Representative Matthew Overcast is a Republican from Ava in the southeastern part of the state. He was elected in November 2024 and represents Douglas, Stone, Taney and Ozark counties, which includes some of the most rural and lowest income areas of the state.
He said he expected rural health care to be a major issue for his constituents, but he was surprised how many people in his district — and across the state — want to talk about alpha-gal syndrome.
"It's a bipartisan bill. I had Democrats that supported it and Republicans that supported it. I would say even the federal legislation is the same way. Ticks don't care what your political party is."Representative Matthew Overcast, R-Ava
“It is by far and large, of all things that I filed and all the things I've done, it’s what I get the most calls about in my office,” Overcast said.
Alpha-gal syndrome is an allergy to mammalian products, such as red meats, dairy and more that is caused by the bite of a lone star tick.
Overcast said, unfortunately, he is very familiar with the condition as three of his five kids and his wife have been diagnosed in the last few years, and he’s heard from numerous constituents in his region about how alpha-gal has impacted their lives and their families.
But when it comes to knowing just how common alpha-gal is — there are only rough estimates. The Centers for Disease Control and Prevention has estimated there’s at least 450,000 cases in the United States, but since the condition is not nationally reportable, that is likely an undercount.
Individual states have begun to pass legislation that makes alpha-gal reportable in each state. There will soon be 11 states with mandatory reporting of alpha-gal cases and four more with voluntary reporting.
In Missouri, Overcast introduced a bill this past legislative session that would add alpha-gal and Lyme disease, another tickborne illness, to the list of conditions that must be reported to the Missouri Department of Health & Human Services.
“That way lawmakers have a better idea of the prevalence of this and how we can combat it,” Overcast said. “I'm married to a teacher. I used to substitute teach — so making data driven decisions just makes, it makes sense.”
While Overcast was able to get May established as "Alpha-Gal Awareness Month" this year, his reporting bill did not move past committee, but Overcast said he’s determined to try again, and he intends to reintroduce an updated version of the mandatory reporting bill next session.
“The people of Missouri want this. A lot of our southern health departments, they want this. Their only concern is funding— to make sure they have the funding to do that,” Overcast said. “So, hopefully ... we can get the department, other individuals all involved, to get this done because it's important, and it's going to inform decisions from a local level all the way to the state and federal level.”
Working to count alpha-gal cases — state by state
The first state to pass state-level surveillance of alpha-gal syndrome was Arkansas in 2023.
Dr. Laura Rothfelt, the state public health veterinarian for the Arkansas Department of Health, said alpha-gal has been a “big burden” on the department due to high numbers of reports and having just one or two staff members doing alpha-gal investigations alongside their other responsibilities.
“In Arkansas, we're a little bit different than Missouri,” Rothfeldt said. “We're a centralized health department, and we have local health units, but we don't have assets at our local health units to do these investigations. So, we literally have two people under me who — and really only one person — who's doing most of these investigations, and she also is responsible for some fungal diseases.”
So, she said, it’s easy to get behind when there are thousands of reported cases each year.
Rothfeldt said an investigation is triggered in Arkansas when the state receives a lab report positive for alpha-gal antibodies, but antibodies alone don’t indicate alpha-gal syndrome. The lab test much be paired with clinical allergic symptoms, such as hives, GI issues or anaphylaxis.
"I think that they do need to be prepared for a large volume of reports, especially if you're more in the south and the east.
But, you know, we're realizing that there's a lot of patients being identified — even in Long Island, so outside of New York City.
So, just because you're not in the south, it doesn't mean you can't be affected."Dr. Laura Rothfeldt, state public health veterinarian for the Arkansas Department of Health
To determine this, the department examines medical records, when available, and sends out follow up surveys to patients to determine the presence of clinical symptoms. Rothfeldt said these surveys include some standard questions, as well as a free text field where patients can add additional comments.
