Idiopathic anaphylaxis and alcohol
Question:
3/4/2020
A 27 year old male presented to our clinic with several episodes of anaphylaxis requiring epinephrine. Each instance has been when he is either eating or drinking alcohol, often together but alcohol is not always involved in the reaction. Food testing and alpha gal were negative. Other causes such as medications, latex exposure etc. have been ruled out. The only commonality we have found is drinking from aluminum cans. He "tested" this prior to his most recent appointment and developed erythema of his face and facial angioedema within minutes of drinking from Shiner Bock from an aluminum can. Have there been reported cases of anaphylaxis to aluminum? Is there any testing available?
Answer:
Ethyl alcohol, a vasodilator, is a well-known co-factor that can lower then threshold for anaphylaxis and urticaria reactions. There is no known mechanism for molecular aluminum to contribute to anaphylaxis and no immediate type hypersensitivity testing is available.
Andrew Murphy MD FAAAAI wrote the following Ask The Expert answer on 11/29/2017.
"I am assuming the patient has been evaluated for the common causes of anaphylaxis (food, drug, venom) and these have been ruled out. One needs also to also consider unusual causes / mimickers of anaphylaxis for example pheochromocytoma, carcinoid, medullary thyroid carcnioma, VIPoma and we should always keep in the back of our minds patients who may be purposefully ingesting an allergen to cause symptoms. Assuming all this is unrevealing, then one is left with idiopathic anaphylaxis. This article is a nice review of treatment of idiopathic anaphylaxis including the use of H1,H2 blockade and alternative agents."
I hope this is helpful.
Eric Macy, MD, MS, FAAAAI