Vomiting, abdominal pain and diarrhea with white wine ingestion, but tolerance of other forms of alcohol
I have a 27 year-old female with hx of mild migraines and no hx of allergic disease. She's presenting with six to eight hour delay of extreme vomiting, abdominal pain and diarrhea lasting for about eight hours after drinking white wine only. During this time period she's not able to drink anything and is incapacitated. There's no associated headache. Reactions occur after drinking and/or cooking with white wine. She can tolerate all other ETOH including red wine. Her SPT for grape is negative and she doesn't eat grapes. I could find any literature regarding FPIES and specific grape varietals. I've advised avoidance, given her zofran and asked her to speak with a migraine specialist to see if this is an atypical presentation.
Alcohol intolerance, with GI symptoms, is not uncommon in individuals with migraine. Individuals will often note that particular type of alcohol is not tolerated, while other forms seem to be tolerated. If white wine avoidance completely prevents her vomiting, abdominal pain and diarrhea, and she is still able to ingest all other forms of alcohol, then her problem is essentially solved. There is no evidence that these types of symptoms are IgE-mediated or reflect immunologically-mediated hypersensitivity. If she had the same symptoms when she ate a dried apricot, with a high level of sulfite, then one could consider sulfite sensitivity, though sulfite sensitivity is usually manifest by upper respiratory symptoms, and not diarrhea. If she had a similar problem with a white grape ingestion, then one could consider FPIES.
I hope this information is of help to you and your patient.
Eric Macy, MD, MS, FAAAAI