Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 2001 Oct;56(10):763–769. doi: 10.1136/thorax.56.10.763

Role of sulfite additives in wine induced asthma: single dose and cumulative dose studies

H Vally 1, P Thompson 1
PMCID: PMC1745927  PMID: 11562514

Abstract

BACKGROUND—Wine appears to be a significant trigger for asthma. Although sulfite additives have been implicated as a major cause of wine induced asthma, direct evidence is limited. Two studies were undertaken to assess sulfite reactivity in wine sensitive asthmatics. The first study assessed sensitivity to sulfites in wine using a single dose sulfited wine challenge protocol followed by a double blind, placebo controlled challenge. In the second study a cumulative dose sulfited wine challenge protocol was employed to establish if wine sensitive asthmatics as a group have an increased sensitivity to sulfites.
METHODS—In study 1, 24 asthmatic patients with a strong history of wine induced asthma were screened. Subjects showing positive responses to single blind high sulfite (300 ppm) wine challenge were rechallenged on separate days in a double blind, placebo controlled fashion with wines of varying sulfite levels to characterise their responses to these drinks. In study 2, wine sensitive asthmatic patients (n=12) and control asthmatics (n=6) were challenged cumulatively with wine containing increasing concentrations of sulfite in order to characterise further their sensitivity to sulfites in wine.
RESULTS—Four of the 24 self-reporting wine sensitive asthmatic patients were found to respond to sulfite additives in wine when challenged in a single dose fashion (study 1). In the double blind dose-response study all four had a significant fall in forced expiratory volume in one second (FEV1) (>15% from baseline) following exposure to wine containing 300 ppm sulfite, but did not respond to wines containing 20, 75 or 150 ppm sulfite. Responses were maximal at 5 minutes (mean (SD) maximal decline in FEV1 28.7 (13)%) and took 15-60 minutes to return to baseline levels. In the cumulative dose-response study (study 2) no significant difference was observed in any of the lung function parameters measured (FEV1, peak expiratory flow (PEF), mid phase forced expiratory flow (FEF25-75)) between wine sensitive and normal asthmatic subjects.
CONCLUSIONS—Only a small number of wine sensitive asthmatic patients responded to a single dose challenge with sulfited wine under laboratory conditions. This may suggest that the role of sulfites and/or wine in triggering asthmatic responses has been overestimated. Alternatively, cofactors or other components in wine may play an important role in wine induced asthma. Cumulative sulfite dose challenges did not detect an increased sensitivity to sulfite in wine sensitive asthmatics and an alternative approach to identifying sulfite/wine sensitive asthma may be required.



