A warning for patients with nut allergies: Alcohol can lead to more severe reactions

A large Canadian study of anaphylaxis in adults found that alcohol was associated with a more severe reaction in people with a nut allergy. The results suggest that nut-flavoured alcoholic drinks could leave those with a nut allergy at high risk for a dangerous anaphylactic reaction. The study was designed to fill a gap in knowledge about why certain triggers cause specific symptoms in anaphylaxis. “For doctors, spotting patterns could mean faster, life-saving treatment in emergencies. For people with allergies, understanding the role of alcohol and other triggers can help them make safer choices,” lead author Roy Khalaf, a fourth-year medical student at McGill University, said in a university press release. Khalaf and fellow researchers used data from the Cross Canada Anaphylaxis Registry (C-Care), which included data from 1,135 adult patients with anaphylactic reactions treated in eight emergency departments across Canada between 2011 and 2023. Data from one electronic medical service was also included. The researchers classed the reactions based on the triggers, including drugs, venom, peanuts, shellfish and tree nuts. Most of the patients, 73.4%, had food-induced anaphylaxis, with peanut as the most common cause, followed by shellfish and tree nuts.Read: U.S. FDA expands use of asthma drug Xolair to treat severe food allergiesIn terms of symptoms, throat tightness was significantly more likely to be associated with a tree nut-induced anaphylaxis episode than other triggers. The authors note that this might be because a third of the patients with tree-nut induced anaphylaxis had eaten almonds, which can prompt severe pollen food syndrome that effects the face and upper GI tract. They also found that low blood pressure was more likely associated with a drug-induced anaphylaxis episode than other triggers.Of the patients studied, 18.9% had severe reactions. These were most commonly caused by drugs (30.1% of severe reactions), venom (27.8% of severe reactions) and tree nuts (18.9%). Alcohol was identified as a factor associated with a more severe reaction in people with a nut allergy, where the type of nut was unspecified. Previous research has suggested reasons why alcohol may trigger a more severe reaction. It could be due to the vasodilation effect of alcohol, causing more severe shock from a food allergy, or that drinking alcohol increases acetaldehyde, which could prompt histamine release by airway mast cells. The specific association between alcohol and nuts may be because nuts are used as flavouring in a number of drinks, the researchers suggest.The researchers found that exercise and asthma aren’t associated with severe reactions as previous studies have suggested. When it came to managing the anaphylaxis, 27.8% of patients not admitted to hospital received epinephrine through an auto-injector, 42.1% received antihistamines and 8.7% received corticosteroids. People with peanut allergies were most likely to get epinephrine through an auto-injector, perhaps due to the high awareness of peanut allergies, the researchers note.Dr. Moshe Ben-Shoshan, an associate professor in the department of pediatrics at McGill University was the senior author of the study. It also included investigators from other universities across Canada. The researchers hope to study milder reactions that are treated outside of the emergency department. They also aim to further explore the connection between nut allergies and alcohol. The study was published in the International Archives of Allergy and Immunology.Read: New guidelines for oral immunotherapy for food allergies

A warning for patients with nut allergies: Alcohol can lead to more severe reactions

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