Misdiagnosis of alpha-gal syndrome as non-celiac gluten sensitivity or lactose intolerance: A diagnostic blind spot for clinicians

Table 1 Tick species implicated in alpha-gal syndrome and their geographical distribution based on collection from available regional data

Tick species (common/scientific)	Typical geographic distribution/reported locations	Evidence/notes
Lone star tick - Amblyomma americanum[7]	Southeastern, mid-Atlantic, and parts of the Midwest United States; expanding northward and westward	Principal vector implicated in most United States AGS cases and in large surveillance studies
Sheep/deer tick - Ixodes Ricinus[16]	Europe (Sweden, France, Germany, Spain and other temperate countries)	Reported to carry α-gal-containing antigens and linked to sensitization in European case series
Paralysis tick - Ixodes holocyclus[14]	Eastern Australia (coastal New South Wales, Queensland)	Identified in Australian reports as associated with α-gal sensitization and tick-bite-related meat allergy
Asian longhorned tick – H. longicornis[17]	East Asia (Japan, Korea), parts of China; also detected in other regions	Salivary proteins with α-gal detected; case series from Japan and case reports implicate H. longicornis in sensitization
Amblyomma sculptum[18]	Brazil and other parts of South America	α-gal epitopes detected in saliva; experimental/serologic data support potential for sensitization
Amblyomma hebraeum/Rhipicephalus spp. (Africa)[19]	Sub-Saharan Africa (limited serologic detection; data sparse)	Serologic detection of α-gal in some parasites/ticks reported, but clinical case correlation and surveillance remain limited
Blacklegged/deer tick - Ixodes scapularis (and other Ixodes spp.)[8]	North America (northeast, upper Midwest); occasional recent case reports linking Ixodes spp. to AGS	Emerging reports suggest other Ixodes species may rarely be associated with α-gal sensitization in addition to Amblyomma spp.

AGS: Alpha-gal syndrome; H. longicornis: Haemaphysalis longicornis; α-gal: Α-1,3-galactose.