He’s known for his bestselling novels and the hit films they inspired: The Firm, A Time to Kill, The Pelican Brief, The Client, to name a few. His protagonists unlock secrets, ferret out corruption, and bring culprits to justice. But 13 years ago author John Grisham found himself caught in his own personal thriller, this one a frightening medical mystery.

Something was causing him to experience unnerving allergic reactions, sometimes in the middle of the night. His skin felt “on fire” with welts that would swell and itch – but what was behind the outbreaks? And how to stop them?

After consulting a physician and keeping a log of every morsel he ate for months, Grisham uncovered the bizarre cause of his misery: red meat (beef, pork and other mammals’ meat). What he didn’t know at the time was that this allergy to a carbohydrate (alpha-gal) in red meat is linked to tick bites. And Virginia, where Grisham’s family lives on a farm, is tick central.

In fact, University of Virginia researchers were among the first to document the tick-meat allergy connection, in part because renowned UVA allergist Dr. Thomas Platts-Mills himself developed meat allergy after being bitten by ticks. What makes the allergy particularly confounding to track is that it causes delayed reactions, often over four hours after eating meat.

Despite his busy schedule of writing, speaking, and supporting good causes, Grisham manages to keep his allergy in check both at home (in Virginia and Mississippi) and on the road. A few years ago, the author sat down in his Charlottesville, Virginia office with Allergic Living contributor Mary Esselman to discuss his bedeviling allergy, making frequent reference to his meticulous log notes.

Beginning of his odd allergy

“The first [reaction] was in June of 2002. I noticed some rashes on my ankles. I remember thinking, ‘This is weird, both ankles.’” [He didn’t think it was a big deal.]

“Then in July 2002, I went with my wife to an annual garden club dinner, and she had prepared these huge beef tenderloins that I had grilled. And while I was cooking, I was shaving some off to sample. By the time we got to the garden club party, my ears were really, really itching. I got my wife and said, ‘Renee, something’s going on.’

There was a doctor there, and he gave me an antihistamine. My skin was on fire.

So we got in the car, and I was so desperate I stripped down, took off all my clothes but my boxer shorts, and I had all the air [conditioning vents] blowing on me, and you could just see the welts. The skin was just welting up. It almost made me nauseated just watching my skin.”

[He wrote down in the food log his doctor advised him to keep that it was beef. The penny began to drop.] “It was always beef.”

Developing delayed reactions

“Two weeks later, we went to a baseball game in Shea Stadium with the kids, and I had a hot dog. And this is when the weird stuff started happening because from that point on [the reactions] were all delayed [by four or five hours after eating]. I’d be asleep – and when you wake up you know you’re in big-time trouble.

I remember standing in the hotel bathroom, Renee was putting damp cloths on my skin, and you can just see it: down your legs, and right into your midsection is where it just really welts up. The inside of your forearms – there have been times when I would scratch until it almost would bleed. You just cannot stop scratching.

So the plot thickens. There were 11 episodes in 2002-2003. By then I’m writing notes to myself, ‘No red meat, you idiot.’ Because it was pork – my favorite pork ribs from a restaurant in Memphis one time – sausage, bacon, ham. Lamb one time. I finally just stopped eating red meat.”

Cheating diet – and paying for it

“Four years go by, and after a while I started eating red meat again. And I got by with it and I’m thinking, ‘This is good’. In 2007, I gave the commencement speech here at UVA [University of Virginia]. Then my wife and my daughter and I came downtown and all had a cheeseburger. That was in May.

In September, Renee fixed some big beef dish, and she had a thick wine reduction sauce, just delicious. And I woke up and thought I was going to die. It was the worst hives and rashes and itching ever. I took two Allegra, got out of bed so she could sleep, went downstairs, and at some point fainted and my head cracked a chair – and broke the chair. Of course I’m hard-headed [laughs] so it didn’t do any damage [to his head].