“Because I find that people who've been affected by alpha-gal syndrome, they want to talk about it, and we love to hear about it,” Rothfeldt said. “We want to hear what their experience is because we feel like there's a lot of common themes in these experiences, and maybe this is going to help get the awareness out. That there'll be more attention and more resources, because, like I said, we don't, we don't have the resources to do a thorough investigation, so that's the sad part.”
Rothfeldt said another challenge of determining the prevalence of the condition in Arkansas is that their data collection process only looks forward.
Alpha-gal syndrome was first identified in 2007, and Rothfeldt said she suspects many people who’ve been diagnosed for years aren’t getting new blood tests to check their antibody levels.
Even without including these pre-existing diagnosis, Rothfeldt said her department is getting reports of alpha-gal at levels “an order of magnitude higher than our tickborne infectious disease.”
In her own department, Rothfeldt said they’re examining news ways to automate the survey process to reduce the burden on staff.
So, she warns other states considering legislation that makes alpha-gal syndrome reportable to “be prepared” for a dramatic influx of reports.
“You do need resources, and unfortunately, with resources — you need money because you need people to do these investigations and/or electronic systems,” Rothfeldt said. “You need these computer systems, surveillance systems that can do the automation where, you know, it can even get to the point where it can determine the case status based off of certain criteria, and then the epidemiologist can just go in and do data quality checks, make sure that everything is working right.”
National efforts — The Alpha-Gal Allergen Inclusion Act
Sharon Forsyth was diagnosed with alpha-gal in 2019 and, since then, has created the Alpha-Gal Information website, the Alpha-Gal Alliance and the Alpha-Gal Alliance Action Fund.
She said that because alpha-gal is not a nationally reportable condition, not every state is conducting their reporting in the same way. While Arkansas is trying to follow up with every lab report, others, such as Virginia, are doing more limited, randomized surveying.
"The first step we took was to work with the community to define our policy priorities, and first and foremost of these was that people really want to have alpha-gal disclosed on the labels of their foods."Sharon Forsyth, executive director of the Alpha-Gal Alliance, Alph-Gal Alliance Action Fund
“State epidemiologists… are responsible for tracking all these important diseases, and we don't want, you know, zika virus or malaria or tuberculosis cases to not be followed up on because people are calling people with alpha gal,” Forsyth said. “Alpha-gal is not contagious, and you don't need to call every single patient.”
Forsyth’s organization hosts webinars for people trying to get alpha-gal syndrome made reportable in their states, but that’s only one of their efforts. They also work to educate the public, raise awareness and funding for research and are working to pass the Alpha-Gal Allergen Inclusion Act at the national level.
The Alpha-Gal Allergen Inclusion Act is a bill currently in the House of Representatives that would require the U.S. Food and Drug Administration to add the sugar molecule that causes alpha-gal syndrome to the list of major food allergens.
Forsyth said that, if passed, this would require food manufacturers to disclose the presence of the alpha-gal sugar on their packaging. This would include ingredients, natural flavors or processing aids.
“So, if you buy a granola bar or a box of cereal, it will say, ‘contains soy, contains milk.’ Those allergens are listed because they're … the top nine food allergens, but alpha-gal is the 10th most common food allergen, so it's the next logical one to add,” Forsyth said.
Forsyth said that she and others with the Alpha-Gal Alliance Action fund have had promising conversations with food manufacturers. She said they know the chemical makeup of the foods they’re producing and don’t expect it to create a “significant burden” for the manufacturing industry.
“And, in fact, it almost would be easier for them just put on the label than to field all the calls because people with alpha-gal, all the time, are calling these manufacturers,” Forsyth said. “Probably some of these people picking up the phone [have] spoken to 1,000 people with alpha-gal all asking, ‘Is there alpha-gal in Oreos?’”
Forsyth says the House bill has been doing fairly well since being introduced in February 2025. She said she’s “very optimistic” about the bill, which currently has 31 co-sponsors from both sides of the aisle.
For the full audio transcript, click here
In piece four of "One Small Bite," we will explore how restaurants in the southwestern part of Missouri are adapting their menus to meet the needs of the growing alpha-gal community.