Full Text

The Full Text of this article is available as a PDF (182.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Dahl R., Henriksen J. M., Harving H. Red wine asthma: a controlled challenge study. J Allergy Clin Immunol. 1986 Dec;78(6):1126–1129. doi: 10.1016/0091-6749(86)90261-7. [DOI] [PubMed] [Google Scholar]
  2. Delohery J., Simmul R., Castle W. D., Allen D. H. The relationship of inhaled sulfur dioxide reactivity to ingested metabisulfite sensitivity in patients with asthma. Am Rev Respir Dis. 1984 Dec;130(6):1027–1032. doi: 10.1164/arrd.1984.130.6.1027. [DOI] [PubMed] [Google Scholar]
  3. Gershwin M. E., Ough C., Bock A., Fletcher M. P., Nagy S. M., Tuft D. S. Grand rounds: adverse reactions to wine. J Allergy Clin Immunol. 1985 Mar;75(3):411–420. doi: 10.1016/0091-6749(85)90080-6. [DOI] [PubMed] [Google Scholar]
  4. Halpern G. M., Gershwin M. E., Ough C., Fletcher M. P., Nagy S. M., Jr The effect of white wine upon pulmonary function of asthmatic subjects. Ann Allergy. 1985 Nov;55(5):686–690. [PubMed] [Google Scholar]
  5. Lazarus S. C., Wong H. H., Watts M. J., Boushey H. A., Lavins B. J., Minkwitz M. C. The leukotriene receptor antagonist zafirlukast inhibits sulfur dioxide-induced bronchoconstriction in patients with asthma. Am J Respir Crit Care Med. 1997 Dec;156(6):1725–1730. doi: 10.1164/ajrccm.156.6.9608006. [DOI] [PubMed] [Google Scholar]
  6. Mansour E., Ahmed A., Cortes A., Caplan J., Burch R. M., Abraham W. M. Mechanisms of metabisulfite-induced bronchoconstriction: evidence for bradykinin B2-receptor stimulation. J Appl Physiol (1985) 1992 May;72(5):1831–1837. doi: 10.1152/jappl.1992.72.5.1831. [DOI] [PubMed] [Google Scholar]
  7. Nichol G. M., Alton E. W., Nix A., Geddes D. M., Chung K. F., Barnes P. J. Effect of inhaled furosemide on metabisulfite- and methacholine-induced bronchoconstriction and nasal potential difference in asthmatic subjects. Am Rev Respir Dis. 1990 Sep;142(3):576–580. doi: 10.1164/ajrccm/142.3.576. [DOI] [PubMed] [Google Scholar]
  8. Nichol G. M., Nix A., Chung K. F., Barnes P. J. Characterisation of bronchoconstrictor responses to sodium metabisulphite aerosol in atopic subjects with and without asthma. Thorax. 1989 Dec;44(12):1009–1014. doi: 10.1136/thx.44.12.1009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Nichol G. M., Nix A., Chung K. F., Barnes P. J. Characterisation of bronchoconstrictor responses to sodium metabisulphite aerosol in atopic subjects with and without asthma. Thorax. 1989 Dec;44(12):1009–1014. doi: 10.1136/thx.44.12.1009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. O'Connor B. J., Barnes P. J., Chung K. F. Inhibition of sodium metabisulphite induced bronchoconstriction by frusemide in asthma: role of cyclooxygenase products. Thorax. 1994 Apr;49(4):307–311. doi: 10.1136/thx.49.4.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pavord I. D., Wisniewski A., Tattersfield A. E. Refractoriness to inhaled sodium metabisulphite in subjects with mild asthma. Eur Respir J. 1994 Jan;7(1):50–54. doi: 10.1183/09031936.94.07010050. [DOI] [PubMed] [Google Scholar]
  12. Sakamoto T., Tsukagoshi H., Barnes P. J., Chung K. F. Involvement of tachykinin receptors (NK1 and NK2) in sodium metabisulfite-induced airway effects. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):387–391. doi: 10.1164/ajrccm.149.2.8306035. [DOI] [PubMed] [Google Scholar]
  13. Seale J. P., Temple D. M., Tennant C. M. Bronchoconstriction by nebulized metabisulfite solutions (SO2) and its modification by ipratropium bromide. Ann Allergy. 1988 Sep;61(3):209–213. [PubMed] [Google Scholar]
  14. Sun J., Sakamoto T., Chung K. F. Effects of sodium metabisulphite on guinea pig contractile airway smooth muscle responses in vitro. Thorax. 1995 Aug;50(8):875–879. doi: 10.1136/thx.50.8.875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Vally H., Carr A., El-Saleh J., Thompson P. Wine-induced asthma: a placebo-controlled assessment of its pathogenesis. J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):41–46. doi: 10.1016/s0091-6749(99)70523-3. [DOI] [PubMed] [Google Scholar]
  16. Vally H., de Klerk N., Thompson P. J. Alcoholic drinks: important triggers for asthma. J Allergy Clin Immunol. 2000 Mar;105(3):462–467. doi: 10.1067/mai.2000.104548. [DOI] [PubMed] [Google Scholar]
  17. Wang M., Wisniewski A., Pavord I., Knox A., Tattersfield A. Comparison of three inhaled non-steroidal anti-inflammatory drugs on the airway response to sodium metabisulphite and adenosine 5'-monophosphate challenge in asthma. Thorax. 1996 Aug;51(8):799–804. doi: 10.1136/thx.51.8.799. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Wright W., Zhang Y. G., Salome C. M., Woolcock A. J. Effect of inhaled preservatives on asthmatic subjects. I. Sodium metabisulfite. Am Rev Respir Dis. 1990 Jun;141(6):1400–1404. doi: 10.1164/ajrccm/141.6.1400. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES