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Alpha-gal syndrome: Suspect-and-test checklist for clinicians

A one-page worksheet that turns the full Alpha-gal syndrome diagnosis guide into something you can use at the point of care: what to look for, what to order, which results should not end the workup, and who else to test or refer.

Who it is forClinicians and care teams who may see Alpha-gal syndrome before it is diagnosed, including primary care, the specialists named in the guide, and referral or genetics coordinators.
When to use itWhen Alpha-gal syndrome is on the differential, when a patient has several red flags, or when you are preparing a referral or a second opinion.

How to use it, section by section

  1. Red flags present: Tick each finding the patient has. They are grouped by body system so you can scan quickly.
  2. Already labeled as: Tick earlier diagnoses on the chart that the sources say are often given first.
  3. Family to test: Note relatives who may need testing, and record when symptoms began and which specialists have already been seen.
  4. Testing, in order: Tick each test as you order it and write the result on its line. The order follows the published sources.
  5. Results that do not rule it out: A reminder of findings that can look reassuring but do not exclude Alpha-gal syndrome.
  6. Specialists: Tick the referral, then write who it went to and any notes.
Two ways to fill it inPrint it blank and write on it, or tick boxes and type on this screen first, then print or save as a PDF. Keep it with the chart or send it with the referral.
PrivacyNothing you type is sent or saved. It stays in this browser tab and disappears when you close it. Use patient initials, not full identifiers.

What it is not: Not a diagnostic score, a protocol or coding advice. It summarizes published sources, and clinical judgment and the treating clinician govern. Every point is sourced in the full Alpha-gal syndrome guide.

One Letter page. Use your browser's print or save as PDF.Full guide with sources
Suspect-and-test checklist
Alpha-gal syndrome

Acquired after tick bites, not inherited. Hives, anaphylaxis or GI distress hours after red meat or dairy.

ICD-10-CMZ91.014Trial Friend for Clinicians

1Red flags present

Reaction pattern

Gut only

Exposure

Medical products

Unexplained

2Already labeled as

3Family to test

4Testing, in the order the sources describe

  1. Alpha-gal sIgE (LOINC 73837-7)Main test per CDC. Positive above 0.1IU/mL; weigh with history.
    Result
  2. Total IgEAlpha-gal sIgE of 2IU/mL or over 2% of total makes AGS very likely (Platts-Mills).
    Result
  3. Skin testingMeat extract prick tests unreliable; intradermal or prick-prick with cooked meat.
    Result
  4. GI-only patientsAGA: test if unexplained; confirm by improvement on avoidance diet over at least a month.
    Result
  5. Seronegative, convincing storyBeef, pork, lamb, gelatin IgE; cetuximab skin test; basophil activation.
    Result
  6. Oral food challengeSpecialist centers only; delayed and inconsistent reactions, some need epinephrine.
    Result

5Results the sources say do not rule it out

  • A positive IgE alone. Seroprevalence reaches 31.2% in some states; most positives are not AGS.
  • Tolerating meat once. Reactions often do not follow every exposure.
  • No remembered tick bite. Many patients recall none.
  • Symptoms within 2 hours. A cohort of over 200 had 16% that fast.

6Specialists the sources name

Diagnosis code: Z91.014 Allergy to mammalian meatsCodes patients often carry before diagnosis are listed in the online guide.
Full guide and sourcesEvery point here is sourced in the online guide, which also has a patient note to print.
Trial Friend, trialfriend.com/for-clinicians. Key sources: CDC clinical testing page (2026); CDC overview (2026); CDC symptoms page (2026); CDC product list (2026); CDC clinician knowledge survey (2023); CDC blood donor seroprevalence study (2026); all 18 with links in the online guide. Checked November 10, 2026. A reference checklist for licensed clinicians that summarizes published sources. It is not a diagnostic tool, a score or a protocol, and it does not replace clinical judgment, local practice or the prescribing information. Not coding advice. Trial Friend never receives anything written or typed on this sheet.