Can beer trigger anaphylaxis in individuals with moderate persistent asthma?

From the Guidelines

Beer can potentially trigger anaphylaxis in individuals with moderate persistent asthma, particularly if they have specific allergies to ingredients in beer. People with asthma are generally at higher risk for severe allergic reactions, including anaphylaxis, as noted in the 2020 practice parameter update on anaphylaxis 1. Beer contains several potential allergens including barley, wheat, hops, yeast, and sulfites, which can trigger reactions in sensitive individuals. Those with moderate persistent asthma should be especially cautious if they have known allergies to any beer ingredients or have experienced adverse reactions to alcoholic beverages in the past.

Key Considerations

• Asthma is a risk factor for severe anaphylaxis, as highlighted in the study published in the Journal of Allergy and Clinical Immunology 1.
• The first-line treatment for anaphylaxis is epinephrine administered intramuscularly, as recommended by the 2020 practice parameter update on anaphylaxis 1.
• Individuals with asthma and known allergies should carry prescribed epinephrine auto-injectors at all times and consider wearing medical alert identification.

Management of Anaphylaxis

If anaphylaxis occurs, immediate administration of epinephrine via an auto-injector (such as EpiPen or Auvi-Q, typically 0.3mg for adults, 0.15mg for children) is the first-line treatment, followed by calling emergency services, as advised in the study on epinephrine for first-aid management of anaphylaxis 1. The mechanism behind this increased risk involves both the allergens in beer and alcohol's potential to enhance absorption of allergens and amplify allergic responses, while also potentially interfering with asthma medications.

From the Research

Beer and Anaphylaxis in Moderate Persistent Asthma

• Beer has been reported to cause anaphylaxis in rare cases, with barley and wheat being identified as potential allergens 2, 3, 4, 5.
• Studies have shown that individuals with allergies to barley or wheat can experience anaphylaxis after consuming beer, even if they have moderate persistent asthma 2, 3.
• The ingredients in beer, such as barley malt, can trigger allergic reactions, including anaphylaxis, in sensitive individuals 3, 5.
• Other components of beer, like yeast, can also cause allergic reactions, although this is less common 6.
• Diagnosis of beer-induced anaphylaxis typically involves skin prick tests, oral challenge tests, and identification of specific IgE antibodies 2, 3, 4, 5.

Specific Allergens in Beer

• Barley is a common allergen in beer, with studies showing that it can cause anaphylaxis in some individuals 3, 5.
• Wheat is another potential allergen in beer, particularly in wheat beers 2, 4.
• Lipid transfer protein (LTP) from cereals can also be an allergen in beer 4.
• Yeast and moulds can cause allergic reactions to beer, although this is rare 6.

Implications for Individuals with Moderate Persistent Asthma

• Individuals with moderate persistent asthma who experience anaphylaxis after consuming beer should undergo diagnostic testing to identify the specific allergen responsible 2, 3, 4, 5.
• Avoiding beer or specific ingredients in beer, such as barley or wheat, may be necessary to prevent future anaphylactic reactions 2, 3, 4, 5.