Do you sneeze when you sip that fine red wine? Wine allergy?

Wine has been a popular beverage since ancient times and across all cultures. While the effects of wine on health are frequently reported, allergy or intolerance to wine has not been as closely studied.

Wine contains many organic compounds including proteins from grapes (of course), bacteria, yeast, sulfites (some wines) and biogenic amines (histamine). These products may contribute to symptoms of an allergic reaction. The alcohol may also trigger an intolerance reaction.

Red wine: more likely to cause allergic reactions due to endochitinase 4A protein and LTP (Lipid Transfer Protein): this particular protein is concentrated in the grape skins. The allergen in vino novella and vino Fragolino is likely endochitinase 4A. Also, there are more tannins in the skins of black grapes (black grapes are really not black, but range in color from light red or blue tint, to ruby or to deep indigo).

White wine: this is fermented without the grape skins, so no LTP is present. White grapes have fewer and slightly different tannins and are usually referred to as “phenolics.” White grapes are not actually white! They can range from green to yellow-green, gold or even light orange.

How common is wine allergy?

In 2010, in the Rhine-Hess region of western Germany (popular wine-producing area), surveys were sent to 4000 adults living in Mainz regarding their alcohol intake and adverse (allergic or intolerant) reactions to wine. Of the 948 adults who returned the survey, 7.2% reported allergic type reactions. This study was published in 2012. http://www.ncbi.nlm.nih.gov/pubmed/22787508

Risk Factors for Wine Allergy:

• Twice as many women (8.9%) than men (5.2%) reported symptoms in the above German study.

• Wine-intolerant persons were also more likely to report intolerance to beer and alcohol in general.

• Asthma: patients with asthma are more likely to react to wine and other alcoholic beverages.

• Peach and cherry allergy can be associated with grape allergy.

Types of Reactions:

• Alcohol (ethanol) intolerance: symptoms are skin flushing and nasal congestion (due to vasodilation—blood vessel expansion in the skin and nose). If this is the case, you will likely react to liquor and beer.

• Allergy (IgE-mediated): symptoms may be rapid onset of itching, swelling (lips, tongue, throat), difficulty breathing, shortness of breath, wheezing, flushing, nasal congestion and diarrhea.

• Exercise-induced allergy to grape: Eating grapes alone is fine; exercising is fine, but eating grapes then exercising lead to anaphylaxis.

• Alcohol-induced anaphylaxis to grape. An 18 year old woman suffered anaphylactic reactions when she ate grapes and drank champagne at the same time. Eating grapes alone or drinking champagne alone did not trigger symptoms. Her grape skin test was positive. Her case was confirmed, when the reaction was recreated in the clinic.http://www.ncbi.nlm.nih.gov/pubmed/17663926

Can certain individual grape varieties trigger a reaction?

Yes! The Merlot grape can trigger a hypertensive (increase in blood pressure) reaction in persons with hypertension or those prone to high blood pressure. The symptoms typically occur at night or in the early morning and resemble those of a heart attack with rapid heart rate. Since even tiny amounts of merlot may trigger such a reaction, blended wines containing a combination of grapes need to be avoided.

What to do if you have experienced a reaction:

• If you have high blood pressure, drink Merlot with caution.

• If the reaction was mild and triggered by red wine, try switching to a white wine.

• If you experienced an allergic reaction to grapes, avoid raisins.

• If the reaction was severe, do not finish that glass and call your doctor or seek medical treatment immediately. Save that bottle of wine for your allergist (not to drink, but to potentially use for allergy testing).

How is wine allergy treated?

• Avoidance is the current accepted treatment for any food or drink allergy. A person should also have self-injectable epinephrine (EpiPen® or Auvi-Q®), wear a medial ID bracelet and have a written anaphylaxis action plan.

• In 2010, a patient who had recurrent anaphylactic reactions to wine, grapes and raisins was treated by induction of oral tolerance (given gradually increasing amounts of grapes over a 3 day period). The treatment was successful as he could now drink wine without having an allergic reaction. To remain, tolerant typically requires ongoing consumption of the food or drink. http://www.ncbi.nlm.nih.gov/pubmed/23282379 This is obviously experimental at this time.

At Family Allergy Asthma & Sinus Care, we desire patients to have a great quality of life. If that “Red, red wine” does not make you feel so fine….contact us. We can help!