WINE FOUND TO BE A COMMON CULPRIT
IN ALCOHOL-INDUCED ASTHMA

PERTH, AUSTRALIA-- Alcoholic drinks are common triggers for asthma, new research indicates.[1] The finding, from a survey of more than 300 patients, confirms anecdotal reports and another study[2] linking alcoholic drinks with asthma symptoms.

However, "the reaction is not due to the alcohol itself. Cofactors, such as other asthma triggers, may be necessary to unmask the alcohol-induced asthma," said lead study investigator Philip J. Thompson, MBBS, FRACP. "Most reactions occur quickly and although varying in severity, are generally reversible with simple therapy," he added.

Researchers led by Dr. Thompson, an associate professor in the department of medicine at the University of Western Australia and the Asthma and Allergy Research Institute in Perth, Australia, investigated the frequency and characteristics of asthmatic reactions triggered by alcoholic drinks in a community-based cohort of people with asthma. The authors also examined food sensitivities to better understand which components of alcoholic drinks might be responsible for these asthmatic responses.

WINE IS THE MOST FREQUENT TRIGGER

Study subjects included 366 asthma patients (age 18 to 83 years) who responded to a food allergy questionnaire that had been sent to a random sample of members of the Asthma Foundation of Western Australia. Nearly three quarters (73%) of subjects had mild to moderate asthma, and 23% had severe to very severe asthma. In addition, about 37% identified themselves as atopic, and 16% reported having nasal polyps.

Of the 366 respondents, 33% indicated that "alcoholic drinks had been associated with the triggering of asthma on at least two occasions." In most cases, the asthma attack developed within one hour of alcohol consumption and was of moderate severity.

Wine was reported as the most frequent trigger--92% of those who said that alcohol induced asthma attacks noted that such attacks developed following wine consumption. Both red and white wine were frequently cited as triggers, but champagne was not.

"Wine-induced asthmatic reactions were reported more often by women, by those taking oral steroids, by individuals who had reported their first asthma attack at a younger age, and by those who had previously visited an alternative health practitioner for asthma," the researchers reported. They also found a significant association between wine-induced asthma and asthma triggered by sulfite-containing foods and by aspirin or nonsteroidal anti-inflammatory drugs (Figure 1).

Figure 1 Acute Asthma Triggers

* Frequency of asthma attacks triggered by these substances among 366 member of the Astma Foundation of Western Australia. Adapted from Vally H et al. J Allergy Clin Immunol. 2000.[1]

Beer was found to induce asthma in only 30% of those who reported sensitivity to alcohol. Brandy, whiskey, and vodka were found to affect no more than a small number of patients.

SENSITIVITIES TO SULFITES

There may be a subpopulation of patients with concomitant allergic rhinitis or nasal polyps who are more sensitive to sulfites, suggested Dr. Thompson. But "whether sulfites are responsible for most or only a minority of patients' responses is unclear. Wine has more than 400 molecules, any of which might contribute to the allergic reaction," he said. Nevertheless, "The nature of the response suggests that pure allergic reactions are likely to be uncommon," Dr. Thompson noted. "Also, it is rarely all wines or all beers and tends to be only certain drinks."

Dr. Thompson's team is conducting additional research to better understand the mechanism by which alcohol, and specifically sulfites, may trigger asthmatic responses. In the meantime, however, "it is important to alert patients that [alcoholic drinks] are potential asthma triggers and that they should consider avoiding anything associated with an asthmatic response," he said. "Patients may be uncomfortable reporting alcohol-related asthmatic responses; however, when physicians raise the topic, they are usually happy to relate their experiences," Dr. Thompson added.

--Debra Hughes

References
1. Vally H, de Klerk N, Thompson PJ. Alcoholic drinks: important triggers for asthma. J Allergy Clin Immunol. 2000;105:462-467.
2. Ayres JG, Clark TJH. Alcoholic drinks and asthma: a survey. Br J Dis Chest. 1983;77:370-375.