Review of Alcoholic Drinks: Important Triggers for Asthma
abstract & commentary
Synopsis: There is a need for increased awareness among asthmatic subjects (and their physicians) that alcoholic drinks can trigger asthma in a large number of patients.
Source: Vally H, et al. J Allergy Clin Immunol 2000;105:462-467.
Alcoholic drinks are known to trigger symptoms in as-thmatic individuals. However, the prevalence, components responsible, and characteristics of those who are sensitive have not been well studied. Using a validated food allergy questionnaire, 366 Australian adults who had experienced attacks with alcoholic drinks on at least two occasions were assessed. A total of 33% responded positively. Wine (red or white) was the worst culprit, with symptoms appearing within less than one hour. The following associations proved statistically significant: symptoms were more often in women, in those taking oral steroids, in those reporting their first attack at a younger age, and by those who had previously visited an alternative health practitioner for asthma. There was a significant association between wine-induced asthma and asthma triggered by foods containing sulfite as well as those triggered by aspirin and nonsteroidal anti-inflammatory medications.
Comment by Sheldon l. Spector, MD
Questionnaires of large numbers of asthmatic subjects as used in this study can yield interesting data such as the high prevalence of alcohol- (especially wine) associated asthma. One of the values of such investigations is to suggest future studies based on the correlations seen. Perhaps Vally and colleagues could have expanded their knowledge further with more subgroup analyses. For example: 1) Were those subjects with aspirin-induced asthma almost invariably those with nasal polyps? Published studies would support this association.1,2 2) Do those individuals with facial swelling or hives have different characteristics (e.g., predominantly react to other alcoholic drinks than wine, vs those with the asthma-induced syndrome)? Again, the mechanisms of these syndromes appear to be different.3 3) Would Asian non-whites behave differently than other nonwhites? Perhaps not enough patients fit into the Asian group but Japanese investigators suggest that alcohol induces high blood concentration of acetaldehyde leading to release of histamine from basophils and mast cells4 and an effect on bronchial hyperresponsiveness.5
The biggest criticism of this study is the severity classification and Vally et al’s conclusions without considering the medications used. A patient requiring both oral steroids and steroid aerosols may have no asthma attacks or doctor visits because of these medications, yet have much more severe asthma than someone taking no asthma medications who is symptomatic. Additionally, medications such as azelastine may specifically block alcohol-induced asthma6 so patients on such medications may not mention symptoms with alcohol due to the blocking effect.
Despite these and other limitations of the study, I agree with Vally et al that there is a need for increased awareness among asthmatic subjects (and their physicians) that alcoholic drinks can trigger asthma in a large number of patients.
References
1. Spector SL, et al. J Allergy Clin Immunol 1979;64:500-506.
2. Stevenson DD, Simon RA. Sensitivity to aspirin and nonsteroidal antiinflammatory drugs. In: Middleton E, Reed CE, Ellis EF, Adkinson NF, Yunginger JW, Busse WW, eds. Allergy Principles and Practice: Vol II. 5th ed. St Louis, Mo: Mosby-Year Book, Inc; 1998: 1225-1234.
3. Szczeklik A. Ann Allergy 1987;59:113-118.
4. Shimoda T, et al. J Allergy Clin Immunol 1996;97(1 Pt 1):74-84.
5. Myou S, et al. Allergy 1996;51(1):52-55.
6. Takao A, et al. Ann Allergy Asthma Immunol 1999; 82(4):390-394.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content