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Alcohol-induced respiratory reactions
Alcohol-induced respiratory reactions, also termed alcohol-induced asthma and alcohol-induced respiratory symptoms, are increasingly recognized as a pathological bronchoconstriction response to the consumption of alcohol that afflicts many people with a "classical" form of asthma, the airway constriction disease evoked by the inhalation of allergens. Alcohol-induced respiratory reactions reflect the operation of different and often racially-related mechanisms that differ from those of classical, allergen-induced asthma.
== History ==
In 1973, Breslin et al. tested the effects of alcoholic beverage consumption on the respiratory symptoms of 11 asthmatic subjects who gave a history of asthma attacks following certain alcoholic beverages. In response to ingesting the type of beverage that the subjects reported to provoke their symptoms, six developed the asthmatic symptom of chest tightness, two developed a symptom often associated with asthma, rhinitis, and one subject developed both chest tightness and rhinitis. Symptoms developed almost immediately after ingestion, inhalation of fumes from the beverages did not precipitate symptoms, and bronchoconstriction in response to the ingestion was confirmed in the three patients evaluated by pulmonary function tests.〔Clin Allergy. 1973 Mar;3(1):71-82〕 The study suggested that these reactions were induced by non-alcoholic allergens that were contained in or contaminated the beverages. In 1978 an non-asthmatic female of Japanese descent with a history of moderately severe bronchoconstriction responses to various alcoholic beverages〔Am Rev Respir Dis. 1978 Jul;118(1):135-9〕 and in 1981 a an asthmatic Japanese male with a similar history〔Chest. 1981 Aug;80(2):167-73〕 beer or 95% pure ethanol were studied and found to develop bronchoconstriction after drinking apple juice but not after drinking apple juice per se; intravenous infusion or inhalation of ethanol also caused bronchospasm responses in the male subject. These studies suggested that alcohol itself caused the asthmatic symptoms triggered by alcoholic beverages. A subsequent study in 1986 found that 9 of 18 patients with a history of red wine-induced asthma symptoms showed bronchoconstriction in response to ingesting red wine; the response correlated positively with the amount of sulfur dioxide contained in the provocative wine.〔J Allergy Clin Immunol. 1986 Dec;78(6):1126-〕 The study suggested that the reaction was not allergen-induced but rather triggered by sulfur dioxide, a sulfur dioxide-related agent, or an agent whose levels in alcohol beverages correlated positively with those of sulfur dioxide. Finally, a questionnaire survey of 366 asthmatic patients conducted in 2000 found that 33% reported asthma symptoms in response to alcoholic beverages; there was a significant association between wine-induced asthma and asthma triggered by sulfite-containing foods, by aspirin, and by nonsteroidal anti-inflammatory drugs (NSAID) other than aspirin.〔J Allergy Clin Immunol. 2000 Mar;105(3):462-7〕 The study suggested the salicylate-"contaminates" in wine may contribute to these responses. In other studies, D.P. Agarwal and colleagues associated race-based variations in the activity alcohol-metabolizing enzymes with the occurrence of alcohol flush reactions to alcohol and alcoholic beverages in certain Asian populations.〔Hum Genet. 1979 Oct 2;51(3):331-4〕〔Am J Hum Genet. 1983 Jul;35(4):769-72〕 This early work is the basis for further studies that have defined not only many alcohol-induced flush reactions but also many alcohol-induced respiratory reactions as due to racially associated genetic differences in alcohol-metabolizing enzymes.
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