Wine-induced asthma: a placebo-controlled assessment of its pathogenesis

Rational Construction of a Two-Photon NIR Ratiometric Fluorescent Probe for the Detection of Bisulfite in Live Cells, Tissues, and Foods

In this study, we report a novel ratiometric fluorescent probe with a blue shift of 180 nm based on a D-π-A-A structure. The probe composed of a hydroxyl moiety as a donor, a naphthyl ring as a π bridge, and benzothiazole/hemicyanine as an acceptor has good selectivity and high sensitivity to bisulfite (HSO₃^-) in aqueous solution. Besides one-photon fluorescence properties, the probe possesses excellent two-photon fluorescence properties and is successfully utilized for fluorescence imaging of HSO₃^- in MCF-7 cells and rat liver tissues. More importantly, the probe also has practical application potential for measuring the HSO₃^- content of real food samples.

Colorimetric Detection of Sulfite in Foods by a TMB-O2-Co3O4 Nanoparticles Detection System

In this paper, we first discovered that Co3O4 nanoparticles (NPs) possess intrinsic oxidase-like activity and can catalytically oxidize peroxidase substrates, such as 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) and 3,3',5,5'-tetramethylbenzidine (TMB), to form colored products, in the absence of exogenously added H2O2. The presence of sulfite inhibited the TMB-O2-Co3O4 NPs reaction system and caused a change in color of the reaction system. On the basis of this phenomenon, a colormetric approach to detect sulfite was established with a good linear relationship ranging from 0.2×10(-6) to 1.6×10(-5) M and a detection limit of 5.3×10(-8) M. The method was used to detect sulfite in foods. Good recoveries ranging from 93.8% to 100.5% were obtained. Furthermore, the mechanism was studied and results showed that the oxidase-like activity of the Co3O4 NPs was not from •OH or O2•- radical generated. It may probably originate from their ability to transfer an electron between the peroxidase substrate and oxygen absorbed on the surface of the Co3O4 NPs.

Alcohol-induced respiratory symptoms are common in patients with aspirin exacerbated respiratory disease

BACKGROUND

A large percentage of patients with aspirin exacerbated respiratory disease (AERD) report the development of alcohol-induced respiratory reactions, but the true prevalence of respiratory reactions caused by alcoholic beverages in these patients was not known.

OBJECTIVE

We sought to evaluate the incidence and characteristics of alcohol-induced respiratory reactions in patients with AERD.

METHODS

A questionnaire designed to assess alcohol-induced respiratory symptoms was administered to patients at Brigham and Women's Hospital and Scripps Clinic. At least 50 patients were recruited into each of 4 clinical groups: (1) patients with aspirin challenge-confirmed AERD, (2) patients with aspirin-tolerant asthma (ATA), (3) patients with aspirin tolerance and with chronic rhinosinusitis, and (4) healthy controls. Two-tailed Fisher exact tests with Bonferroni corrections were used to compare the prevalence of respiratory symptoms among AERD and other groups, with P ≤ .017 considered significant.

RESULTS

The prevalence of alcohol-induced upper (rhinorrhea and/or nasal congestion) respiratory reactions in patients with AERD was 75% compared with 33% with aspirin-tolerant asthma, 30% with chronic rhinosinusitis, and 14% with healthy controls (P < .001 for all comparisons). The prevalence of alcohol-induced lower (wheezing and/or dyspnea) respiratory reactions in AERD was 51% compared with 20% in aspirin-tolerant asthma and with 0% in both chronic rhinosinusitis and healthy controls (P < .001 for all comparisons). These reactions were generally not specific to one type of alcohol and often occurred after ingestion of only a few sips of alcohol.

CONCLUSION

Alcohol ingestion causes respiratory reactions in the majority of patients with AERD, and clinicians should be aware that these alcohol-induced reactions are significantly more common in AERD than in controls who are aspirin tolerant.

