Q:

3/15/2013
I saw a 20 yo college student in Nov. 2012 for angioedema of face that began in assoc. with consumption of large amount of alcohol including vodka, bourbon and tequila. Work up otherwise was negative. IgE only 15. Subsequently did well until recently when he had urticaria on 2 occasions that seemed to be associated with 1.5 shots of bourbon on one occasion and one shot of vodka in cranberry juice on another. He has not consumed any beer or wine in a long time. I am writing re: workup. I have read the “Expert” section of website, but was not sure how far to go. I cannot find a lab where I can obtain acetaldehyde dehydrogenase 2 levels. The pt. is not Asian. What about testing with ethanol (? what dilutions) or the individual alcoholic drinks? What about a challenge with beer or wine or the beverages in question? What about testing with acetic acid as mentioned in one study? I could tell pt. not to consume alcohol again, but I am sure he would not do this. Any additional suggestions?

A:

Thank you for your inquiry.

I am sending your question to Dr. Carmen Vidal, who does research in IgE-mediated reactions to carbohydrates, and has published extensively in regards to alcohol-related reactions. As soon as we receive her response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response to your Ask the Expert inquiry from Dr. Carmen Vidal. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Carmen Vidal:
Well, first of all, it is important to know the composition of these beverages. As you know, alcoholic drinks differ in their composition (beer, for instance, can be made of barley...). I do not know the composition of these kind of spirits, perhaps some fruits or something like this.

The best option should be to perform an oral controlled challenge test in order to see the nature of the reaction. First of all, prick-prick tests with those drinks should be advisable. If positive, and knowing the exact composition, more prick tests should be performed. If negative, oral challenge test with increasing doses of the drinks should be performed. This patient seems to react against one kind of drink but tolerates others. That should be enough to rule out alcohol per se hypersensitivity.

Typical clinical picture of acetaldehyde dehydrogenase misfunction includes flushing but not angioedema.

Best Regards,
Carmen Vidal

AAAAI - American Academy of Allergy Asthma & Immunology