Allergy to Wine? Correct Diagnosis May be Wine-Induced Anaphylaxis and Sensitization to Hymenoptera Venom

From ABC:

"If you ask people if they have an allergic reaction to wine, 8 percent of the population will say 'yes, alcohol will cause me to have an allergic reaction."

Differential Diagnosis

Alcohol Flush Reaction

"A metabolic phenomenon called "alcohol flush reaction" is common among people of East Asian decent, and is commonly called an allergy.:

Alcohol flush reaction is a condition in which the body cannot break down ingested alcohol completely, due to a missense polymorphism that encodes the enzyme, acetaldehyde dehydrogenase, normally responsible for breaking down acetaldehyde, a product of the metabolism of alcohol. Flushing is associated with the erythema (reddening caused by dilation of capillaries) of the face, neck, shoulder, and in some cases, the entire body after consumption of alcohol.

Sulfites

"There are a handful of people reported in the medical literature who were allergic to something in the grape. But a lot more goes into a bottle of wine than grapes. Take sulfites, which are commonly blamed for allergies. Vineyards add sulfites to wine to keep it from spoiling into vinegar too quickly. Despite their notoriety, allergists say the chances of someone responding to sulfites are one in 100. Even when sulfites cause problems, doctors are debating whether it is technically an allergy. Especially among asthmatics, sulfites act as irritants to the nose and lungs in a similar way as cigarette smoke and perfume can. You're not really allergic to the cologne if you start sneezing. Whether sulfite sensitivity is technically an allergy or not, the statistic that just 1 percent of people actually react to sulfites."

Oral Allergy Syndrome

An alternative explanation may be "oral allergy syndrome": a cross reaction between pollen in the air and a chemical in food can magnify any existing allergies. Among the culprits are banana, kiwi, melon and grapes."

Wine-Induced Anaphylaxis and Sensitization to Hymenoptera Venom

Wine contains chemical and biological contaminants. Symptoms such as facial flushing, asthma and oral allergic swelling and burning (oral allergy syndrome) have been attributed to these contaminants and food additives.

Recent studies have shown a reported high prevalence of hypersensitivity symptoms after intake of alcoholic drinks with red wine as the most common implicated beverage.

Wine contains many contaminants. Some of them come from Hymenoptera insects that fall into the wine when grapes are collected and pressed. We have found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venom without previous stings.

A Spanish study reported patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venoms. Challenges were negative with sulfites, other additives and aging wines, but positive with young wines. Sera from all the patients detected Hymenoptera venom antigens.

The author claims that those were the first cases of sensitization to venom antigens by the oral route.

References:
This Wine Is Making Me Feel... Sneezy? ABC.
Adverse reactions to wine: think outside the bottle. Armentia A. Curr Opin Allergy Clin Immunol. 2008 Jun;8(3):266-9.
Prevalence of self-reported hypersensitivity symptoms following intake of alcoholic drinks. Linneberg A, Berg ND, Gonzalez-Quintela A, Vidal C, Elberling J. Clin Exp Allergy. 2008 Jan;38(1):145-51. Epub 2007 Oct 10.
Wine-induced anaphylaxis and sensitization to hymenoptera venom. Armentia A, Pineda F, Fernández S. N Engl J Med. 2007 Aug 16;357(7):719-20.
Alcohol-induced anaphylaxis to grapes. Alcoceba Borràs E, Botey Faraudo E, Gaig Jané P, Bartolomé Zavala B. Allergol Immunopathol (Madr). 2007 Jul-Aug;35(4):159-61.
Urticarial reaction caused by ethanol. Nakagawa Y, Sumikawa Y, Nakamura T, Itami S, Katayama I, Aoki T. Allergol Int. 2006 Dec;55(4):411-4.

Alcohol Allergy - Medscape blog post, 2011.

Challenge test to metabisulfites - AAAAI Ask the Expert, 2011.
Biogenic amines (histamine) can cause adverse health effects in susceptible individuals http://goo.gl/B2bhA
Sensitization to Hymenoptera venoms antigens by the oral route via wine consumption http://goo.gl/9nXnW
Allergy to wine and beer - consider testing for barley, malt, hops, wheat, corn, rye, rice, oat flour, grape, Botrytis (mold) and Saccharomyces cerevisiae (yeast). AAAAI Ask the Expert, 2011.
Alcohol allergy? 1. Prick-prick tests with suspected drinks. 2. If negative, oral challenge test with increasing doses of the drinks should be performed. http://buff.ly/16uHYbi

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