Study Reveals Hidden Dangers at Dentist Office for Tick Bite Allergy
Jeff Clayton knew he was having a medical emergency. The spring day in 2022 had started normally — including one of his favorite meals, a pit beef sandwich — but within hours, he was in the emergency room with a severe allergic reaction that included loss of consciousness and difficulty breathing.
John Brooks, DDS
It was his third mysterious allergic reaction in two months, each one following a meal containing beef. What Clayton didn't know was that a previous tick bite had changed his life forever.
"It has changed my relationship with food greatly," said Clayton, who was diagnosed that July with alpha-gal syndrome (AGS) — also known as red meat allergy or tick bite meat allergy. "Gone are the carefree days of ordering whatever I want in a restaurant and eating anything at parties.”
Clayton's experience reflects a growing health concern that has caught the attention of John Brooks, DDS, clinical professor in the Department of Oncology and Diagnostic Sciences at the University of Maryland School of Dentistry (UMSOD), whose groundbreaking study published in the May 2025 edition of The Journal of the American Dental Association warns that routine dental care could pose hidden dangers for patients like Clayton.
Alpha-Gal Syndrome
Alpha-gal syndrome develops after being bitten by a lone star tick, whose saliva contains a complex sugar called galactose-α-1,3-galactose. This exposure sensitizes the immune system, causing allergic reactions — ranging from hives to life-threatening anaphylaxis — when patients later come in contact with red meat, dairy products, or medical and dental products containing similar compounds.
According to the Centers for Disease Control and Prevention (CDC), more than 110,000 suspected cases have been identified in the United States since 2010, with the numbers rising rapidly. The CDC reports that from 2017 to 2022 alone, more than 90,000 cases were documented.
The condition affects all age groups, with an average diagnosis age of 48. While lone star ticks are most common in southeastern and south-central states, cases have been reported nationwide, the CDC notes.
A Patient's Story Sparks Research
Brooks' interest in alpha-gal syndrome began in the UMSOD Undergraduate Dental Clinic around 2022. A woman seeking routine dental care mentioned her AGS diagnosis, explaining how it had complicated her daily life.
"I had never heard of that condition before, and the patient was very gracious to explain what it was," said Brooks, who says he is intrigued by emerging threats in health care.
The patient's medical history was long and complex. Thirty-two years earlier, she had experienced an almost immediate "feeling of liquid fire in her body" and itching after receiving local anesthetic injections containing paraben, Brooks wrote in the JADA article. Seven years before meeting Brooks, she had developed severe itching after a flu shot that required a month of antihistamine treatment.
Most concerning was her alpha-gal diagnosis. Lab testing revealed elevated alpha-gal antibody levels, and an allergist had diagnosed class I alpha-gal syndrome, likely caused by tick bites she received while living in a heavily wooded area.
But it was her dental-related experience that would drive Brooks' research. Five years before their meeting, the woman was being treated for a dental abscess and was prescribed doxycycline in gelatin capsules by a private practice dentist. Within 12 hours of taking the second dose, she developed an "itchy" throat and swelling of her throat and tongue.
"She telephoned the Robert Wood Johnson Research Foundation in Princeton, N.J., and discovered that the doxycycline gelatin capsules were composed of animal-based gelatin," Brooks explained in the published case report.
The patient didn't return to the UMSOD clinic for about two years. When a dental student resumed her care and approached Brooks for consultation, his curiosity was reignited.
"That's when I started thinking about this condition again," Brooks recalled. He realized that while there was documentation about AGS in medical journals, dental literature was silent on the syndrome.
“There's essentially zero information in the dental literature on the topic, and I began mulling around the idea of preparing a manuscript so that the dental community would learn about it,” Brooks recalled.
Hidden Dangers in Dental Care
Brooks and his research team, including dental students Naomi and Ellie Hoch and colleague Ahmed Sultan, BDS, PhD, assistant professor in oncology and diagnostic sciences, conducted an extensive investigation of dental products. They scoured the internet for ingredient lists on vendor sites, reviewed material safety data sheets, and even visited drugstores to photograph product ingredients.
Their findings, published in a comprehensive literature review and case report titled "Alpha-gal syndrome: Potential for a Hypersensitivity Reaction After the Use of Dental Products," revealed that common dental products could trigger life-threatening reactions, including hemostatic agents used to control bleeding during oral surgery, certain toothpastes and mouthwashes, bone graft materials, collagen-based dermal fillers, some suture materials, and medications in gelatin capsules.
The research uncovered five documented cases of alpha-gal reactions related to dental procedures — four involving hemostatic agents and one involving gelatin capsules. All patients required emergency treatment.
For Clayton, who is not a patient of Brooks, this research hits close to home. "Yes, most definitely!" he said when asked if he had considered that dental visits could trigger symptoms. "I had a root canal last year and discussed AGS with the endodontist to ensure that nothing used for the procedure could trigger an allergic reaction."
Living with Alpha-Gal
Clayton's daily life now requires constant vigilance. "I no longer consume products containing dairy, beef, pork, lamb, etc., and try to focus on eating a more seafood and plant-based diet," he said. "Now, I ask questions, read labels thoroughly — even medicines — and never leave home without an EpiPen."
Brooks' patient faces similar challenges. Despite strictly avoiding foods and products that could trigger an episode, she continues to experience occasional breakthrough allergic reactions.
According to the CDC, at least 90 percent of patients with AGS have allergic reactions to red meat, and nearly 52 percent of those who develop reactions progress to anaphylaxis. Reactions typically occur three to eight hours after exposure, making the connection between trigger and symptoms difficult to identify initially.
"You have to become an almost neurotic person reading every single product you ever want to consider using so that you don't promote another alpha-gal reaction," Brooks said.
Prevention and Protection
The CDC emphasizes that prevention focuses on avoiding tick bites. When spending time outdoors, especially in wooded or grassy areas, the agency recommends using EPA-approved insect repellents, wearing long sleeves and pants, and doing thorough tick checks after outdoor activities.
If you find a tick attached to your skin, the CDC advises removing it promptly with fine-tipped tweezers, grasping the tick as close to the skin as possible and pulling upward with steady pressure. Clean the bite area and your hands with rubbing alcohol or soap and water and monitor for symptoms of tick-borne illnesses.
Knowledge Is Key
Brooks stresses that awareness is the first line of defense. Dental providers must learn to identify at-risk patients by taking thorough medical histories and asking specific questions about food allergies and tick exposures.
"If a patient admits they have alpha-gal, that’s the red flag," he said. "You need to know about your patient's health so that you can seamlessly move forward."
He recommends that providers consult with patients' allergists before treatment, carefully review all dental products for problematic ingredients, and maintain emergency protocols for severe reactions. For patients with AGS, he advises reading all ingredient labels, working with compounding pharmacies for safer drug alternatives, and carrying emergency epinephrine.
As tick populations expand across the United States and alpha-gal cases continue to multiply, Brooks' research represents more than an academic exercise — it's a critical wake-up call for an entire profession.
For the growing number of Americans living with alpha-gal syndrome, the research offers something invaluable: the knowledge that health care providers are gaining awareness about AGS in order to care for them safely and effectively. And as Brooks concluded, “Knowledge is power" for both the patient and the provider.