Improved sample preparation and rapid UHPLC analysis of SO2 binding carbonyls in wine by derivatisation to 2,4-dinitrophenylhydrazine

Sulphur dioxide (SO2) is essential for the preservation of wines. The presence of SO2 binding compounds in musts and wines may limit sulphite efficacy leading to higher total SO2 additions, which may exceed SO2 limits permitted by law and pose health risks for sensitive individuals. An improved method for the quantification of significant wine SO2 binding compounds is presented that applies a novel sample treatment approach and rapid UHPLC separation. Glucose, galacturonic acid, alpha-ketoglutarate, pyruvate, acetoin and acetaldehyde were derivatised with 2,4-dinitrophenylhydrazine and separated using a solid core C18 phase by ultra high performance liquid chromatography. Addition of EDTA to samples prevented de novo acetaldehyde formation from ethanol oxidation. Optimised derivatisation duration enhanced reproducibility and allowed for glucose and galacturonic acid quantification. High glucose residues were found to interfere with the recovery of other SO2 binders, but practical SO2 concentrations and red wine pigments did not affect derivatisation efficiency. The calibration range, method accuracy, precision and limits of detection were found to be satisfactory for routine analysis of SO2 binders in wines. The current method represents a significant improvement in the comprehensive analysis of SO2 binding wine carbonyls. It allows for the quantification of major SO2 binders at practical analyte concentrations, and uses a simple sample treatment method that prevents treatment artifacts. Equipment utilisation could be reduced by rapid LC separation while maintaining analytical performance parameters. The improved method will be a valuable addition for the analysis of total SO2 binder pools in oenological samples.

Colorimetric chemodosimeter based on diazonium-gold-nanoparticle complexes for sulfite ion detection in solution

A fast and simple colorimetric detection system for sulfite, based on diazonium-gold-nanoparticle(AuNP) complexation, has high selectivity and sensitivity in aqueous media. The positively charged diazonium has affinity for the AuNP surface due to an electrostatic effect, which prevents AuNPs from aggregating in highly saline solutions. Upon addition of sulfite, the AuNPs are free to aggregate due to the formation of a neutral and insoluble phenylhydrazine derivative.

Metabolism of SO₂ binding compounds by Oenococcus oeni during and after malolactic fermentation in white wine

Sulfur dioxide SO₂ is the key additive for the preservation of wines. Carbonyl and keto compounds in wine can bind to SO₂ and decrease its efficacy, resulting in higher total SO₂ requirements. Increased consumer demand for low sulfite and organic wines pose production challenges if SO₂ binders have not been properly managed during vinification. Malolactic fermentation (MLF) has been known to reduce bound SO₂ levels but detailed time course studies are not available. In this work, the kinetics of major SO₂ binding compounds and malic acid were followed during MLF in wine with 12 commercially available strains of Oenococcus oeni. Pyruvic acid, acetaldehyde and α-ketoglutaric acid were degraded to various degrees by O. oeni, but galacturonic acid was not. At the time of malic acid depletion, percent degradation of pyruvate, α-ketoglutaric acid and acetaldehyde was 49%, 14% and 30%, respectively. During MLF, the decrease in average bound SO₂ levels, as calculated from carbonyl metabolism, was 22%. The largest reduction in wine carbonyl content occurred in the week after completion of MLF and was 53% (107 mg/L to 34 mg/L) calculated as bound SO₂. Prolonged activity of bacteria in the wines (up to 3 weeks post malic acid depletion) resulted only in reduced additional reductions in bound SO₂ levels. The results suggest that microbiological wine stabilization one week after malic acid depletion is an effective strategy for maximum removal of SO₂ binders while reducing the risk of possible post-ML spoilage by O. oeni leading to the production acetic acid and biogenic amines.

Phytoceuticals: the new 'physic garden' for asthma and chronic obstructive pulmonary disease

Phytoceuticals (non-nutritional but beneficial plant chemicals) merit investigation as pharmacotherapy for asthma and chronic obstructive pulmonary disease (COPD). Although asthma is mostly treated adequately, COPD is not. Thus, there is a need for new drugs with improved therapeutic benefit, especially in COPD. Recent interest in herbal remedies has redirected attention towards plants as sources of improved treatments for lung disease. Phytoceuticals from a variety of plants and plant products, including butterbur, English ivy, apples, chocolate, green tea and red wine, demonstrate broad-spectrum pharmacotherapeutic activities that could be exploited in the clinic. Well-designed clinical trials are required to determine whether these beneficial activities are reproduced in patients, with the prospect that phytoceuticals are the new physic garden for asthma and COPD.

