Alcohol / red wine allergic reaction
66 year-old white female presents with a 4 year history of adverse reaction thought to be due to red wine. Four hours after ingestion of red wine she becomes extremely sleepy with subsequent nausea, vomiting, and diarrhea. Similar symptoms occurred four hours after the application of a red wine infused lotion applied to anterior wrist. An evaluation for alpha gal allergy is pending. Please help.
“Allergic” reactions to alcohol are distinctly unusual and I would have several questions about this reaction and, importantly, if she reacts to other forms of alcohol. I am a little puzzled by her having the same reaction when using a red wine infused lotion. I would attempt to understand what ingredients are used in her red wine. It is not clear to me that there are any definitive skin tests one could do for alcohol allergy. Depending upon the ingredients in the wine she is consuming one could see if these are ingredient to which skin test reagents are available. One could also consider if this is an unusual presentation of a “flushing syndrome” or other pathology. Anecdotally I had a patient years ago who was having unusual reactions to alcohol and eventually was diagnosed with colon cancer. Whether the patient's alcohol reaction was a paraneoplastic syndrome was never definitively answered. As a practical point if consuming red wine is causing her to have these symptoms then she will need to stop consuming red wine.
I hope this has been somewhat helpful.
Andrew Murphy, MD