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Previous Volume 357:719-720 August 16, 2007 Number 7 Next

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To the Editor: Alcoholic drinks have been described as triggering or initiating anaphylactoid reactions.¹ Although little is known about the pathogenesis of these reactions,² wine contains many biologic and chemical components derived from grapevines, yeast, bacteria, and insects (including those of the order Hymenoptera) that might explain the observed symptoms.^3,4

We report on five patients who presented with symptoms after drinking grape juice or newly pressed wines (both red and white). Three of the patients had an oral allergy syndrome and facial flushing, one had asthmatic symptoms, and one had anaphylaxis. Skin tests with conventional allergens, including commercial grape extract, egg white, and wines aged for up to 1 year, were negative. None of the patients had a history of ingesting drugs containing sulfites that was concomitant with these symptoms, nor had any of them been stung by Hymenoptera species. Yet all had positive skin tests for specific IgE antibodies (levels >0.35 kU per liter, CAP, Phadia) to Hymenoptera (Apis mellifera and vespula and polistes species) and to an extract of the wine or grape juice under suspicion for causing the symptoms.

We investigated sensitization to Hymenoptera antigens as a possible cause of these symptoms. The patients with symptoms after drinking red wine were sensitive to both vespula and polistes species, whereas those with symptoms after drinking white wine were sensitive only to polistes species. Patch tests and oral- and bronchial-challenge tests with sulfites were negative in all five patients. Four of the patients had a positive reaction to an oral challenge with the exact wine they had ingested (an oral allergy syndrome and flushing), and in the remaining patient (who had an oral allergy syndrome, flushing, and asthma), there was a 25% fall in the forced expiratory volume in 1 second. Challenges with aging wines were negative. These tests were negative in 6 patients who were not reactive to Hymenoptera antigen and in 12 patients who had had anaphylaxis after a Hymenoptera sting.

Immunoblotting revealed two 22-kD and 27-kD bands for grape juice and freshly pressed wines and one 22-kD band for aging wine in pooled serum samples from the five patients and from the Hymenoptera-positive control subjects. Aging wines (except for sample wine 3) did not show IgE binding to these allergens (Figure 1). The use of venom extract from polistes species as the inhibitory phase (immunoblot inhibition) inhibited these proteins in serum from the patients and from the Hymenoptera-positive control subjects. Immunoblot inhibition with venom extracts from vespula species and A. mellifera used as the inhibitory phase did not show any inhibition.

View larger version (23K): [in this window] [in a new window]   Figure 1. Results of IgE Immunoblotting after Exposure to Several Wine Extracts. Panel A shows pooled serum samples from the five patients who had an allergic reaction after drinking grape juice or newly pressed wine. Panel B shows pooled serum samples from control subjects who had had anaphylaxis after a Hymenoptera sting. Panel C shows the results of immunoblot inhibition with venom from a polistes species in pooled serum samples from the Hymenoptera-positive control subjects and the five patients with an allergic reaction. The wine samples used in the analysis are shown as follows: lane 1, red grape, first press; lane 2, white grape, first press; lane 3, sample wine 1 (first press, 1 week); lane 4, sample wine 1 (first press, 4 weeks); lane 5, sample wine 2 (aging wine); lane 6, sample wine 3 (aging wine); lane 7, sample wine 4 (aging wine); and lane 8, sample wine 5 (aging wine). All sample wines were from different origins.

 
Venom antigens found in wines were from venoms of the most prevalent species in Spain.⁴ The development of allergic symptoms after drinking wine indicates that sensitization to Hymenoptera venom may occur by the oral route.

Alicia Armentia, M.D., Ph.D.
Hospital Río Hortega
47010 Valladolid, Spain

Fernando Pineda, D.Pharm., Ph.D.
Diater Laboratories
28330 Madrid, Spain
f.pineda{at}diater.com

Sara Fernández, M.D.
Hospital Río Hortega
47010 Valladolid, Spain

Dr. Pineda reports being employed by Diater Laboratories, a pharmaceutical company specializing in the production of allergenic extracts for in vivo diagnosis and treatment of allergies. No other potential conflict of interest relevant to this letter was reported.

References

1. Ayr]es JG, Clark TJH. Alcoholic drinks and asthma: a survey. Br J Dis Chest 1983;77:370-375. [Web of Science][Medline]
2. Vally H, Carr A, El-Saleh J, Thompson P. Wine-induced asthma: a placebo-controlled assessment of its pathogenesis. J Allergy Clin Immunol 1999;103:41-46. [CrossRef][Web of Science][Medline]
3. Vena GA, Foti C, Angelini G. Sulfite contact allergy. Contact Dermatitis 1994;31:172-175. [CrossRef][Web of Science][Medline]
4. Navarro LA, Peláez A, de la Torre F, Tenias Burillo JM, Megías J, Martínez I. Epidemiological factors on hymenoptera venom allergy in a Spanish adult population. J Investig Allergol Clin Immunol 2004;14:134-141. [Web of Science][Medline]

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