The 47-year-old JetBlue pilot went to a barbecue, where he ate a hamburger, at roughly 3 p.m. He returned to his suburban New Jersey home and mowed the lawn for an hour. By 7:20, he was in the bathroom, vomiting. By 7:37, he was unconscious. Soon, his son was trying to resuscitate him.
The pilot, Brian Waitzel, was declared dead later that night. The conclusion of an autopsy: “Sudden unexplained death.”
Now, more than a year after Mr. Waitzel died, a team of doctors say they have found an answer.
The physicians linked his death to a growing menace: an allergy to red meat triggered by a tick bite. They published their findings last week in a medical journal, asserting that it is the first death of its kind linked to the tick-borne allergy, called alpha-gal syndrome.
The pilot’s widow, Pieper Waitzel, said that she recalled discussing alpha-gal once with her husband years ago, as they sat on the back porch of their home in Wall Township, in Monmouth County, reading the paper and sipping coffee. She came across an article about people stricken with meat allergies after tick bites — it sounded like a plotline out of science fiction. “I said to my husband, ‘You should read this,’” she recalled.
It seemed too exotic to worry about in Wall Township, where her husband had grown up. They were just inland from some of the Jersey Shore’s wealthier beach towns.
Alpha-gal, she said, “was just a little too obscure” to worry about. She put it out of her mind.
In the intervening years, cases of alpha-gal syndrome soared. The Centers for Disease Control and Prevention estimated in 2023 that between 96,000 and 450,000 people nationwide might have developed the allergy since 2010, although many were unaware that they had.
In interviews, disease specialists urged people to get tested for alpha-gal if they found themselves getting violently ill hours after eating red meat. And they urged doctors in tick-heavy regions to consider that a patient with repeated bouts of abdominal pain and vomiting might be experiencing anaphylactic shock, not a stomach bug.
“It can so often present like a food poisoning situation,” one of the journal article’s authors, Dr. Erin McFeely, said.
The allergy is usually sparked by the bite of the lone star tick, which has proliferated in New York and New Jersey in recent decades. The allergy can cause a range of symptoms: hives, nausea, diarrhea or anaphylactic shock. The symptoms, which generally appear several hours after eating meat, can be severe enough for patients to end up seeking emergency care, although a correct diagnosis is sometimes made only after repeated allergic attacks.
A 2017 study suggests that red meat may have led to other deaths from alpha-gal syndrome, but that the cause was overlooked.
“Because diagnosis rarely occurs, it is likely related deaths are not detected,” the study concluded, although doctors have become more familiar with alpha-gal syndrome in the years since.
More than 400 cases of alpha-gal syndrome were reported in 2024 in New Jersey, where the lone star tick, and the red meat allergy, are expanding northward. Eastern Long Island is another hotbed of the condition, with more than 3,700 suspected cases between 2017 and 2022.
Alpha-gal is a sugar molecule found in the saliva of some ticks, including the lone star. It is also found in many red meats. The tick bite can trigger an overactive immune response in some people, causing a severe allergic reaction when they next encounter it.
Scientists first gained insight into alpha-gal syndrome by studying a cancer drug, cetuximab. Some cancer patients were going into anaphylactic shock after being treated with the drug, and a few died. Researchers discovered that the allergic reaction was related to alpha-gal, a sugar molecule in the drug.
Around the same time, researchers were evaluating a growing number of patients who didn’t have cancer but had developed allergic reactions to red meat. Again, alpha-gal was the culprit.
They eventually discovered that both groups had a history of tick bites. Certain tick bites, they realized, primed people for an allergic reaction.
Mr. Waitzel’s death appears to be the first account of a fatal case of alpha-gal triggered by eating red meat to be published in a medical journal, said Dr. Thomas Platts-Mills, the article’s lead author and an allergist at the University of Virginia School of Medicine who played a leading role in the discovery of alpha-gal syndrome.
Many people who are bitten by a lone star tick never develop alpha-gal, and even many of those with the telltale antibodies never seem to have an allergic reaction to red meat, according to Dr. Erin McGintee, an allergist and immunologist in Southampton, on Long Island, who has taken care of more than 1,000 patients with alpha-gal.