Development of animal models and sandwich-ELISA tests to detect the allergenicity and antigenicity of fining agent residues in wines

Food allergy can cause food-related anaphylaxis. Food allergen labeling is the principal means of protecting sensitized individuals. This motivated European Directive 2003/89 on the labeling of ingredients or additives that could trigger adverse reactions, which has been in effect since 2005. During this study, we developed animal models with allergy to ovalbumin, caseinate, and isinglass in order to be able to detect fining agent residues that could induce anaphylactic reactions in sensitized mice. The second aim of the study was to design sandwich ELISA tests specific to each fining agent in order to detect their residue antigenicity, both during wine processing and in commercially available bottled wines. Sensitized mice and sandwich ELISA methods were established to test a vast panel of wines. The results showed that although they were positive to our highly sensitive sandwich-ELISA tests, some commercially available wines are not allergenic in sensitized mice. Commercially available bottled wines made using standardized processes, fining, maturation, and filtration, do not therefore represent any risk of anaphylactic reactions in sensitized mice.

Electrocatalytic sulfite biosensor with human sulfite oxidase co-immobilized with cytochrome c in a polyelectrolyte-containing multilayer

An efficient electrocatalytic biosensor for sulfite detection was developed by co-immobilizing sulfite oxidase and cytochrome c with polyaniline sulfonic acid in a layer-by-layer assembly. QCM, UV-Vis spectroscopy and cyclic voltammetry revealed increasing loading of electrochemically active protein with the formation of multilayers. The sensor operates reagentless at low working potential. A catalytic oxidation current was detected in the presence of sulfite at the modified gold electrode, polarized at +0.1 V (vs. Ag/AgCl 1 M KCl). The stability of the biosensor performance was characterized and optimized. A 17-bilayer electrode has a linear range between 1 and 60 microM sulfite with a sensitivity of 2.19 mA M(-1) sulfite and a response time of 2 min. The electrode retained a stable response for 3 days with a serial reproducibility of 3.8% and lost 20% of sensitivity after 5 days of operation. It is possible to store the sensor in a dry state for more than 2 months. The multilayer electrode was used for determination of sulfite in unspiked and spiked samples of red and white wine. The recovery and the specificity of the signals were evaluated for each sample.

Prevalence of self-reported hypersensitivity symptoms following intake of alcoholic drinks

BACKGROUND; Although hypersensitivity symptoms following alcoholic drink consumption are common in asthmatics, the prevalence of such symptoms in the general population is not known.

OBJECTIVE

To assess the prevalence of hypersensitivity symptoms following alcoholic drink consumption in an adult Northern European general population and the association of these symptoms with the prevalence of allergic rhinitis (AR) and asthma.

METHODS

In 2006, a postal questionnaire was sent to a random sample of 18-69-year-olds living in Copenhagen, the capital of Denmark. The response rate was 70.7% (4242/6000).

RESULTS

The prevalence of alcohol-induced symptoms from the upper airways, lower airways, and skin was 7.6% [95% confidence interval (CI): 6.8-8.4%], 3.2% (95% CI: 2.7-3.8%), and 7.2% (95% CI: 6.4-8.9%), respectively. A total of 13.9% (95% CI: 12.9-15.0%) had ever experienced alcohol-induced symptoms from at least one of the three regions (upper airways, lower airways, or skin), and 9.9% (95% CI: 9.0-10.8%) had experienced symptoms in the last 12 months. All types of beverages were commonly reported as triggers of hypersensitivity symptoms, red wine being the most common. Alcohol-induced hypersensitivity symptoms from the upper and lower airways were significantly more prevalent in persons with AR and asthma (odds ratios between 3.0 and 8.1, P-value <0.001 for all associations).

CONCLUSIONS

In this Northern European general population, self-reported hypersensitivity symptoms following the intake of alcoholic drinks are common. These symptoms were markedly more prevalent in persons with AR and asthma. The underlying mechanisms and the clinical significance of these symptoms remain to be elucidated.

Changes in bronchial hyperresponsiveness following high- and low-sulphite wine challenges in wine-sensitive asthmatic patients

BACKGROUND

Previous studies suggest that challenge of most wine-sensitive asthmatic patients may not result in a reduction in forced expiratory volume in 1 s (FEV(1)).

