Urticarial eruptions (A) and laboratory data (B) in a patient with alpha-gal related red meat allergy. A 48 year-old patient presented with recurrent urticarial eruptions and dyspnea 5 to 7 hours after red meat ingestion. Patient reported history of tick bites 2 weeks prior to his first reaction. Initial workup showed negative IgE to beef and pork. SPT to beef was not performed. Repeated testing was positive to beef and alpha-gal. Patient avoids red meat products and symptoms are well controlled.