Alcohol allergy is an increased sensitivity of the body to the components contained in alcoholic beverages with the development of allergic or pseudoallergic reactions. Clinical manifestations are characterized by lesions of the skin (urticaria, Quincke’s edema, dermatitis), upper respiratory tract (rhinoconjunctivitis, bronchospasm), digestive tract, systemic anaphylactoid reactions. Diagnosis is based on the study of anamnestic information, objective examination data used in allergy tests. Treatment – refusal to use the identified problematic product, compliance with a special diet, the use of antihistamines and symptomatic agents.
L27.8 Dermatitis caused by other substances taken orally
Alcohol allergy is an intolerance of individual components that make up alcoholic beverages due to immunological or non-immunological mechanisms. The clinical picture of alcohol intolerance is similar with true allergy and pseudoallergia, manifested mainly by the development of urticaria and dermatitis, less often by symptoms of allergic rhinitis and bronchial asthma, even less often by anaphylactoid reactions. According to statistics, in the vast majority of cases of alcohol intolerance, pseudoallergic reactions develop (in 80-95% of cases).
A true allergy to alcohol is a fairly rare phenomenon. The main number of detected cases of alcohol allergy are not true, but pseudo-allergic reactions. The main products that can lead to the development of pseudoallergic reactions to alcohol are all kinds of dyes, flavors and stabilizers added to alcoholic beverages to improve the appearance and taste. Many true allergens can simultaneously cause pseudo-allergy to alcohol.
There are products-histaminoliberators that provoke and enhance the release of histamine (ethyl alcohol itself, dyes and flavors that are part of alcoholic beverages, as well as eggs, wheat, chocolate, etc.). In addition, histamine itself is always present in beer (brewer’s yeast) and fermented wine (especially in red varieties), which leads to the summation of adverse effects on the body (histaminoliberator + histamine).
A connection was found between the development of alcohol allergy and the presence in alcoholic beverages (primarily in wine) of sulfur dioxide, a preservative used to reduce bacterial processes (souring, fermentation), natural and artificial salicylates, as well as sulfites – fermentation products of wines used as preservatives of bottled alcoholic beverages.
False allergy to alcohol can also occur in people who abuse alcoholic beverages for a long time due to the frequent presence of chronic intestinal diseases and easier penetration of true and false allergens into the bloodstream through the irritated mucous membrane of the digestive tract.
True allergy is caused by the development of immediate or delayed reactions when vegetable protein inclusions (egg white, wheat, malt, hops, yeast, wormwood, mint, ginger, hazelnut, etc.), often present in alcoholic beverages in small quantities, enter the digestive tract. IgE-mediated hypersensitivity is more common, and class G immunoglobulins are less likely to participate in the development of a true allergy to alcohol.
With pseudoallergia, there is no immunological stage (antigen-antibody reaction) in the mechanism of hypersensitivity development, and the pathological process begins immediately from the second stage, that is, with the release of inflammatory mediators – in particular, histamine by mast cells and basophils in response to some excipients that are part of alcohol.
Symptoms of alcohol allergy
Specific clinical manifestations of allergy are diverse and depend both on a certain substance that caused intolerance and its amount, and on the reactivity of the body, age, concomitant diseases and other factors.
Most often there are skin manifestations. With a true allergy to alcohol, symptoms such as urticaria and atopic dermatitis are usually noted on the skin of the face, upper chest, accompanied by itching of varying severity. Another skin manifestation with a true allergy to alcohol is angioedema Quincke. With pseudoallergia, skin lesions can be widespread (face, trunk, upper and lower extremities) and are characterized by polymorphic skin rashes (urticaria, papular, erythematous, macular, hemorrhagic, bullous manifestations).
Respiratory manifestations of alcohol allergy include symptoms of allergic rhinitis (copious mucous-watery discharge from the nose, difficulty in nasal breathing, itchy skin in the nasal area and in the nasal passages), bronchospastic reactions (shortness of breath, attacks of suffocation).
