Putting a cork in Wine Allergy for Valentine’s Day!

Valentine’s Day has been a special day for me since I met the love of my life and soulmate, Phil. We almost never go out on the day because it is typically on a workday and it is too crowded to be fun. This is fine because Phil always finds a beautiful way to celebrate. However, I wanted the rest of you diehard Valentine’s Day fans to be prepared, with a little primer about wine allergy.

Wine is usually made from grapes but technically can be made from any fruit or vegetable that can be fermented as well as brewer’s yeast, known as Saccharomyces cerevisiae, and preservatives.

Grape allergy is rare. If patients are allergic to grapes, reaction to raw grapes and dishes that also contain the grapes is also expected. Many patients allergic to grape have an allergy to apple as well due to the chemical thaumatin which is responsible for sweetness in these fruits and is also commercially available as a natural sweetener. Other allergies are those to the yeast and other byproducts of fermentation or additives that are used to keep the wine from turning to vinegar.

Alcohol is a common cause of flushing, so much so that the reaction is called an alcohol flushing reaction. Alcohol flushing is an intolerance caused by an inherited inability to metabolize alcohol as efficiently. When alcohol is metabolized, it is converted to acetaldehyde and then to other substances that are less toxic. If acetaldehyde is not metabolized, it causes the release of histamine. Medications can alter the breakdown of acetaldehyde as well. Patients with rosacea have an exaggerated flush with alcohol, which does have vasodilatory properties on blood vessels. Finally, acetaldehyde is a byproduct of yeast metabolism. It is also largely responsible for the “hangover”.

Wine allergy causes the same symptoms as any other allergy and may include:

• Shortness of breath
• Wheezing
• Chest tightness
• Swelling of the throat
• Swelling of the tongue
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Flushing
• Hives
• Hoarseness

There are also intolerances which may be as concerning as allergy. These may seem the same or even have the same symptoms but the process leading up to the symptoms is different.

Flushing from alcohol is a typical example of intolerance. The most important implication for patients who flush due to alcohol is that acetaldehyde is toxic and can increase the predisposition for developing esophageal and breast cancer. Acetaldehyde may be the byproduct of alcohol that causes patients with rosacea to flush more. The fuel oils and other alcohols that are produced can also contribute to intolerance as well as hangover. However, these alcohols also provide some of the smell and taste that differentiates wine from grapes.

Biogenic amines such as putrescine, cadaverine, histamine, ethanolamine, and tyramine are all byproducts of wine fermentation. You know about one of these chemicals, histamine, because it is also released by allergic cells during an allergic reaction and the antidote is antihistamine. Unfortunately, there is not much we can do about the other biogenic amines, which cause many of the same symptoms as an allergic reaction (see above). The amount produced is dependent on many factors. For example, Saccharomyces cerevisiae, the “tame” yeast that is typically used to ferment wine, has been “bred” to minimize toxic byproducts, “off” flavors and odors, and the quantity of biogenic amines produced during fermentation. The hygienics of the brewery can be a major factor and whether the winery uses filtration, which can minimize wild yeast or bacteria from invading and increasing the undesirable byproducts. They cause similar bodily reactions, depending on the amount ingested. However, we only have an antidote to one, that is antihistamines for histamine.

Patients taking medications in the drug class of monamine inhibitors, which prevent breakdown of tyramine, or those in the drug class of diaminooxidase inhibitors, which prevent breakdown of histamine, should be mindful of the presence of biogenic amines because these inhibitors prevent breakdown of the biogenic amines and when the biogenic amines are present in excess amounts, they can precipitate a hypertensive crisis. These inhibitors are present in a variety of medications. If this was the cause, problems would have started at the same time as the medication was begun.

Wine drinkers can also have problems from tannins, anthocyanins and sulfites.

Tannins are bitter and about 25% of the population does not care for them when present in wine or other foods such as kale, coffee, tea, nuts and legume seeds, chocolate and cereals. Intolerant patients can get headache, nausea, vomiting, stomach pain, and diarrhea. Tannin breaks down over time so aged wines will have less. Tannins are highest in red wines as more are in wine when it sits on its skin to give the red color.

Anthocyanins provide the red color to wine and high levels are found in cherries, berries, beetroot, and natural colorings. Anthocyanins are a natural antioxidant and anti-inflammatory. They are reputed to have cancer-fighting and heart protective properties as well as help prevent age-related mental decline. The amount in wine and foods is considered safe, but anthocyanin supplements are not recommended as the excess amount may cause side effects such as kidney failure. Anthocyanin content is variable, depending on the varietal, and Cabernet Sauvignon has the most whereas Pinot Noir and Cabernet Franc has the least.

Sulfites are used to preserve food because of its anti-microbial properties which prevent spoiling and its antioxidant properties that prevent browning. Sulfites can trigger asthma flares as well as hives and anaphylaxis, but the FDA requires labeling for foods that contains more than 10 parts per million. If sulfites are the problem, other foods such as dried fruits, Dijon mustard, and burger and breakfast sausage meat can also be an issue. Sulfites are lowest in dry, red wine, higher in dry, white wines and higher still for sweet wines.

There are medications that can decrease alcohol flush. These include the H2 blockers such as cimetidine (Tagamet) and famotidine (Pepcid). You will recognize these medications as those that are typically used to treat heartburn. However, these medications have no effect on the levels of acetaldehyde and therefore no decrease in the risk of cancer.

Otherwise, if true allergy is at play or if intolerance is caused by a necessary medication, complete avoidance is recommended.

If you think you need help controlling allergies and would like to be tested or treated for your allergies and believe you may be a good candidate for allergen immunotherapy, Dr. Wendt and her team staff at Relieve Allergy, Asthma & Hives would love to help.

Relieve Allergy Asthma & Hives is located near Kierland Commons, Scottsdale Quarter, DC Ranch and Grayhawk at 21803 N. Scottsdale Road Ste. 200, on the corners of Deer Valley and Scottsdale Roads, and has convenient evening and early morning hours to accommodate your schedule.

Dr. Wendt is also available for telemedicine appointments as appropriate. Insurance plans accepted. Call 480-500-1902 today to schedule an appointment now and begin your allergy testing and treatment with Dr. Wendt at Relieve Allergy, Asthma & Hives in Scottsdale, Arizona.

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