A sudden death with no clear cause

On the afternoon of Sept. 3, 2024, 47-year-old JetBlue pilot Brian Waitzel attended a barbecue at his daughter's new high school, where he ate a hamburger. When he got home, he mowed the lawn, not noticing or experiencing anything out of the ordinary.

But by the early evening, he became violently ill. At 7:20 p.m., he was vomiting in the bathroom. By 7:37, he had collapsed. His teenage son began CPR until paramedics arrived. Later that night, Waitzel was pronounced dead.

The autopsy offered no explanation. The cause of death was listed only as "sudden unexplained death."

For Waitzel's wife, Pieper, the uncertainty deepened the loss. "Everything changed in our life in 10 minutes and to not know why," she said. "That was so upsetting."  

After Waitzel's death, Erin McFeely, a physician and family friend, said she felt something about the case "just didn't add up." Visiting with Pieper, McFeely discussed Waitzel's death and any earlier symptoms he might have experienced.

A few weeks before he died, Waitzel experienced severe symptoms. In August 2024, Waitzel and his family went on a camping trip where they had steak for dinner one night. A few hours later, Waitzel woke up with uncontrollable diarrhea.

"It was raining, and he was rolling around on the tent platform in such pain, he couldn't even tell me what was happening," Pieper said.

At the time, Waitzel dismissed his symptoms as food poisoning, even though no one else had gotten sick. These symptoms, along with an EMT asking if Waitzel was allergic to anything on the night he died since his lips and tongue were swollen, would eventually help provide clues to the cause of his death.

Later, Pieper remembered something a friend had mentioned to her after Waitzel's death: a nearby family had developed an unusual allergy to red meat after tick bites, a condition known as alpha-gal syndrome. At first, Pieper thought "it sounded crazy," but then she remembered an incident earlier in the spring.

After jogging in a nearby state park, Waitzel came home with "a dozen small bites around his ankles," which his wife assumed were from chiggers, a type of mite. The larvae of the lone star tick, which causes alpha-gal syndrome, are often mistaken for chiggers, specialists say.

Pinpointing the cause

After Pieper mentioned her suspicions about alpha-gal syndrome, McFeely looked up experts on the condition and found Thomas Platts-Mills, an allergist at the University of Virginia School of Medicine and a leading figure in the discovery of alpha-gal syndrome.

After arranging to test a sample of Waitzel's autopsy blood, Platts-Mill found that the sample had elevated levels of an enzyme that suggested anaphylactic shock. The antibody profile also showed a "significant percentage" of alpha-gal antibodies, indicating Waitzel had the allergy.

Although alpha-gal syndrome may seem obscure, the number of people with the condition has soared in recent years. In 2023, CDC estimated that between 96,000 and 450,000 people nationwide might have developed alpha-gal syndrome since 2010, though many are likely unaware that they have it. 

According to Erin McGintee, a New York-based allergist and immunologist who has treated more than 1,000 patients with alpha-gal syndrome, some people will develop an allergy to milk, as well as red meat. Other people may eventually be able to eat red meat again without any issue.

"If they've been very good at avoiding bites, and their antibody levels go down, we can consider a trial of meat reintroduction," McGintee said. However, she added that "a new tick bite can reset the clock."

Increasing awareness of alpha-gal syndrome

Experts say Waitzel's case highlights how easily alpha-gal syndrome can be overlooked, especially in emergency settings. Its delayed timeline — often several hours after eating meat — means patients frequently wake up in the night with symptoms that resemble infection, stomach illness, or food poisoning.

Disease specialists now urge physicians in tick-heavy regions to consider alpha-gal syndrome when patients present repeatedly with abdominal pain and vomiting, since they might be experiencing anaphylactic shock and not just gastrointestinal issues.

Recently, Platt-Mills, McFeely, and other researchers published their findings on alpha-gal syndrome and Waitzel's death in The Journal of Allergy and Clinical Immunology: In Practice. According to the researchers, Waitzel's death is the first of its kind officially linked to alpha-gal syndrome. Previous research suggests that the condition may have caused other deaths in the past, but these deaths were likely not detected or overlooked.

For the Waitzel family, the diagnosis doesn't lessen their loss, but it closes the agonizing gap between what happened and why. As Pieper said, knowing the truth "brings a lot of closure."