The irregular frequency of The Friday Fermentable has been due mostly to my focus on two cases of a (inexpensive) private label wine that has kept my summer drinking variety to a bare minimum. Thankfully, my guest blogger, Erleichda, has often come to the rescue with fabulous descriptions of his group wine dinners.
The focus this time is instead a very interesting research letter published in this week's (16 August 2007) New England Journal of Medicine entitled, "Wine-Induced Anaphylaxis and and Sensitization to Hymenoptera Venom." The full text is currently available freely. Two Spanish physicians made some interesting clinical observations and followed up with a colleague in Madrid whose company specializes in the diagnosis and treatment of allergic reactions:
We report on five patients who presented with symptoms after drinking grape juice or newly pressed wines (both red and white). Three of the patients had an oral allergy syndrome and facial flushing, one had asthmatic symptoms, and one had anaphylaxis. Skin tests with conventional allergens, including commercial grape extract, egg white, and wines aged for up to 1 year, were negative. None of the patients had a history of ingesting drugs containing sulfites that was concomitant with these symptoms, nor had any of them been stung by Hymenoptera species. Yet all had positive skin tests for specific IgE antibodies (levels >0.35 kU per liter, CAP, Phadia) to Hymenoptera (Apis mellifera and vespula and polistes species) and to an extract of the wine or grape juice under suspicion for causing the symptoms.
Apis mellifera is the Western, or European, honeybee.
If you've ever been around wine grapes being crushed, you'll know that it is impossible to keep bees away from the sweet aroma released by the process. However, bees often end up in the mix and are not separated from the fermenting must until the grapeskins are pressed. Crushing bees in the process would be expected to release the venom peptides into the fresh wine but it is unusual to expect any reaction in sensitive individuals if the wine is drunk (as opposed to the venom being injected by a bee sting).
Well, these sensitive individuals were certainly somehow responsive to the wines themselves:
Four of the patients had a positive reaction to an oral challenge with the exact wine they had ingested (an oral allergy syndrome and flushing), and in the remaining patient (who had an oral allergy syndrome, flushing, and asthma), there was a 25% fall in the forced expiratory volume in 1 second. Challenges with aging wines were negative. These tests were negative in 6 patients who were not reactive to Hymenoptera antigen and in 12 patients who had had anaphylaxis after a Hymenoptera sting.
The investigators then went on to perform antibody immunoblots revealing that the allergic individuals had antibodies against a major (27kD) and minor (22kD) venom protein present in the grape juice and the freshly pressed wine. These proteins were the same detected when using serum from patients who had been stung by bees. Interestingly, and perhaps fortunately, these proteins were only detected in one of four aging wines tested. Although not stated by the authors, my hypothesis would be that prolonged incubation in 12-15% alcohol and binding and settling of wine pigments and polyphenols would remove the bee venom. Because this was a letter to the editor and not a full research paper, many details are missing including how long the "aging" wines had been aged.
Regardless, this report emphasizes that the tasting of wine during the winemaking process can expose sensitive individuals to bee venom that can somehow elicit an immune reaction when taken orally. While most wines did not contain immunoreactive protein, at least one sample did, raising the question of how prevalent bee venom might be in aged wines sold in the marketplace.
If the mainstream media picks up on this story, that point is certainly the one that will be stressed. Are people who are unusually sensitive to some wines experiencing an allergic reaction to bee venom? I can certainly think of several wines I've had that gave me tremendous hangovers that were unrelated to the amount of alcohol ingested. More often than not, these cases are due to other long-chain alcohols produced as fermentation byproducts.
Again, because of the space limitations of the research letter, it is not clear how extensively the authors searched for evidence that the individuals were not stung by bees during the grape crushing process. However, the fact that some had reactions after ingesting the newly pressed wines (several days to several weeks after the crush) is suggestive these people did indeed have a reaction to the venom when taken orally.
I look forward to a more complete follow-up on the characterization of these cases.
Armentia A, Pineda F, Fernández S. Wine-Induced Anaphylaxis and Sensitization to Hymenoptera Venom. New Engl J Med 2007; 357:719-720. (no doi; free full text at time of posting)
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I made wine last year, and yes, a significant number of bees goes into the flavoring.
Does that make it non-vegetarian?
Erleichda carries an epi-pen almost everywhere for bees and wasp stings-- will forward this on to him!!!! Hmm, maybe he needs to carry it to more places
Despite a strong sensitivity toward hymenoptera, sufficient to curtail my hobby of insect collecting, i've fortunately not experienced a single allergic episode from drinking commercial wine products. That said, however, I do make a point of avoiding vineyards during harvest time, and may now be cautious when tasting recently barreled juice.
I think this needs to be studies from an epidemiological study as well. Are there any figures regarding the number of people treated for severe allergic reaction cause by drinking wine?