OBJECTIVE

The aim of this study was to assess whether changes in bronchial hyperresponsiveness (BHR) occur following wine challenge of asthmatic patients who report sensitivity to wine, and whether such changes could help clarify the role of sulphite additives in wine-induced asthmatic responses.

METHODS

Eight self-reporting wine-sensitive asthmatic patients completed double-blind challenges with high- and low-sulphite wines on separate days. FEV(1) and histamine PC(20) were measured before and after consumption of 150 mL of wine.

RESULTS

None of the eight subjects demonstrated a clinically significant >or=15%) reduction in FEV(1) following challenge with either high- or low-sulphite wine. In contrast, one patient demonstrated clinically significant increase in BHR following challenge with both high- and low-sulphite wines, and a smaller increase in BHR following placebo challenge. A second patient showed a significant increase, while another showed a significant decrease in BHR following challenge with low-sulphite wine. A fourth patient showed borderline increases in BHR following challenge with both high- and low-sulphite wines.

CONCLUSIONS

Although changes in BHR, in the absence of reductions in FEV(1), were observed in some asthmatic patients following wine challenge, these changes were not consistent with a single aetiology. Consequently, this study did not support a major role for the sulphite additives in wine-induced asthmatic responses in the patients studied. The aetiology of wine-induced asthma is likely to be complex and appears to vary among individuals who are sensitive to these drinks.

Determination of sulfite in beer samples using an amperometric fill and flow channel biosensor employing sulfite oxidase

A simple method is described to determine sulfite in beer samples using a fill and flow channel biosensor. A droplet of sample is placed into the inlet of a rectangular flow cell and begins to flow through the channel by capillarity. The flow is maintained and controlled by a porous outlet plug of defined porosity. In a rectangular flow cell, the sample solution flows through three consecutive zones: over a predictor electrode, an enzyme layer and a detector electrode. Together these three zones enable the differentiation between current due to sulfite and current due to other electroactive species in the sample. The predictor electrode is located upstream, and on the opposite channel wall to the enzyme layer and detector electrode, and is poised at the same potential (+0.65 V versus Ag/AgCl) as the detector electrode. On this electrode, the current contribution from all species in the sample solution that are oxidized at that potential is determined. The enzyme layer contains sulfite oxidase, which, in the process of oxidizing sulfite, produces hydrogen peroxide, which itself is reduced by excess sulfite. The current at the downstream detector electrode is therefore different from that at the predictor electrode as a result of the enzyme reaction and the difference of the currents, corrected for the dimensions of the electrodes, is proportional to the concentration of sulfite. The method enables a straightforward correction of the interfering current at the detector electrode and a determination of the analyte concentration. The effect of interferences from ascorbic acid, ethanol, sorbic acid and tartaric acid in the detection of sulfite is efficiently removed. The concentration of sulfite in a sample of beer measured by the biosensor is equivalent to that measured using a reference method based on the AOAC-recommended Monier-Williams method.

Alcohol, IgE and allergy

Alcoholic drinks are involved in a variety of hypersensitivity reactions. These include flushing syndrome, anaphylactoid reactions (urticaria/angioedema and even shock), as well as the triggering of asthma, food allergy or exercise-induced anaphylaxis in susceptible subjects. In addition, there is increasing evidence that alcohol intake may play a role as a promoter of the development of immunoglobulin-E (IgE)-mediated hypersensitivity to different allergens. It seems clear that alcohol intake (alcohol abuse and even moderate alcohol consumption) is associated with increased total serum IgE levels. Similarly, alcohol intake may be associated with allergic (IgE-mediated) sensitization to environmental allergens. The clinical significance of these facts is probably moderate. The mechanisms by which alcohol can influence IgE responses are not entirely known, but further developments in this area could increase the understanding of both allergic diseases and alcohol-induced alterations in the immune system.

