Vinum Vine

|Sunday| Allergy to red wine?

Posted in Food, People, Vinum Vine by Vinum Vine on January 14, 2018

A very interesting post from https://www.aaaai.org/ask-the-expert/anaphylaxis-to-grapes

Q:

4/30/2012
I have been seeing a 34 year old female who had a nebulous history of allergic reactions to red wine. RAST tests to grape were negative as were prick-prick tests to grape, white wine, red wine, and grape juice. However, she had anaphylaxis in the clinic after receiving 5 mL of red grape juice. She required epinephrine and ED evaluation. She is now instructed to avoid grapes and all grape products, including wine but not sure what to tell her about future alcohol ingestion, as not sure if reactions secondary to grape proteins or another component of wine/grape juice (i.e. sulfites). Please advise. 

A:

Thank you for your inquiry.

As you can see from the references and abstracts copied below, there is a moderate amount of literature (albeit case reports) regarding anaphylaxis to grape/wine. Causes have ranged from insect sting parts contained in the grape product (in this case, wine) (see New England Journal article copied below) to allergens contained within the grapes, and finally, in some instances, to no discernible allergen or to excipients. Thus the mechanism(s) of production can be highly variable. This of course presents a diagnostic dilemma, since in the majority of instances an oral challenge is the only way to identify the culprit.

Obviously your suggestion to avoid grapes and grape products is appropriate. However, I would doubt that she needed to avoid alcohol per se since the reaction she experienced in your office was to grape juice. It would also be doubtful that she would need to avoid sulfites, but you did not mention whether sulfites were contained within the grape juice preparation to which she was challenged. Metabisulfite reactions are, for the most part, purely respiratory in nature, and would be very unlikely to occur to such a small amount (5 mL) of a liquid containing metabisulfites. If there were cutaneous manifestations (hives), I think the odds would be strongly against a reaction to sulfites.

Unfortunately, the only definitive way to answer these questions is to do a challenge. Whether or not to do a challenge to alcohol I believe would be entirely dependent upon how strongly she wished to continue to drink non-grape-containing alcoholic beverages.

Unfortunately, alcohol products may contain small amounts of sulfites (usually less than 10 parts per million), and this level does not require labeling.

In summary, there is no definitive way to answer your questions regarding sulfites and other alcoholic beverages other than to perform a challenge. But from what you have described, I think it would be likely she could drink other alcoholic beverages, and that it is unlikely that sulfites are the culprit.

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