Symptoms of damage to the digestive tract with a true or false allergy to alcohol can manifest as an oral syndrome (itching in the oral cavity, numbness or a feeling of swelling of the tongue, as well as soft palate, swelling of the oral mucosa). Nausea and vomiting after drinking alcohol, abdominal pain by the type of intestinal colic, decreased appetite, stool disorder, disorders of general well-being (headache, general weakness, dizziness, etc.) are often noted.
The symptoms of a false allergy to alcohol (pseudoallergia) are most often caused by a sharp release of inflammatory mediators (and primarily histamine) by cells and manifest themselves in the form of pronounced vegetative-vascular reactions (severe hyperemia of the skin, a feeling of heat throughout the body, migraine headaches, a feeling of lack of air, gastric and intestinal dyspepsia), which can be combined with skin or respiratory manifestations.
Systemic allergic reactions in the form of anaphylactic shock when drinking alcoholic beverages are rare enough, anaphylactoid reactions that occur with pseudoallergia and occur more favorably may be noted somewhat more often.
Identifying a true or false allergy to alcohol is quite a difficult task, since in this case the clinical manifestations are diverse, and the emerging similar symptoms may be caused by completely different causal factors. It is often very difficult to identify a specific substance that caused an allergic or pseudoallergic reaction, given the combined effect of several components, frequent cross-reactions between them, as well as concomitant toxic damage to various organs and tissues during alcohol abuse and sometimes congenital alcohol intolerance.
A thorough collection of general and allergological anamnesis, information about alcohol consumption, the presence of signs of food intolerance to certain products, food additives is necessary. To identify a true allergy to alcohol, a complex of laboratory and special allergological studies is carried out, including skin allergy tests with potential food allergens that may be part of alcoholic beverages (egg white, wheat, yeast, herbs, nuts, citrus fruits, etc.). Such tests should be performed by an allergist-immunologist in a specialized medical institution. Allergen-specific immunoglobulins (classes E and G) to the above food allergens can be detected.
The presence of negative results of allergological studies indicates the probable pseudoallergic nature of alcohol intolerance. Sometimes in such cases, a test with histamine can be performed: the introduction of this substance into the duodenum and fixation of the developing reaction of the body, followed by comparison with similar reactions to the use of wine, beer and other alcoholic beverages.
Differential diagnosis of alcohol allergy is carried out with other allergic diseases, including food allergies, diseases of the gastrointestinal tract, poisoning, chronic intoxication, vegetative-vascular dystonia, neuropsychiatric and endocrine disorders, some intestinal infections.
Alcohol allergy treatment
After identifying a specific allergen or substance that caused a pseudoallergic reaction, it is necessary to exclude the use of alcoholic beverages containing the problematic component and food products in which it is included.
Given the negative role of histamine in the development of a false allergy to alcohol, it is necessary to use a diet with the exclusion or minimization of products containing histamine and tyramine in increased amounts, as well as liberators (wine and beer, hard cheeses, sausages, sausages, smoked and pickled foods), food dyes and preservatives. It should be remembered that even pure alcohol without special impurities and additives promotes the absorption of other products containing histamine, that is, in any case, it is a liberator that increases the risk of developing pseudoallergic reactions.
With pronounced clinical manifestations of alcohol allergy, antihistamines (preferably of the second or third generation), histaglobulin are prescribed, with systemic allergic and pseudoallergic reactions – glucocorticoids, drugs that support the work of the circulatory and respiratory systems. Concomitant somatic diseases (gastroduodenitis, enterocolitis, hepatitis and pancreatitis), vegetative-vascular dystonia and neuropsychiatric disorders are treated.
Prognosis and prevention
If you refuse to use ethanol-containing products, allergic symptoms regress. Prevention of alcohol allergy is based on the use of high-quality alcoholic beverages in small doses. In some cases, a complete rejection of alcoholic beverages is necessary, compliance with an elimination diet with the exclusion of potential allergens, liberators and products containing histamine in increased quantities, as well as timely treatment of diseases of the digestive tract.