Some people with the condition are not only allergic to beef, pork and lamb, but also cannot tolerate milk. Some people can eventually resume eating red meat without problems.
“If they’ve been very good at avoiding bites, and their antibody levels go down, we can consider a trial of meat reintroduction,” Dr. McGintee said, but added that “a new tick bite can reset the clock.”
For Mr. Waitzel, the first sign of illness came in August 2024, during the family’s annual camping trip to Lake George, in New York. “We had steak for dinner that night,” his widow recalled in a phone interview.
Four hours later, her husband awoke and crawled out of their tent. He started to heave. He had uncontrollable diarrhea. “It was raining, and he was rolling around on the tent platform in such pain, he couldn’t even tell me what was happening,” Ms. Waitzel recalled.
His wife asked if his head hurt, or his heart. He couldn’t answer. She sat next to him crying, trying to clean him up.
Then it ended. He went back to sleep. “He bounced out of bed at 7 a.m. like nothing ever happened,” she recalled. He joined his family on a five-mile hike.
He figured it was food poisoning, his wife recalled, though no one else had fallen ill. He and his wife discussed whether he should see a doctor. But now he felt fine, so what was there to say?
About two weeks later, on Sept. 3, Mr. Waitzel attended the barbecue at his daughter’s new high school. He ate the hamburger as his daughter went to each classroom so that she would not feel lost on her first day.
Returning home, he mowed the lawn. A neighbor would later say that his face looked puffy as he mowed, his wife recalled.
At 7:05 p.m., his wife left to pick their daughter up from a soccer team dinner. Soon, her older son called. He explained that dad was getting sick again and was in the bathroom. At first, there had been some noises. No longer. He told his mother he was afraid.
His son, then 16, found his father unconscious. He began performing CPR, which he had learned while training to become a lifeguard. Then the paramedics came. Mr. Waitzel was declared dead that night.
At the time, Mr. Waitzel’s family had no idea what had killed him. As a pilot, he had regular physical exams and was in good health. A postmortem exam turned up nothing unusual.
Not knowing took a toll. “Everything changed in our life in 10 minutes and to not know why,” his wife said. “That was so upsetting.”
Dr. McFeely, a family friend, remembered thinking that something “just didn’t add up.”
She would visit Ms. Waitzel and discuss the death and the earlier symptoms. Dr. McFeely asked what Mr. Waitzel had eaten on the night of his death and during the camping trip. There was another clue: On the night Mr. Waitzel died, an EMT had asked what Mr. Waitzel was allergic to, because his tongue and lips were swollen. Family members said they were unaware of any allergies.
A Theory Emerges
Ms. Waitzel remembered something that a friend had mentioned shortly after Mr. Waitzel died. The woman knew of a family nearby that had developed alpha-gal syndrome and were allergic to red meat. Maybe that’s what killed Mr. Waitzel? At first, Ms. Waitzel thought “it sounded crazy.”
She mentioned it to Dr. McFeely. The Waitzels had pulled plenty of ticks off themselves over the years. But one episode stuck out.
Earlier that spring, Ms. Waitzel recalled, her husband had gone jogging in a nearby state park and returned with a dozen small bites around his ankles. He assumed they were bites from chiggers, a type of mite. The larvae of the lone star tick are often mistaken for chiggers.
Dr. McFeely looked up experts on alpha-gal syndrome and found Dr. Platts-Mills. She emailed him.
Dr. Platts-Mills arranged to test a sample of Mr. Waitzel’s autopsy blood. It found elevated levels of an enzyme that suggested he’d suffered anaphylactic shock. And then there were the antibodies. A significant percentage were alpha-gal antibodies, evidence of an allergy.
Dr. Platts-Mills and several colleagues, along with Dr. McFeely, published their findings this month in The Journal of Allergy and Clinical Immunology: In Practice.
Ms. Waitzel said it was a relief to no longer have to tell people, “We don’t know why he died.”
“It brings a lot of closure,” she added.
Joseph Goldstein covers health care in New York for The Times, following years of criminal justice and police reporting.
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