Wine is More Likely to Cause Reactions in Individuals with Asthma
Wine, particularly white wine, is more likely to trigger asthmatic reactions than beer, primarily due to higher sulfite content, though both beverages can cause reactions through different mechanisms.
Sulfite Content and Asthmatic Reactions
Sulfites in wine (especially white wine) are the primary culprit for asthmatic reactions, with white wine containing approximately 160 mg% of metabisulfite used for sterilization during fermentation 1.
Sulfites can precipitate asthma symptoms in up to 5% of adults with asthma, particularly those with unstable or poorly controlled disease 1.
In a controlled study of 24 asthmatics challenged with 4 oz of white wine containing 160 mg% metabisulfite, 7 patients (29%) experienced >10% decrease in FEV1 at 20 minutes, with 4 patients showing severe decreases of 23-36% 2.
White wine typically contains higher sulfite levels than red wine or beer, making it the most problematic alcoholic beverage for sulfite-sensitive asthmatics 1, 3.
Beer vs. Wine: Comparative Risk
Over 40% of asthmatics report triggering of allergic or allergic-like symptoms following alcoholic drink consumption, with wine being the most commonly reported trigger 4.
Beer allergies are typically due to specific proteins in barley or lipid transfer proteins, and occasionally to yeasts and molds, representing a different and less common mechanism than wine reactions 5.
Wine-induced reactions occur significantly more frequently in persons with pre-existing rhinitis and asthma (affecting 10% of the general population with hypersensitivity reactions) 3.
Mechanisms of Wine Reactions
Wine reactions involve multiple mechanisms beyond sulfites, including histamine and other biogenic amines (particularly in red wine), ethanol, acetaldehyde, acetic acid, and flavonoids 3, 4.
Histamine in wine has been associated with triggering sneezing, rhinitis, itching, flushing, headache, and asthma, with reactions occurring mainly in persons with diamine oxidase (DAO) deficiency 3.
True IgE-mediated wine allergy can occur from grape proteins (particularly lipid transfer protein Vit v1), fining agents (fish gelatin, ovalbumin, casein), enzymes (lysozyme), molds (Botrytis cinerea), and yeasts 3.
Clinical Evidence Complexity
Direct challenge studies reveal that wine-induced asthma is complex and may not be solely sulfite-dependent: In a double-blind study, only 1 of 16 asthmatics with strong histories of wine-induced asthma reacted to low-sulfite wine, and only 2 of 10 reacted to high-sulfite wine 6.
This suggests that while sulfites are implicated, the actual mechanism may involve co-factors or multiple pathways, making wine reactions unpredictable even in those reporting sensitivity 6, 4.
Risk Stratification for Asthmatics
Patients with poorly controlled asthma are at highest risk for severe reactions to wine 1.
Adolescents and young adults with asthma and known food/beverage sensitivities face increased risk of fatal anaphylactic reactions 1.
Asthmatics taking β-adrenergic blocking agents are at higher risk for serious reactions and may be less responsive to epinephrine treatment 1.
Clinical Recommendations
Advise asthmatic patients to avoid both beer and wine if they report any history of respiratory symptoms after alcohol consumption, but emphasize that wine (especially white wine) poses greater risk due to sulfite content 1.
Patients with asthma who are sensitive to sulfite-containing foods (shrimp, dried fruit, processed potatoes) should specifically avoid beer and wine 1.
Ensure patients carry short-acting nonsedating antihistamines and adrenaline autoinjectors if they have documented reactions to alcoholic beverages 5.
Common Pitfalls
Do not assume that red wine is safer than white wine—while white wine has higher sulfites, red wine contains more histamine and biogenic amines that can trigger different reaction pathways 3.
Do not rely on patient history alone to predict reactivity, as controlled challenge studies show poor correlation between reported sensitivity and actual reactions 6.
Do not overlook that individuals with both food allergy and asthma are at increased risk for fatal anaphylactic reactions, requiring heightened vigilance 1.