Tick-borne allergy poses hidden risks in dentistry

Iveta Ramonaite, Dental Tribune International

Tue. 19. August 2025

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BALTIMORE, US: Alpha-gal syndrome is a delayed allergic reaction to a specific carbohydrate molecule found in mammalian meat and certain medical products and has important, yet under-recognised implications for dentistry. In a recent literature review and case report, researchers from the US have examined the potential for alpha-gal syndrome reactions related to dental products and identified multiple materials and ingredients that could pose risks to affected patients. Their findings highlight the urgent need for awareness, careful product selection and collaboration with medical specialists to prevent severe allergic events in the dental setting.

Prof. John K. Brooks has recently published an important review on alpha-gal syndrome. (Image: University of Maryland)

According to the US Centers for Disease Control and Prevention (CDC), more than 110,000 suspected cases of alpha-gal syndrome were identified in the US between 2010 and 2022, over 90,000 of them from 2017 to 2022 alone—indicating a marked increase in cases in recent years. The CDC reports that at least 90% of patients with alpha-gal syndrome react to red meat, and nearly 52% progress to anaphylaxis. Because symptoms often appear 3–8 hours after exposure, identifying the trigger can be challenging.

Although most cases are linked to bites from the lone star tick—common in south-eastern and south-central US states—patients have been diagnosed nationwide, and reports from other countries are emerging. The condition affects all age groups, and the average age of diagnosis is 48.

Lead author of the study Dr John K. Brooks, a clinical professor in the Department of Oncology and Diagnostic Sciences at the University of Maryland School of Dentistry in Baltimore, told Dental Tribune International that his interest in alpha-gal syndrome began in 2022 and was prompted by the scarcity of information on the topic in the dental literature: “I had examined a patient in our dental clinic who elicited a history of alpha-gal syndrome. She provided a detailed history of her adverse incidents, particularly one episode related to her taking an antibiotic for a dental infection. She stated that the antibiotic was contained in a bovine-based gelatin capsule, resulting in potentially severe allergic reaction. This outcome prompted me to search the medical literature to learn more about this condition and ascertain whether other patients had had similar experiences.”

Discussing some insights from his literature review and case report, he noted: “I learned that the saliva of a lone star tick contains a complex carbohydrate. When bitten by this tick, this substance primes one’s immune system to prepare it for re-exposure. When subsequently exposed to foods (mainly red meats and dairy products), medicines, and other medical or dental products that contain similar chemical compounds found in tick saliva, individuals may develop an acute hypersensitivity reaction, including difficulty breathing, rash and itching, and, concerningly, anaphylaxis.”

As part of the study, Prof. Brooks and his team analysed a wide range of dental products, combing through ingredient lists, reviewing safety data sheets and visiting retail pharmacies to verify formulations. “There are many dental products that may contain compounds that could promote an alpha-gal reaction, such as haemostatic solutions, suture materials, toothpastes, artificial saliva substitutes, fluoride gels, soft-tissue and bone grafting materials, tooth prophylaxis pastes and mouthwashes,” he said. “Many of these aforementioned products contain gelatin, collagen, glycerine and other compounds that could trigger a reaction with repeated exposure.”

“There are many dental products that may contain compounds that could promote an alpha-gal reaction.”—Prof. John K. Brooks, University of Maryland

The team also identified five documented cases of alpha-gal reactions related to dental procedures—four involving haemostatic agents and one linked to a gelatin capsule. All cases required emergency medical intervention.

In light of the findings, Prof. Brooks emphasised that awareness and preventive measures are essential. As case numbers continue to rise, dental professionals have a vital role to play in identifying at-risk patients and preventing life-threatening allergic reactions in the dental chair. “Oral healthcare providers need to be familiar with the alpha-gal syndrome and carefully review the ingredients of dental products before use in affected patients. When a patient has mentioned that he or she has had this condition, the attending clinician should consult with the patient’s allergist or internist to be apprised of the relevant inciting chemical agents and inquire about management strategies that have been employed. Moreover, the attending clinician needs to be prepared to manage an emergent outcome associated with a severe allergic reaction.”

The literature review and case report, titled “Alpha-gal syndrome: Potential for a hypersensitivity reaction after the use of dental products”, was published online in the July 2025 issue of the Journal of the American Dental Association.