After identifying a specific allergen or substance that caused a pseudo-allergic reaction, it is necessary to exclude the use of alcoholic beverages containing the problematic component and the food products in which it is included.
Given the negative role of histamine in the development of false allergy to alcohol, it is necessary to use a diet with the exception or minimization of foods containing histamine and tyramine in increased amounts, as well as liberators (wine and beer, hard cheeses, sausages, sausages, smoked meats and pickled foods), food dyes and preservatives.
It should be remembered that even pure alcohol without special impurities and additives contributes to the absorption of other products containing histamine, that is, in any case, it is a liberator, increasing the risk of pseudo-allergic reactions.
In case of pronounced clinical manifestations of allergy to alcohol, antihistamines are prescribed (preferably of the second or third generation), histaglobulin, and for systemic allergic and pseudoallergic reactions, glucocorticoids, agents that support the circulatory and respiratory system. The treatment of concomitant somatic diseases (gastroduodenitis, enterocolitis, hepatitis and pancreatitis), vegetative-vascular dystonia and neuropsychiatric disorders is carried out.
Allergy to alcohol – intolerance of the individual components that make up the composition of alcoholic beverages, due to immunological or non-immunological mechanisms. The clinical picture of alcohol intolerance is similar in true allergy and pseudo-allergy, manifested mainly in the development of urticaria and dermatitis, less often with symptoms of allergic rhinitis and bronchial asthma, and even less often with anaphylactoid reactions. According to statistics, in the vast majority of cases of alcohol intolerance, pseudo-allergic reactions develop (in 80-95% of cases).
Causes of Alcohol Allergies
True allergy to alcohol is a rare occurrence. The main number of detected cases of allergy to alcohol is not true, but pseudo-allergic reactions. The main products that can lead to the development of pseudo-allergic reactions to alcohol are all sorts of dyes, flavors and stabilizers, added to alcoholic beverages to improve appearance and taste. Many true allergens can simultaneously cause pseudo-allergies to alcohol.
There are products-histaminole, provoking and enhancing the release of histamine (ethyl alcohol itself, dyes and flavors that make up alcoholic beverages, as well as eggs, wheat, chocolate, etc.). In addition, histamine itself is always present in the composition of beer (brewer’s yeast) and fermented wine (especially in red varieties), which leads to the summation of the adverse effects on the body (histamine liberal + histamine).
A link has been found between the development of alcohol allergy and the presence in alcoholic beverages (primarily in wine) of sulfur dioxide, a preservative used to reduce bacterial processes (souring, fermentation), natural and artificial salicylates, and sulfites, which are fermented wines. as preservatives bottled alcoholic beverage.
False allergy to alcohol can also occur in people who abuse alcohol long-term because of the frequent presence of chronic intestinal diseases and easier penetration of the true and false allergens through the irritated mucous membrane of the digestive tract into the bloodstream.
Pathogenesis of alcohol allergy
True allergies are caused by the development of reactions of immediate or delayed type during the penetration of plant protein inclusions (egg white, wheat, malt, hops, yeast, wormwood, mint, ginger, hazelnut, etc.), often in small quantities in alcoholic beverages, into the digestive tract .
More often, this is the case of IgE-mediated hypersensitivity, less commonly immunoglobulins of class G are involved in the development of true allergy to alcohol.
When pseudoallergy in the mechanism of development of hypersensitivity there is no immunological stage (antigen-antibody reaction), and the pathological process starts immediately from the second stage, that is, with the release of inflammatory mediators – in particular, histamine with mast cells and basophils in response to some auxiliary substances composition of alcohol.
Alcohol Allergy Symptoms
Specific clinical manifestations of allergy are diverse and depend on both the specific substance that caused the intolerance and its quantity, and on the reactivity of the organism, age, associated diseases and other factors.
The most common skin manifestations. In case of true allergy to alcohol, symptoms such as urticaria and atopic dermatitis are usually observed on the skin of the face, upper chest, accompanied by itching of varying severity. Another skin manifestation in true allergy to alcohol is angioedema. In pseudo-allergies, skin lesions can be widespread (face, trunk, upper and lower extremities) and are characterized by polymorphic skin rashes (urticaria, papular, erythematous, macular, hemorrhagic, bullous manifestations).
Respiratory manifestations of allergy to alcohol include symptoms of allergic rhinitis (abundant mucous and watery nasal discharge, difficulty in nasal breathing, itching of the skin in the nasal area and nasal passages), bronchospastic reactions (shortness of breath, asthma attacks).
Symptoms of damage to the digestive tract with true or false allergy to alcohol can manifest itself in the form of oral syndrome (itching in the mouth, numbness or feeling of tearing of the tongue, as well as the soft palate, swelling of the oral mucosa). Nausea and vomiting after drinking alcohol, abdominal pain like intestinal colic, loss of appetite, upset stool, disturbances of general well-being (headache, general weakness, dizziness, etc.) are often noted.
Symptoms of false allergy to alcohol (pseudoallergy) are most often caused by a sharp release of inflammatory mediators (and above all histamine) by the cells and manifested as pronounced vegetative-vascular reactions (severe skin hyperemia, heat feeling throughout the body, migraine headaches, a feeling of air scarcity, gastric and intestinal dyspepsia), which can be combined with skin or respiratory manifestations.
Systemic allergic reactions in the form of anaphylactic shock in the use of alcoholic beverages are quite rare, the anaphylactoid reactions that occur with pseudo-allergy and occur more favorably, are somewhat more common.
Alcohol Allergy Diagnosis
Identification of true or false allergy to alcohol is a rather difficult task, since in this case the clinical manifestations are diverse, and the resulting similar symptoms may be due to completely different causal factors. Often, it is very difficult to identify a specific substance that caused an allergic or pseudoallergic reaction, given the combined effect of several components, frequent cross-reactions between them, as well as the concomitant toxic damage of various organs and tissues when alcohol is abused and sometimes there is congenital intolerance to alcohol.
Careful collection of general and allergic history, information about alcohol use, signs of food intolerance of certain products, food additives are needed.
A complex of laboratory and special allergological studies, including skin allergy tests with potential food allergens that may be part of alcoholic beverages (egg white, wheat, yeast, herbs, nuts, citrus, etc.), is conducted to identify the true allergy to alcohol. Such tests should be performed by an allergist-immunologist in a specialized medical facility. Allergen-specific immunoglobulins (classes E and G) can be identified for the food allergens listed above.
The presence of negative results of allergological studies indicates a probable pseudo-allergic nature of alcohol intolerance. Sometimes in such cases a test with histamine can be carried out: the introduction of this substance into the 12 duodenum and the fixation of the developing reaction of the organism with subsequent comparison with similar reactions to the consumption of wine, beer and other alcoholic beverages.
Prediction and prevention of alcohol allergies
When refusing to use ethanol-containing products, allergic symptoms regress. Alcohol allergy prevention is based on the use of high-quality alcoholic beverages in small doses.
In some cases, a complete rejection of alcoholic beverages, adherence to an elimination diet with the exception of potential allergens, liberators and products containing histamine in increased amounts, as well as timely treatment of diseases of the digestive tract are necessary.