Acute respiratory failure from abused substances

Acute respiratory failure is a common complication of drug abuse. It is more likely to develop in the setting of chronic lung disease or debility in those with limited respiratory reserve. Drugs may acutely precipitate respiratory failure by compromising respiratory pump function and/or by causing pulmonary pathology. Polysubstance overdoses are common, and clinicians should anticipate complications related to multiple drugs. Impairment of respiratory pump function may develop from central nervous system (CNS) depression (suppression of the medulla oblongata, stroke or seizures) or respiratory muscle fatigue (increased respiratory workload, metabolic acidosis). Drug-related respiratory pathology may result from parenchymal (aspiration-related events, pulmonary edema, hemorrhage, pneumothorax, infectious and non-infectious pneumonitides), airway (bronchospasm and hemorrhage), or pulmonary vascular insults (endovascular infections, hemorrhage, and vasoconstrictive events). Alcohol, cocaine, amphetamines, opiates, and benzodiazepines are the most commonly abused drugs that may induce events leading to acute respiratory failure. While decontamination and aggressive supportive measures are indicated, specific therapies to correct seizures, metabolic acidosis, pneumothorax, infections, bronchospasm, and agitation should be considered. Drug-related respiratory failure when due to CNS depression alone may portend well, but in patients with drug-related significant pulmonary pathology, a protracted course of illness may be anticipated.

Effects of loratadine on red wine-induced symptoms and signs of rhinitis

OBJECTIVE

Intake of red wine may produce nasal symptoms. Little is known about the pathophysiology and pharmacology of this condition. The aim of this study was to examine whether nasal symptoms produced by red wine are reproducible, associated with mucinous secretion or plasma exudation and affected by antihistamine treatment.

MATERIAL AND METHODS

Twenty-eight subjects with a history of nasal symptoms associated with red wine intake received oral challenges with red wine and raspberry juice in a crossover design. Nasal symptoms and peak inspiratory flow (PIF) were assessed. Nasal lavages were performed and levels of fucose and alpha2-macroglobulin were determined as indices of mucinous secretion and plasma exudation, respectively. Twelve responders (according to preset criteria) were re-challenged 1 h after loratadine (10 mg) treatment, in a double-blind, placebo-controlled crossover design. Nasal symptoms and PIF were reassessed. Nasal lavages were performed and levels of fucose were redetermined.

RESULTS

Red wine intake produced nasal symptoms (p < 0.05) and decreased nasal PIF (p < 0.01-0.05). A total of 54% of subjects were categorized as responders, and in this group red wine produced a slight increase in lavage fluid levels of fucose (p < 0.05). In contrast, levels of alpha2-macroglobulin were unaffected. A total of 83% of responders developed symptoms at re-challenge. Loratadine reduced post-challenge nasal secretion (p < 0.05). Also, red wine failed to reduce nasal PIF in patients receiving loratadine.

CONCLUSION

Nasal symptoms associated with red wine intake can be reproduced by oral red wine challenges. This symptomatology may be associated with mucinous secretion, but not with plasma exudation. Loratadine may partially reduce nasal symptoms associated with intake of red wine.

Allergic and asthmatic reactions to alcoholic drinks

Alcoholic drinks are capable of triggering a wide range of allergic and allergic-like responses, including rhinitis, itching, facial swelling, headache, cough and asthma. Limited epidemiological data suggests that many individuals are affected and that sensitivities occur to a variety of drinks, including wine, beer and spirits. In surveys of asthmatics, over 40% reported the triggering of allergic or allergic-like symptoms following alcoholic drink consumption and 30 - 35% reported worsening of their asthma. Sensitivity to ethanol itself can play a role in triggering adverse responses, particularly in Asians, which is due mainly to a reduced capacity to metabolize acetaldehyde. In Caucasians, specific non-alcohol components are the main cause of sensitivities to alcoholic drinks. Allergic sensitivities to specific components of beer, spirits and distilled liquors have been described. Wine is clearly the most commonly reported trigger for adverse responses. Sensitivities to wine appear to be due mainly to pharmacological intolerances to specific components, such as biogenic amines and the sulphite additives. Histamine in wine has been associated with the triggering of a wide spectrum of adverse symptoms, including sneezing, rhinitis, itching, flushing, headache and asthma. The sulphite additives in wine have been associated with triggering asthmatic responses. Clinical studies have confirmed sensitivities to the sulphites in wine in limited numbers of individuals, but the extent to which the sulphites contribute to wine sensitivity overall is not clear. The aetiology of wine-induced asthmatic responses may be complex and may involve several co-factors.

