No red meat, no dairy, and no end in sight: How a tick-borne allergy has transformed Martha’s Vineyard

“Lone star tick,” he said, coolly.

This was one of the scary ones, the relatively new arrivals that spread alpha gal syndrome, an incurable allergy to red meat, dairy, even some medicines found in everyday life across the island.

Martha’s Vineyard is famous as a summer playground for presidents and celebrities, but a nearly microscopic menace now haunts the dune grasses, marshlands, lawns, and scrub that cover nearly all this island.

While ticks are nothing new to Martha’s Vineyard, alpha gal is, and the fear of contracting it casts a shadow over virtually every aspect of summer fun, from flip-flops to burgers on a grill.

Want to hike safely? Wear long pants tucked into your socks. Not exactly ideal summer ware. Longtime islanders have to be wary of going in their own yards, and school lunches pose a threat to kids who might be allergic. Even some medicines pose a risk if the gel caps they come in are derived from animal proteins that could trigger an outbreak.

The tiny bugs have some neighbors at odds over the chemicals used to control ticks.

The upheaval on Martha’s Vineyard, as well as on neighboring Nantucket, may be a preview of what the mainland can expect, said Dr. Catherine Brown, the state epidemiologist and public health veterinarian. Lone star ticks are turning up elsewhere in Massachusetts, and alpha gal has been diagnosed in people with no clear ties to Martha’s Vineyard, suggesting the ticks may be advancing beyond the islands.

“Those two things combined make me very suspicious that these are things we’re going to see expand across the state,” Brown said.

While most experts say that tackling the massive population of deer on the island is the best way to reduce tick numbers, that will take time. And there are signs the life cycle of the lone star tick is not as tied to deer as it is for other species, said Martin Feehan, deer and moose biologist at MassWildlife.

Meanwhile, residents and island leaders are clinging to anything that might help. Chemical sprays, organic sprays, pesticide-treated clothes, acupuncture, herbal medicine, even genetically engineered mice — all are on the table as preventatives or cures.

Back in Aquinnah, Roden-Reynolds stood on the lawn with homeowner Jon Posner. He had sprayed the perimeter of his lawn with a heavy duty pesticide, lambda-cyhalothrin, he said. His neighbor wasn’t happy about it, he noted. That kind of spray can kill other invertebrates, including pollinators, Roden-Reynolds said, but it seemed to work. He’d found just nine ticks during his survey, all outside where Posner had sprayed.

Then he spotted a 10th as a red speck crawling up Posner’s right pant leg. Roden-Reynolds plucked it off with tweezers. A lone star nymph, just as capable of transmitting the alpha gal syndrome as its adult brethren.

Four years ago, when the InterIsland Public Health Excellence Collaboration hired Roden-Reynolds, he found lone star ticks mostly in the island’s less populous southern stretches. Now they’re everywhere. In 2021, Martha’s Vineyard Hospital ran 78 tests for alpha gal. Last year, the number topped 1,600; about 44 percent were positive.

“We’ve come to the point that the tick problem is so overwhelming, people are desperate for any solution,” Roden-Reynolds said.

The hospital doesn’t have exact numbers of patients seeking care for alpha gal syndrome, but that will soon change. Governor Maura Healey made the syndrome a reportable condition as of April and the state hopes to release numbers later this summer.

Ticks have long been a problem on the island and throughout the state. Lone star ticks, though, have changed the game on an island where residents have become blasé about getting Lyme disease multiple times.

Likely brought to Martha’s Vineyard and Nantucket by migrating birds, lone star ticks are native to the American South, but climate change has allowed them to survive in northern coastal areas and given them a longer active season. Their typical period runs from April through September.

And they are more likely than deer ticks, which carry Lyme, to be found in the short grass of a mown lawn.

“Even just a few steps outside your door is a real risk,” said Roden-Reynolds.

Lone star ticks are also faster and more aggressive than other species. Their larva cluster into what’s called a tick bomb. When disturbed, the larva, about the size of a grain of sand, can swarm a person by the hundreds.

The source of the allergy is a sugar in lone star ticks’ saliva. It sparks an immune reaction when it enters the blood of a person bitten. For many, that never causes a problem. But for some, that sugar primes their immune system to wildly overreact when they eat food that contains that same molecule, such as red meat and dairy. Symptoms range from a mild rash, hives, itching, stomach pain, and diarrhea to, in some, anaphylaxis. It is believed that repeated bites from lone star ticks can worsen the allergic reaction.

It remains unclear why only some people develop the allergy. Adding to the confusion, allergic reactions often kick in hours after a meal, leading to the nickname, the midnight allergy.

Alpha gal syndrome was first identified less than two decades ago, and there is much about it that remains unknown. But it is becoming more common: One study found a more than 5,000 percent increase in five-year case counts between 2015 to 2020 and 2021 to 2025.

People with the allergy find the reaction can rear up from unexpected sources.

