We present a 48-year-old patient who complained for 1 year about urticarial reactions which appeared always when he ingested alcoholic beverages. Skin prick tests with ethanol were negative but positive with 10% acetic acid in the patient. Normal controls tested negative with acetic acid. Skin prick tests to common immediate-type allergens were negative. The patient underwent a double-blind, placebo-controlled challenge test. A few minutes after challenge with ethanol but not with placebo, the patient developed erythema and wheals on the chest and the upper arms. The tryptase serum level rose from undetectable (0.1 U/ml) before challenge to 3.8 U/ml after skin lesions had appeared. This case demonstrates that increased tryptase serum levels can help in the diagnosis of ethanol-induced urticaria.

Keywords:
Alcohol, Anaphylaxis, Tryptase
1.
Sticherling M, Brash J, Brüning H, Christophers E: Urticarial and anaphylactoid reactions following ethanol intake. Br J Dermatol 1995; 132:464–467.
2.
Boehncke WH, Gall H: Ethanol metabolite acetic acid as causative agent for type I hypersensitivity-like reactions to alcoholic beverages. Clin Exp Allergy 1996;26:1089–1091.
3.
Kelso JM, Keating MU, Squillace DL, O’Connel EJ, Yunginger JW, Sachs MI: Anaphylactoid reaction to ethanol. Ann Allergy 1990;64: 452–454.
4.
Przybilla B, Ring J: Anaphylaxis to ethanol and sensitization to acetic acid. Lancet 1983;i: 483.
5.
Lesie RD, Pyke DA: Chlorpropamide-alcohol flushing: A dominantly inherited trait associated with diabetes. Br Med J 1978;ii: 1519–1520.
6.
Truitt EB Jr, Gaynor CR, Mehl DL: Aspirin attenuation of alcohol-induced flushing and intoxication in Oriental and Occidental subjects. Alcohol Alcohol 1987;suppl 1:595–599.
7.
Shimoda T, Kohne S, Takao A, Fujiwara C, Matsuse H, Sakai H, Watanabe T, Hara K, Asai S: Investigation on the mechanism of alcohol-induced bronchial constriction. J Allergy Clin Immunol 1996;97:74–84.
8.
Zellweger JP: Asthme et rhinite déclenchés par l’ingestion d’éthanol pur et par l’inhalation de vapeur d’alcool. Schweiz Med Wochenschr 1982;112:212–214.
9.
Geppert EF, Boushey HA: An investigation of the mechanism of ethanol-induced bronchoconstriction. Am Rev Respir Dis 1975;112: 423–436.
10.
Wantke F, Gotz M, Jarisch R: The red wine test intolerance to histamine as a model for food intolerance. Allergy Proc 1994;15:27–32.
11.
Wantke F, Hemmer W, Haglmuller T, Gotz M, Jarisch R: Histamine in wine: Bronchoconstriction after a double-blind placebo-controlled red wine provocation test. Int Arch Allergy Immunol 1996;110:397–400.
12.
Jarisch R, Wantke F: Wine and headache. Int Arch Allergy Immunol 1996;110:7–12.
13.
Wüthrich B, Kägi MK, Hafner J: Disulphite-induced acute intermittent urticaria with vasculitis. Dermatology 1993;187:290–293.
14.
Gall H, Boehncke WH, Gietzen K: Intolerance to sodium metabisulfite in beer. Allergy 1996; 51:516–517.
15.
Wüthrich B, Kägi MK, Stücker W: Anaphylactic reactions to ingested carmine (E120). Allergy 1997;52:1133–1137.
16.
Hicks R: Ethanol, a possible allergen. Ann Allergy 1968;26:641–643.
17.
Ormerod AD, Holt PJA: Acute urticaria due to ethanol. Br J Dermatol 1983;108:723–724.
18.
Ting S, Rauls DO, Ashbaugh P, Mansfield LE: Ethanol-induced urticaria: A case report. Ann Allergy 1988;60:527–530.
19.
Israël Y, MacDonald A, Niemelä O: Hypersensitivity to acetaldehyde-protein adducts. Mol Pharmacol 1992;42:711–717.
20.
Ordoqui E, Zubeldia JM, Aranzabal A, Rubio M, Herrero T, Tornero P, Rodriguez VM, Prieto A, Baeza ML: Serum tryptase levels in adverse drug reactions. Allergy 1997;52:1102–1105.
1998
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.