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Wine allergy: rare and often confused with intolerance

IS WINE A DRINK OF THE GODS, A HEALING ELIXIR OR A DANGEROUS ALLERGEN?

Wine is a drink that has long been admired by humanity. Even the ancient Greek physician Hippocrates (460 BC) prescribed wine as a remedy for fever, gastrointestinal diseases, bleeding, lack of appetite and to maintain general health.

Today it is known that this drink, which began to be produced as early as 8000 years ago in Ancient Persia, in moderation can lower cholesterol levels. And the antioxidants present in it, in particular resveratrol, help prevent cancer and act as an antibiotic. In addition, wine contains a high level of potassium, which plays a crucial role in counteracting the negative effects of salt in our diet.

According to Hippocrates, one glass of wine a day is enough to maintain health.

The second and third glasses of the drink, in his opinion, improved mood and sleep, respectively. But the doctor considered the use of each next glass dangerous.

However, there are people for whom even a small amount of wine causes unpleasant symptoms. And it’s not about the hangover.

In particular, in 2010 in Mainz, in western Germany, in the popular Rhine-Hess wine region, a survey was conducted on alcohol consumption. Adverse reactions to wine in the form of intolerances or allergies were also recorded. Of the 948 adults who completed the questionnaire, 7.2% reported some kind of reaction to this drink.

At the same time, women reported side symptoms almost twice as often as men: 8.9% versus 5.2%. And people with wine intolerance more often reported intolerance to beer and alcohol in general.

It is believed that wine intolerance is the cause of most reactions to this drink. Whereas allergies to wine or some of its ingredients are less common.

REASONS FOR THE DEVELOPMENT OF ALLERGIES TO WINE

People with asthma are more likely to develop allergies to wine and other alcoholic beverages.

In addition, different types of wines have different allergenic potential. In particular, red wine causes an allergic reaction more often than white.

In one 2005 study of people suffering from upper respiratory symptoms in response to alcohol, white wine provoked a reaction in 31% of those surveyed. Whereas the reaction to red developed in 83% of the respondents.

The reason is in the grape peel, without which the production of red wine is impossible, and in the allergenic proteins that it contains. These are, in particular, the proteins endochitinase and LTP (lipid transfer protein or lipid transfer protein). 

Due to the presence of grapes in LTP wine, people with sensitivity to peaches and cherries can also react to this drink. Responsible for such cross-reactions is the main grape allergen, the lipid transfer protein Vit v 1. 

Because of this same protein, a 2006 study suggests that people with grape allergies can also react to certain other fruits. In particular:

  • apples
  • peanut
  • walnuts
  • strawberries
  • hazelnut
  • almond
  • pistachios.

Also, there are more tannins in the skins of colored grape varieties. On the one hand, they give the wine its characteristic aroma, on the other, as studies show, they increase the release of serotonin, which is the cause of headaches.  

But white wine is made by fermenting grapes without the skin. Therefore, it does not contain LTP and slightly differs in the composition of tannins. Here they are based on phenols.

ALLERGENS IN WINE

In general, the allergens responsible for wine allergy include:

– grape proteins (Vitis vinifera), especially the already mentioned Vit v1;   

– proteins and ingredients that are used to refine wines. For example, egg white albumin, which is the oldest purification method in winemaking;  

– tannins and gelatin – animal protein that is used in red wine as a way to reduce excess viscosity;  

– sucrose polymer chitosan . It is added to white wine to enhance the flavor. But because it is composed of the exoskeletons of crabs, shellfish, shrimp and other crustaceans, this substance can be especially problematic for wine lovers who are allergic to shellfish; 

– izinglas – a protein produced from collagen taken from the air bladders of fish. It is used in wine as a mild thinner and as a way to prevent aroma degradation due to the use of proteins. Dangerous for people with fish allergies. The latter is one of the most severe and easily leads to anaphylaxis;  

– casein – a type of phosphoprotein found in milk. It is used to help brighten white wines;  

– gluten – gluten can get into wine, as a mixture of flour and water is often used to seal oak barrels;  

Also, ovalbumin, gums, enzymes (lysozyme, pectinase, glucanase, cellulase, glucosidase, urease, aromatic enzymes), fungus (especially Botrytis cinerea ) can lead to allergic reactions . The latter is responsible for the noble rot in wines. Wine can contain both yeast and insect proteins that have come into contact with grapes.       