The last one was November 3rd, my wife’s birthday, 2010. To celebrate, we were in Paris. We went to a fancy restaurant, and I had a very rich rabbit dish in heavy sauce and I woke up about four hours later with yet still the worst case of hives, itching. I had Allegra, and we almost called to get a doctor. But I didn’t want to go to the doctor in a strange city, or a hospital, so we toughed it out.

And that was it. That episode was so bad I said, ‘I can happily give it [red meat] up now’. So I’ve had 15 episodes in 10 years with a gap, oddly enough, when I thought I could eat beef and pork. But I can’t.”

Treating his reactions

“I always have Allegra nearby. There have been times when I would wake up in the middle of an episode and take the Allegra, and it kills the itching but not the swelling. But you can sleep it off. The next day is ruined; you feel terrible.

When this got cranked up in the summer of 2002, I had an EpiPen close by. Renee was always afraid I was going to have a heart attack or stop breathing, so I carried an EpiPen …. From June of 2002 through July of 2003, that 13-month period, there were 11 episodes, and that’s when I had the EpiPen. And then, I just figured it out. And I’ve only had four [reactions] since then.”

His wife develops, effect on their life

“What’s odd is now Renee has the same affliction. She started about a year ago. We live on a farm – ticks everywhere. And we’re from Mississippi and never had the problem there. We moved here in ’94, and again it wasn’t a problem.

But I think the problem is being seen everywhere around here [Charlottesville]. It’s being studied and all of that. [Renee] has been through it, I would guess, four times with rashes, but nothing as uncomfortable what I’ve gone through. But she doesn’t want to do what I’ve done, so she stays away from red meat.”

“There are times when you think, boy, I’d love to have a big old steak or cheeseburger or a side of ribs or even, you know, a Bolognese pasta sauce or something like that. But you say, well, it’s not worth it.

Renee is a very healthy cook, and I’ve never had a problem with cholesterol, nor does she, or blood pressure. But it’s a whole lot lower now [laughs], cholesterol. There’s no real drawback. I could easily be a vegetarian. But my wife is also a wonderful cook. We spend a lot of time in the kitchen; we open a bottle of wine every evening about 6 and start thinking about what can we cook, or we go out. But we do eat a lot of chicken. A LOT of chicken.

[Outdoors,] we’re much more careful now. We hike all the time, through the trails. We’re much more careful with the [tick repellant] spray and spray the dogs.”

Lack of understanding of tick-related allergy

“When the article [about red-meat allergy] came out in Allergic Living magazine, I couldn’t wait to run copies and send them to all the skeptics in my life. ‘There you go, take it.’

Because the article’s perfect: this guy’s a doctor at UVA [Dr. Thomas Platts-Mills], and suddenly he’s breaking out in hives, and it’s linked to a tick, and you can’t eat red meat. I said, ‘There it is, now get off my back.’” [Laughs]

“I guess the worst part is just having an allergy and wondering, you know, where it came from. I hope they figure this all out. I hope – maybe you can take a pill for it someday, or get some immunity …. I’ve always told [my allergist], any time you think I need to go do something – I’ll subject myself to any kind of test. If I can help out, I’m happy to. Thus this interview.”

Sidebar: The Doctor’s Check-Up

Allergic Living asked New York allergist Dr. Paul Ehrlich* to grade John Grisham’s allergy approach.

Top Marks: We like to say, “a good history solves the mystery.” Thanks to a master of the art for validating this point with his methodical record-keeping and observations.

Caution ahead: I’d worry that some chef may add beef or veal stock to liven up a vegetarian recipe or a braised chicken. Cross-contamination accidents do happen, and Mr. Grisham needs to be ready.

Medication use: It’s interesting that he uses Allegra – it’s slow-acting. With food allergies, most allergists recommend Benadryl. Given the severity of some of his reactions, always carrying epinephrine would be an excellent precaution.

See also: Red Meat Allergy Found to Be Mystery Trigger Behind Many Anaphylaxis Cases

*Dr. Paul Ehrlich is author of Asthma Allergies Children: A Parent’s Guide.