Ethanol as a cause of hypersensitivity reactions to alcoholic beverages

BACKGROUND

Adverse reactions after ingestion of alcoholic beverages are common. Metabolic differences in individuals and also the histamine content in alcoholic beverages have been implicated. By contrast pure ethanol has rarely been reported as a cause of hypersensitivity reactions and its mechanism has not been clarified yet.

OBJECTIVE

To determine whether ethanol itself accounts for alcohol hypersensitivity in patients with anaphylactic reactions after alcohol intake. In search of possible pathomechanisms all patients were analysed by skin prick testing and sulfidoleukotriene production of peripheral leucocytes using ethanol and its metabolites.

METHODS

Double-blind, placebo-controlled food challenges with a cumulated amount of 30 mL ethanol were performed in 12 adult patients with a positive history of adverse reactions after consumption of different alcoholic beverages. Skin prick tests and measurement of sulfidoleukotriene production were performed using different concentrations of ethanol and acetaldehyde from 50 to 1000 mm.

RESULTS

Oral challenges with pure ethanol were positive in six out of eleven patients. All challenge-positive patients, but also four out of five challenge-negative patients, showed an increased sulfidoleukotriene production in-vitro compared with healthy controls. Skin prick tests using alcoholic beverages, ethanol, acetaldehyde and acetic acid were negative in all patients (12/12).

CONCLUSION

Our study shows that ethanol itself is a common causative factor in hypersensitivity reactions to alcoholic beverages. These reactions occur dose-dependent and a non-IgE-mediated pathomechanism is likely, because skin prick tests were negative in all cases. Increased sulfidoleukotriene production was determined in some patients, but is no reliable predictor. Therefore oral provocation tests remain indispensable in making the diagnosis of ethanol hypersensitivity.

Role of sulfite additives in wine induced asthma: single dose and cumulative dose studies

BACKGROUND

Wine appears to be a significant trigger for asthma. Although sulfite additives have been implicated as a major cause of wine induced asthma, direct evidence is limited. Two studies were undertaken to assess sulfite reactivity in wine sensitive asthmatics. The first study assessed sensitivity to sulfites in wine using a single dose sulfited wine challenge protocol followed by a double blind, placebo controlled challenge. In the second study a cumulative dose sulfited wine challenge protocol was employed to establish if wine sensitive asthmatics as a group have an increased sensitivity to sulfites.

METHODS

In study 1, 24 asthmatic patients with a strong history of wine induced asthma were screened. Subjects showing positive responses to single blind high sulfite (300 ppm) wine challenge were rechallenged on separate days in a double blind, placebo controlled fashion with wines of varying sulfite levels to characterise their responses to these drinks. In study 2, wine sensitive asthmatic patients (n=12) and control asthmatics (n=6) were challenged cumulatively with wine containing increasing concentrations of sulfite in order to characterise further their sensitivity to sulfites in wine.

RESULTS

Four of the 24 self-reporting wine sensitive asthmatic patients were found to respond to sulfite additives in wine when challenged in a single dose fashion (study 1). In the double blind dose-response study all four had a significant fall in forced expiratory volume in one second (FEV(1)) (>15% from baseline) following exposure to wine containing 300 ppm sulfite, but did not respond to wines containing 20, 75 or 150 ppm sulfite. Responses were maximal at 5 minutes (mean (SD) maximal decline in FEV(1) 28.7 (13)%) and took 15-60 minutes to return to baseline levels. In the cumulative dose-response study (study 2) no significant difference was observed in any of the lung function parameters measured (FEV(1), peak expiratory flow (PEF), mid phase forced expiratory flow (FEF(25-75))) between wine sensitive and normal asthmatic subjects.

CONCLUSIONS

Only a small number of wine sensitive asthmatic patients responded to a single dose challenge with sulfited wine under laboratory conditions. This may suggest that the role of sulfites and/or wine in triggering asthmatic responses has been overestimated. Alternatively, cofactors or other components in wine may play an important role in wine induced asthma. Cumulative sulfite dose challenges did not detect an increased sensitivity to sulfite in wine sensitive asthmatics and an alternative approach to identifying sulfite/wine sensitive asthma may be required.