The latter problem is typical, as a rule, for young wines. At least one study showed symptoms in 5 patients after eating grapes. But after each testing with older wine samples, the sensitivity was negative.

Intolerance of wine

But ethanol, acetaldehyde and acetic acid, flavonoids (anthocyanins and catechins), sulfites, histamine and other biogenic amines are the main causes of wine intolerance reactions. They are also called pseudo-allergic reactions. 

Intolerance is a condition where your body is unable to effectively break down alcohol. This problem may be due to genetics or it appears over time for other reasons. 

Among the aforementioned constituents of wine, histamine and sulfites are almost the most common reactions. Sulfites are sulfur-containing substances found naturally in wine. But they are also added by winemakers to prevent spoilage of the product. 

There are more sulfites in white wine than in red, because they are needed to protect its delicate taste and color.

An extra portion of sulfites is also found in sweet wines with a high sugar content.

By some estimates, one in 100 people is susceptible to sulfites. And 5-10% of people with asthma have severe sulfite sensitivity.

Besides wine, sulfites are also found in a number of foods, such as:

  • pickled vegetables,
  • vinegar,
  • beer and cider,
  • sauce and dried fruits.

They can be found as a preservative in certain medicines and cosmetics.

But if sulfites can be found more often in white wine, then reactions of intolerance to histamine and other biogenic amines occur mainly after drinking red wine and in people with diamine oxidase (DAO) deficiency.

This is because wine naturally contains histamine. It is also secreted from the white blood cells (lymphocytes) of a person during an allergic reaction. Therefore, the symptoms of wine allergy and intolerance can often be very similar.

Symptoms of Wine Allergy and Intolerance

Due to the similarity of symptoms, wine intolerance is sometimes very difficult to distinguish from an allergic reaction to this drink.

Symptoms of an intolerance may include:

  • redness of the skin
  • runny or stuffy nose
  • headache or migraine
  • nausea or vomiting
  • fast heartbeat
  • low blood pressure (hypotension)
  • worsening asthma

The main symptoms of an allergic reaction include:

  • a rash, usually hives
  • swollen lips / tongue / eyes
  • feeling hot
  • itchy skin
  • labored breathing
  • dyspnea
  • wheezing
  • nasal congestion
  • diarrhea.

However, sometimes an allergic reaction gets out of control and becomes life-threatening. This condition is called anaphylaxis. 

Symptoms to look out for in this case include:

  • rash or hives that may itch
  • labored breathing
  • wheezing or coughing
  • throat swelling
  • fast heartbeat
  • low blood pressure (hypotension)
  • indigestion (nausea, vomiting, or diarrhea)
  • a sense of doom
  • fainting.

One documented case of a severe allergic reaction involves an 18-year-old woman who developed an anaphylaxis attack while eating grapes and drinking champagne at the same time.

Sometimes anaphylaxis may not occur on its own, but under certain conditions. For example, after playing sports or other physical work. That is, physical activity, which is preceded by the use of grapes or wine, leads to a strong reaction. 

And sometimes reactions only occur to a particular grape and wine variety. So, Merlot grapes can provoke an increase in blood pressure in people with hypertension or in those who have a tendency to increase it. Symptoms usually occur at night or early in the morning and resemble a heart attack with an accelerated heart rate. 

In this case, the reaction can develop even after drinking a small amount of wine. Therefore, people at risk should avoid not only wines made from Merlot grapes, but also mixed wines.

If you suspect that you are allergic to wine, it is better to consult an allergist, who, with the help of testing, will confirm or deny this diagnosis.

If confirmed, then the best solution would be to avoid the allergen. In mild cases of an allergic reaction, antihistamines may help. They relieve symptoms, but do not address the cause of the allergy. That is, they do not prevent the occurrence of repeated reactions. To this end, doctors are increasingly beginning to practice the method of oral immunotherapy. People with food allergies are slowly injected with increasing amounts of the allergen to increase their tolerance. But in Ukraine, this type of therapy in the case of wine is not yet available.  

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