampton since she was 5 years old. No one in her family of five has ever been treated for Lyme disease. Maybe they were lucky, but vigilance helped. As a physician in her field, she preaches the gospel of prevention with notable urgency. “The biggest message that people need to take home is, apart from keeping your yard neat and your grass cut, is to be vigilant about using insect repellent when you’re spending time outdoors, and then checking and checking and checking — you and your kids.” Because the word has gotten out over the past decade or so and people are paranoid about Lyme, the number of cases has fallen from 1,800 in 1993 to fewer than 250 in 2015. Obviously, the gospel is spreading.
“Fortunately, Lyme isn’t even the issue I deal with,” she says. “And I’m kind of happy I don’t because it’s a tough discussion to have with people out here. The red-meat allergy I deal with is much more cut and dried, easier to treat.” It’s also new on the scene. As the daughter of a retired N.Y.P.D. detective who started in academics, she chose a specialty that requires a lot of digging for information. She first read about it in the medical journals in 2009 and started diagnosing cases on the East End in 2010. Today, she has around 370 cases of patients with this allergy, from Riverhead to the North and South forks, and even a few patients from Westchester and New Jersey.
McGintee says she came to the red-meat allergy “by necessity, because the lone star tick has outcompeted the deer tick out here. It’s very aggressive and fast – the only tick where the larval form will feed on the human host.” It seems that the more bites you get, the more likely you are to develop the allergy. This puts landscapers, people who work on golf courses, hunters, trail walkers, and birdwatchers in the cross hairs for what’s clinically known as the alpha-gal allergy.
“The worst thing that can happen is that you can have an anaphylactic reaction and die,” says Dr. Tick. “I’ve seen my patients get epi-pin injections on the scene, but that’s the worst. A sudden onset of hives after a meal of burgers or steak is the most common reaction.”
The allergy is not an infection like Lyme, so you can’t treat it with an antibiotic. So, what’s her role in helping people? “First of all, I teach them about the allergy, what food needs to be avoided, and how to treat a reaction if they have an accidental exposure.” Unlike an all-or-nothing peanut allergy, this is a little more nuanced.
“I’ll see a lot of people who’ve had a really severe allergic reaction to meat, and when I tell them I believe they have the red-meat allergy, they’ll say they ate meat two days ago with no problem.” Alpha-gal is strongly related to how much you eat and how fatty the meat is. It can change with time. You’re at your biggest risk of reaction in the several weeks or months following a lone star tick bite. As time passes, your antibody level will go down. The good news is that this is an allergy that can go away if you’re very vigilant about checking for lone star tick bites.
When should residents and visitors to the East End start their daily tick check? According to Dr. Tick, right now.
“The Memorial Day weekend is high risk for lone star ticks, as well as deer ticks. The nymphs and the adult ticks will be out in full force then. I would say you’re more likely to sustain a bite from a lone star tick than you are from a deer tick.”
Other than fanatical checking of your scalp area, and those damp, dark bodily nooks that these critters love, Dr. Tick advises keeping your lawn cut low, and your property clear of leaf and wood piles. If you work in grassy or wooded areas, be especially vigilant.
Since the great white shark in Jaws scared people out of the ocean here in 1975, there hasn’t been another creature more dreaded than these match-head-size pests. If the deer ticks and Lyme weren’t enough, now we have lone star ticks and the red-meat allergy. They’re new, they’re here in droves, and one doctor has decided to take them on.
It’s proven a smart career move. McGintee has become one of those doctors with a YouTube following and international media coverage. The folks selling steaks at Bobby Van’s may not be big fans, but say one of them busts out in hives one day and comes running to the Alpha Gal, as some of her fellow clinicians like to call Erin McGintee. We may start to see a few vegetarian items on the menu — who knows?