Alcoholic drinks: important triggers for asthma

BACKGROUND

Although anecdotally alcoholic drinks seem to be common triggers for asthma, little is known of the prevalence, the characteristics, or the mechanisms underlying these reactions.

OBJECTIVES

The primary aim of this study was to determine the frequency and characteristics of asthmatic reactions triggered by alcoholic drinks in a community-based cohort of asthmatic subjects. Investigations of other food sensitivities were also completed to explore some of the possible components of alcoholic drinks that may be responsible for these asthmatic responses.

METHODS

A validated food allergy questionnaire was used to assess the characteristics of alcoholic drink-induced asthma in 366 adult patients recruited from the Asthma Foundation of Western Australia. The food allergy questionnaire was sent out by mail and self-administered by recipients.

RESULTS

Thirty-three percent of respondents indicated that alcoholic drinks had been associated with the triggering of asthma on at least 2 occasions. Wines were the most frequent triggers, with responses being rapid in onset (<1 hour) and of mild to moderate severity. Logistic regression analysis indicated that wine-induced asthmatic reactions were reported more often by women (P =.032), by those taking oral steroids (P =.021), by individuals who had reported their first asthma attack at a younger age (P <. 001), and by those who had previously visited an alternative health practitioner for asthma (P =.041). A significant association between wine-induced asthma and asthma triggered by sulfite-containing foods (P <.001) and by aspirin and nonsteroidal anti-inflammatory medicines (P =.01) was also observed.

CONCLUSION

Alcoholic drinks, and particularly wines, appear to be important triggers for asthmatic responses. Sensitivity to the sulfite additives in wines seems likely to play an important role in many of these reactions. Sensitivities of individuals to salicylates present in wines may also play a role.

Recent advances in alternative therapies

Complementary and alternative medicine (CAM) is becoming more popular, and CAM remedies are used instead of, or integrated with, orthodox allopathic therapies by many patients with asthma. Although most CAM remedies may have no discernible effects when analyzed by conventional medical techniques, some double-blind controlled studies do suggest that a meaningful benefit can be obtained with acupunture and homeopathic management in asthma. Herbal medicine is more popular, despite little evidence that the vast majority of herbs for asthma have any useful effects other than a nonspecific expectorant action. Dietary adjustment may benefit a small percentage of patients with asthma, but extreme measures are very rarely indicated. Formal pyschologic approaches can help some patients by reducing anxiety. Although most CAM approaches are harmless, the lack of benefit of many remedies and the potential harm from some of them must be recognized.

Asthma induced by alcoholic drinks: a new food allergy questionnaire

OBJECTIVE

Asthmatic reactions to foods and drinks are a significant health problem in the community, however, the true extent of this problem is unclear. In this study, a new food allergy questionnaire (FAQ) was designed to specifically investigate the prevalence and characteristics of asthmatic reactions triggered by alcoholic drinks, as well as other foods and chemicals. The questionnaire's validity and reliability were assessed by comparing respondents' answers with data from clinical interview and repeat application.

METHODS

Twenty consecutive outpatients attending a Hospital Asthma Clinic completed the FAQ and subsequently were interviewed independently by their respiratory physician. The FAQ's ability to classify the asthma severity and atopic status of respondents, and to identify those asthmatics sensitive to alcoholic drinks, sulphite-containing foods and aspirin was assessed by comparison with clinical interview. The questionnaire's reliability was assessed in a separate and diverse community group of 20 asthmatic volunteers using the test-retest method.

RESULTS

Responses to the FAQ were found to correlate highly with assessment by clinical interview for all of the parameters assessed. Specifically, the FAQ identified reactions to alcoholic drinks with a coefficient of agreement of 88.9%, a sensitivity of 100%, and a specificity of 83.3%. Responses to the FAQ were also found to be reproducible for all of the parameters assessed.

CONCLUSION AND IMPLICATIONS

The FAQ is a useful and reliable tool for assessing the sensitivity of asthmatics to alcoholic drinks and various foods and chemicals, and provides a means to collect data relating to the prevalence and characteristics of these responses in community-based populations.