Alcohol (OH) and the Skin – Urticaria and Anaphylactoid reactions (For professionals)

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Urticarial and anaphylactoid reactions

• reported to occur minutes after alcohol intake. May occur with anaphylactic symptoms
• reproductible with oral challenge with ethyl alcohol (=ethanol).
• may have genetic intolerance with defects in alcohol-metabolizing enzymes (Oriental flushing syndromes). Many though develop a reaction after red or white wine intake suggesting the preservative, not the alcohol are responsible.
• Differential diagnosis cholinergic urticaria

Alcohol and urticaria: because this phenomenon is incompletely understood, we have selected interesting articles in the scientific literature.

• Nakagawa Y, Sumikawa Y, Nakamura T, Itami S, Katayama I, Aoki T. Urticarial reaction caused by ethanol.Allergol Int. 2006 Dec;55(4):411-4

1. Urticarial and anaphylactoid reaction  for two years duration observed every time after drinking alcohol beverages in a 47-year-old man.
2. Prick tests with diluted ethanol, alcohol beverages and their metabolites (acetaldehyde, acetic acid) were done . Only acetic acid was positive (negative in healthy volunteers).
3. Oral challenge test with diluted-ethanol caused pruritus and swelling of his lips. An oral challenge test with 8% diluted Shochu (Japanese distilled alcohol from rice or wheat) caused wheals on his upper back.

• Sticherling M, Brasch J, Brüning H, Christophers E. Urticarial and anaphylactoid reactions following ethanol intake. Br J Dermatol. 1995 Mar;132(3):464-7

1. Three patients who presented with recurrent generalized urticaria, which developed within minutes of consumption of small amounts of ethyl alcohol.
2. All patients produced positive prick tests with acetic acid, and developed urticaria after oral challenge with small amounts of highly purified ethyl alcohol.

• Ehlers I, Hipler UC, Zuberbier T, Worm M. Ethanol as a cause of hypersensitivity reactions to alcoholic beverages. Clin Exp Allergy. 2002 Aug;32(8):1231-5

1. In search of possible pathomechanisms all patients were analysed by skin prick testing.
2. The study shows that ethanol itself is a common causative factor in hypersensitivity reactions to alcoholic beverages. These reactions occur dose-dependent and a non-IgE-mediated pathomechanism is likely, because skin prick tests were negative in all cases. Therefore oral provocation tests remain indispensable in making the diagnosis of ethanol hypersensitivity.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland