Which is more likely to cause anaphylaxis in asthmatics, beer or wine?

From the Guidelines

Wine is more likely to cause anaphylaxis in asthmatics compared to beer. This is primarily due to wine containing higher levels of sulfites, which are preservatives that can trigger severe allergic reactions in sensitive individuals, particularly those with asthma. According to a study on anaphylaxis management 1, cofactors such as ingestion of ethanol can lower the threshold at which triggers can cause anaphylaxis, and concomitant asthma is a significant risk factor for fatal anaphylaxis. Some key points to consider include:

• Sulfites are naturally present in wine and are often added during the winemaking process to prevent oxidation and bacterial growth, with white wines typically containing higher concentrations than red wines.
• Beer generally contains lower levels of sulfites, making it less likely to trigger anaphylactic reactions in asthmatics.
• Individuals with asthma who are sensitive to sulfites should exercise caution with all alcoholic beverages, as symptoms of sulfite sensitivity can range from mild wheezing to severe anaphylaxis.
• If you have asthma and experience symptoms after consuming wine, it's essential to seek medical attention immediately and consider carrying an epinephrine auto-injector (such as EpiPen) if prescribed by your healthcare provider, as prompt epinephrine administration can be life-saving in cases of anaphylaxis 1.

From the Research

Comparison of Beer and Wine in Causing Anaphylaxis in Asthmatics

• Both beer and wine can cause allergic reactions, but the likelihood of causing anaphylaxis in asthmatics differs between the two.
• Beer has been reported to cause anaphylaxis in rare cases, often due to sensitization to barley or wheat, as seen in studies 2 and 3.
• Wine, on the other hand, is more commonly associated with allergic and asthmatic reactions, with studies suggesting that up to 40% of asthmatics may experience adverse symptoms after consuming wine 4 and 5.
• The main allergens responsible for wine allergy include grape proteins, sulfites, and biogenic amines, whereas beer allergy is often attributed to barley or wheat proteins 6.

Key Findings

• A study published in 2004 found that a 59-year-old man experienced severe anaphylaxis after ingesting wheat beer, highlighting the potential for beer to cause anaphylaxis in rare cases 2.
• Another study published in 1999 reported two cases of severe systemic reactions due to beer ingestion, with barley sensitization being the likely cause 3.
• In contrast, studies have consistently shown that wine is a more common trigger for asthmatic reactions, with sulfite additives and biogenic amines being potential culprits 4 and 5.

Asthmatic Reactions to Beer and Wine

• Asthmatic reactions to beer are relatively rare and often require sensitization to specific ingredients such as barley or wheat.
• Wine, however, is more likely to trigger asthmatic reactions, particularly in individuals with pre-existing asthma or sensitivities to sulfites or biogenic amines 6 and 4.