Nancy Aronie, a columnist for the Martha’s Vineyard Times and a Chilmark resident with alpha gal syndrome, underwent open heart surgery in January. Her care included the blood thinner heparin, which is typically derived from the intestinal tissue of pigs. Aronie was soon covered in hives, she said. (A 2022 study determined alpha gal allergies rarely react to heparin.)

Likewise, anything made with gelatin, including gel capsules used for medicines, can be a threat. For some people, even the smell of a burger on a grill can trigger a reaction.

“I’ve been very, very good about sticking to the diet,” Aronie said. “I had to change my shampoo, needed pills with vegan gel caps. I couldn’t go a day without a breakout.”

When she has a reaction, half a Zyrtec usually helps quickly, she said. She’s resigned herself to living without some favorites, “parmesan reggiano cheese, pizza, cheese on my Caesar salad,” and has embraced duck bacon. Recently, she’s found acupuncture surprisingly effective at reducing her sensitivity.

Rick Fischer, 68, a New York transplant to West Tisbury, has felt isolated from friends and his favorite activities since contracting alpha gal two years ago. Even when a restaurant claims to have an alpha gal-friendly menu, he doesn’t trust that a piece of chicken wasn’t cooked on the same surface as a steak. Friends are uncomfortable inviting him over for meals, he said, for fear of accidentally triggering his allergy.

“I don’t get invited to barbecues anymore,” Fischer said.

His reactions include hives, swelling in his face, itchiness, tingling on his hands and feet, and constrictions in his throat.

The allergy can fade, and he’s begun carefully testing his sensitivity. He recently ate pizza with mozzarella and parmesan cheeses. He had no reaction. But he can’t risk another tick bite that could enflame the allergy.

“I miss walking around in a bathing suit in my bare feet,” Fischer said. “That’s over.”

The entire island is reorienting itself around the reality of alpha gal syndrome. At the popular Mocha Mott’s coffee shop in Oak Bluffs, shelves are now stocked with “alpha-gal friendly” chocolate chip brownies and molasses cookies that are dairy free. Jennifer LoRusso, owner of the Chilmark General Store, trained staff to help people find alpha-gal-safe foods on the shelves. The store, famous for its generous slices of pizza, is considering serving a cheese-free tomato pie.

There is little guidance, though, and LoRusso is among those confused about how best to protect customers, she said. She would like to carry EpiPens, but has been told by the town health department she cannot out of concern they wouldn’t be used properly.

Jenna Petersiel, owner of the tony, intimate Chilmark Tavern next door, prefers to ask customers about their alpha gal sensitivity before they even arrive. She offers chicken, fish, and a new duck dish that are alpha gal safe, but acknowledged people with severe allergies may not want to risk eating out.

“Right now the best they have is Google,” said Lea Hamner, an infectious disease epidemiologist with the Martha’s Vineyard Tick Program. “It’s not codified at all.”

Schools, too, are learning to provide students with lunches that are alpha gal safe.

“This is what I tell my whole staff: they’re on a vegan diet, but they can have chicken or fish,” said Gina deBettencourt, a chef and kitchen manager at the Edgartown School, where a handful of kids have the allergy.

Hamner noted Congress is considering a bill to classify alpha gal syndrome as a major allergen, which would lead to food labeling requirements and restaurant training.

An unanswered question is what alpha gal will do to the island’s tourist industry.

Some longtime residents doubt ticks will deter visitors from enjoying the island’s rustic charm.

“We still have wonderful beaches,” said Betsy Larsen, who owns the Chilmark institution Larsen’s Fish Market. “Very few people get ticks on the beach.”

While alpha gal has drawn new attention to the tick problem, it’s not the only tick-borne illness afflicting the island. Martha’s Vineyard has the state’s highest rate of babesiosis infections, a malaria-like illness, and many residents say Lyme disease infections are routine here. At particular risk are those who work outdoors.

About 14 years ago, Jadivan DaSilva, a landscaper and member of the island’s large Brazilian population, caught tularemia, a life-threatening illness spread to wildlife by ticks. He was hospitalized for four days.

The island’s landscapers are so accustomed to ticks as a workplace hazard, they have been slow to adapt to the new risks of alpha gal.

“The island doesn’t stop because of ticks,” he said.

There are warning signs, though.

Some of Aronie’s friends said they won’t visit the island this summer due to concerns about the ticks. Fischer hasn’t seen his daughter in two years and has yet to meet his 6-month-old grandson, because his family is nervous about coming to the island. He erected a 9-foot fence to keep deer off his property, he said, which he hopes will make visitors more comfortable.

Alpha gal has also caused new tensions.

Lawn pesticide sprays are inherently controversial, and Roden-Reynolds considers them an option of last resort because of the ecological harm they cause. Organic sprays made of essential oils are more environmentally friendly, but it’s not clear how effective they are against ticks, the biologist said.

