On a June night in 2022, 16-year-old Jeremy Webb was camping with friends on the New South Wales Central Coast, north of Sydney, when he vomited after eating beef sausages.
Struggling to breathe, the teenager ran from the campground to knock on the window of a nearby camper van, and asked the occupants to call an ambulance. Then he collapsed.
His friends administered CPR until the ambulance arrived at 11.26pm. He was declared dead at hospital just over an hour later.
Webb’s death was originally attributed to asthma. But a coronial inquest has now found an allergic reaction to meat – triggered by a tick bite – caused the acute asthma attack.
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It is the first documented fatal case of mammalian meat allergy in Australia.
Prof Sheryl van Nunen, a clinical immunologist and allergist at the National Allergy Centre of Excellence, is only aware of one other case in the world: that of a 47-year-old pilot in New Jersey, who died in 2024.
“Jeremy was the first worldwide,” Van Nunen told Guardian Australia.
The inquest followed extensive advocating from Jeremy’s parents, who wanted to improve public awareness about the issue. In findings handed down on Thursday, the deputy NSW state coroner Carmel Forbes said that “Jeremy died as a result of anaphylaxis due to mammalian meat allergy after tick bite, causing an acute exacerbation of asthma.”
Van Nunen first identified the connection between tick bites and developing mammalian meat allergy – an association that has since been confirmed by researchers on all six continents where tick bites occur.
The allergen associated with reactions, alpha-gal, is a sugar molecule present in the saliva and gut of ticks, as well as many mammals, including beef, lamb, pork, goat, kangaroo and venison.
“This is a 21st-century allergy,” Van Nunen said, on the rise because of ecological change.
After two or more tick bites, one in two people’s bodies will make an alpha-gal allergy antibody. When the person eats meat, the alpha-gal is released, triggering the allergy.
The symptoms occur three to six hours after eating meat, because that is the time it takes to digest the food and for the alpha-gal to be released, Van Nunen said.
Symptoms can range from gastrointestinal symptoms to welts and swellings and anaphylaxis.
Irritable bowel-like symptoms are the most common, and the Australasian Society of Clinical Immunology and Allergy recommends people living in tick-infested areas who experience regular gut discomfort should be screened for the alpha-gal allergy.
The allergy can also be triggered by mammalian products including milk and gelatin.
The meat product eaten can also determine the severity of the reaction, the coroner’s report noted.
“[A]lpha-gal is present in higher concentrations in offal, so a meal including offal, such as sausages encased in mammalian intestines, may trigger a more severe reaction.”
Jeremy experienced a number of tick bites after his family moved to a large block of land surrounded by dense bush on the NSW Central Coast, the coroner’s report stated.
When he started having reactions to eating red meat around the age of 10, his family suspected that he had mammalian meat allergy caused by the tick bites.
However, “Jeremy, his family and his GP were unaware that his allergy may have carried an attendant risk of life-threatening anaphylaxis,” the report stated.
The coroner’s report noted previous episodes of illness, including when he was taken to hospital by ambulance with severe respiratory distress, which was diagnosed as an asthma attack. (Jeremy had also suffered from asthma throughout his life.)
But the discharge summary did not mention anaphylaxis as a possible diagnosis – a “missed opportunity”, said Van Nunen, given features that were unusual for asthma but consistent with anaphylaxis – in particular, the sudden and severe onset of his symptoms, as well as his need for multiple doses of adrenaline and the teenager’s positive response to it.
Van Nunen, who was commissioned to write the expert report, emphasised that asthma is also a risk factor for dying from food allergy anaphylaxis – with 85% of food allergy deaths caused by anaphylaxis triggering asthma.
Jeremy’s mother, Dr Myfanwy Webb, told the coroner’s court of the pain she experienced “each and every day in missing her kind and loving son” who loved martial arts, and tinkering with computers and engines.
The family recalled hearing neglected motors – from lawn mowers to jetskis – “change from silence to spluttering to humming” thanks to Jeremy, the report mentioned
“Three of his mates have tattoos in remembrance of Jeremy,” the report also stated.
Preventing a tick bite from occurring is the most important strategy, Van Nunen said. If a bite does occur, she recommended people make sure the tick is removed correctly and check the Tick Anaphylaxis and Mammalian Meat Allergy Resources (Tiara) website.
