James L. Cummins
When a Bull’s-Eye Rash isn’t Lyme Disease by James L. Cummins
Southern tick-associated rash illness (STARI) is an infectious disease related to Lyme disease that has spread from the Southeastern and South-central United States to the Northeast and Great Lakes regions. This disease is also known as Master’s Disease to honor Dr. Robert Masters, whose observations lead to further identification of the disease.
It is carried by the Lone Star tick, named so because of the white dot on the back of the adult female, not because of any association with the state of Texas. Diagnosis is based on a circular “bull’s-eye” rash at the site of the infection, which is very similar to that seen in Lyme disease, but smaller, and with more pronounced central clearing making the bull’s-eye appearance more apparent.
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The symptoms of STARI are mild and best described as flu-like, with fatigue, muscle aches, joint pains, and headache. Fever is sometimes present, and the rash usually develops within a week of the tick bite. According to the CDC, it is not known whether antibiotic treatment is necessary or beneficial for patients with STARI.
Nevertheless, because STARI resembles early Lyme disease, physicians will often treat patients with the same antibiotics that are used to treat Lyme disease, namely amoxicillin or doxycycline. No long-term effects are known for this disease. Along with infection of STARI, the Lone Star tick is also the vector of Q Fever and human Ehrlichiosis. It is also unique in that it can transmit a molecule that causes alpha-gal syndrome, which is a food allergy to red meat. People bitten by the tick develop an allergic reaction to red meat, in the form of itchy hives and/or the even-more dangerous, anaphylactic shock. This happens 3 to 6 hours after consuming beef, lamb, or pork.
This allergy has been found only in people who have been bitten by ticks, for the tick bite seemingly triggers the immune reaction. Those bitten by the ticks develop antibodies against the alpha-gal sugar, and individuals with symptoms can be diagnosed by a blood test that looks for the presence of those antibodies (IgE). This allergy affects people living in parts of the United States where the Lone Star is not found, e.g., Hawaii, therefore other tick species must also carry the same substance.
Because of the delay of an average of 4 hours between meat consumption and the onset of allergic symptoms, most people don’t make the connection. Between 2010 and 2022, the CDC reported there were more than 110,000 suspected cases of alpha-gal syndrome in the United States.
Although there are promising studies for treatments, there is presently no cure for this allergy making it imperative that you take all the precautions to avoid the bite of the Lone Star tick: DEET on the skin, permethrin on your clothing, regular tick checks when coming inside, and checking gear and pets for ticks as well.
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