But even the supposedly friendly pesticides can irritate humans. In May, Nisa Counter, a Chilmark resident, raised concerns with the local department of public health about a severe allergic reaction she had to an organic spray her neighbor used that blew onto her property. The symptoms, swelling of her lips and face, numbness, and throat discomfort, lasted for hours.

“My concern is not only about individual sensitivity, but about how these products are being applied in residential areas without clear communication, consent, or consideration of drift,” Counter said by email.

Essential oil sprays are less heavily regulated than chemical pesticides, and concerns drew nearly two dozen people to the board meeting, said Katie Carroll, the chair of the Chilmark Board of Public Health, an unheard of number. Residents are frustrated with the lack of regulations and guidance.

“Just because they’re all natural doesn’t mean they’re safe and nontoxic,” she said.

One company that uses essential oils, Oh Deer Martha’s Vineyard, , is called to about 100 homes a week for yard treatments, said owner Mario Spindola, who is getting his workers to be more careful about keeping the spray from drifting into other people’s yards. The cedarwood oil mix, with some lemon grass, castor oil, coconut oil, soap, and water mixed in, is about 70 to 80 percent effective at reducing ticks on most lawns, he said.

“We always stress that the spraying doesn’t preclude the need for the personal tick protection,” he said.

Meanwhile, medical providers are finding their practices transformed by ticks. Martha’s Vineyard Hospital’s emergency department is at times flooded with tick-related complaints. Two staffers are dedicated to patients with tick-borne illnesses, said Dr. Ellen McMahon, the hospital’s chief of medicine.

In May, Martha’s Vineyard Medical, a private practice in Vineyard Haven, launched the Tick Center, aiming to meld conventional medical treatments with holistic care. The center offers patients meditation, yoga, and therapy to address both alpha gal and the frustration, isolation, and anxiety that can accompany the allergy. Acupuncture appears to give some patients relief from the worst symptoms, said Katie Friedman, a nurse practitioner there.

“Anecdotally, that has had a good amount of success,” she said. “That’s sort of how I base my practice — let’s try to manage your symptoms.”

In collaboration with Yale researchers, the Vineyard Haven practice is testing up to 1,000 asymptomatic people for the alpha gal antibody. It might help explain why some people develop allergies and others don’t, and could eventually lead to a vaccine, said Dr. Gerry Yukevich, the center’s medical director.

Few on the island have more exposure to tick-borne illnesses than Roden-Reynolds, the biologist, but he has yet to develop the alpha gal allergy. He loves living on the island and isn’t afraid of the ticks — he’s even thinking of getting a tick tattoo exactly the size of the bug itself. The Virginia transplant grew up hunting and fishing with his father, and his study of wildlife conservation was a natural extension of his passion.

“It’s hard to get me off this island during hunting season,” he said.

The island’s wildlife — rabbits, mice, and, especially, deer — are critical vectors for ticks. A single deer can host hundreds of ticks, and the island has an overabundance of them: an estimated average of about 55 deer per square mile, with significantly more in rural pockets. The ideal deer population for that space is between 12 and 18, said Feehan of MassWildlife.

The natural landscape of the island’s southern stretches, a tangle of oak scrub, greenbriar, thorns, and brambles, makes for an ideal deer habitat but also is virtually impenetrable to hunters. Yet, hunting is considered the most effective and sustainable remedy.

The state expanded the hunting season for deer on Martha’s Vineyard and Nantucket, and Healey proposed three changes that experts said are significant: lifting a ban on Sunday hunting; shrinking the radius around a home where archery is not permitted; and allowing crossbow hunting, which may attract hunters who can’t wield a long bow.

The island participates in a food pantry donation program that accepts venison from hunters, which both culls deer and helps food scarcity. The program took in 102 deer this past hunting season, compared to just 17 the year before.

“It’s exciting to me that we actually have a way out,” said Virginia Barbatti, a founder of Tick Free MV. “We’re not stuck in this situation.”

Another solution under consideration is releasing genetically engineered white-footed mice that will pass on an antibody that would prevent ticks from spreading Lyme disease. The mice could be engineered within six months to a year and ready to be released on a small private island soon after, said Dr. Joanna Buchthal, research director of the Mice Against Ticks project at MIT. While her current research isn’t focused on alpha gal syndrome, the technique could be adapted. Eventually, the method could create mice that block the ability of ticks to feed, potentially starving the island’s tick population.

For now, dodging the allergy comes down to people being willing to forgo shorts and flip-flops in favor of shoes and pants, preferably ones treated with the tick-killer permethrin.

Islanders say they may have to adapt but won’t leave. Near sunset last week, Frank and Lauren Giglio, who have lived in West Tisbury for almost four decades, picked up fresh oysters and lobster at Chilmark’s Larsen’s Fish Market and sat behind the store to eat and watch as the sun set over the island’s placid water.

“Everyone who comes down here to enjoy all this beauty, to enjoy this beautiful place,” said Frank Giglio, “are not running from ticks.”

Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.