The Hong Kong Asthma Society (HKAS) conducted a survey on asthma attacks after alcohol consumption and interviewed 130 asthma patients in Apr 2012. The findings revealed that 64% of asthma patients drank, some frequently and some only on festive occasions. Among the 83 patients who drank, 56(67%) had allergic reactions of various kinds; 44 (53%) had asthma attacks afterwards. Of all these attacks, 90% occurred within an hour after drinking. This percentage of asthma attacks (53%) after alcohol consumption is much higher than the 30% found in western countries. On the World Asthma Day on 1st May, 2012, the HKAS reminded asthma patients that alcoholic drinks such as red wine, white wine or beer may be harmful to their health.
Dr. Maureen Wong, a HKAS ExCo, stated that according to Australian and UK medical literature, 30% of patients had their asthma worsened within a few hours after drinking; most of the attacks were severe and lasted for several hours; some patients even needed to go to the emergency room at once. All these happened after they drank. In Hong Kong, there has not been any discussion on asthma attacks after alcohol consumption. To have a further understanding of the local situation, the HKAS has undertaken the research above and will pass the finding to local professional medical societies for study purpose.
Among the 83 asthmatic interviewees having a drinking habit, 95% of them were aged 18 years or above; 43% of them were male; 67% had allergic reactions of various severities and manifestations, including runny or stuffy nose, cough; 36% experienced more than one reaction.
Among the 44 interviewees having asthma attacks after drinking, 90% of them had the attacks within the first hour after drinking and 4.5% within 5 hours; 68% needed a bronchodilator and 2% went to see a doctor immediately. The alcohol that triggers allergic reactions include: red wine, white wine, champagne, sparkling wine, beer, cocktail, liqueur, rice wine, spirit and medicated wine. Dr. Wong stated that no alcohol, whether red wine, white wine or beer, was completely safe for asthma patients.
Dr. Wong further explained that few asthma patients were allergic to pure alcohol; in fact, what patients were allergic to were other contents of wine or alcoholic beverages: grapes and barley proteins, protein and sulfites added during the filtering process, histamine produced during fermentation, or aspirin naturally found in wine. Besides, alcohol dilates blood vessels, which enhances absorption of allergens. Gastric reflux caused by alcohol may also trigger asthma.
Japanese medical literature points out that some Asians do not have adequate enzyme, aldehyde dehydrogenase, to process alcohol, which after being taken will turn into acetaldehyde; much of it will accumulate in the body and cannot be broken down into vinegar. This is why Asians, after taking alcohol, experience red face, increased heart beat, hot flushes, or even nausea and abdominal pain (effects of acetalaldehyde). It is more common for Asian patients to have asthma attacks after drinking because acetalaldehyde will turn into histamine, a mediator of allergic reaction and airway spasm. The HKAS research indeed showed that among the 83 people who drank frequently or only on festive occasions, 46 experienced the Asian flush, and 85% (39 people) of them an asthma attack at the same time.
Dr. Wong stated that not only frequent drinkers had asthma attacks after alcohol consumption; 56% of the interviewees who drank only on festive occasions experienced breathlessness and wheeze (41% for frequent drinkers). Asthma patients should be cautious with drinking (especially when asthma is not under controlled) when dining out with friends. For those who had no problem with alcohol before, it may not be absolutely safe for them to drink even with the same type of wine. “Wine-induced asthma” may signify uncontrolled asthma. Patients should seek medical advice from doctors.
Red wine, white wine and beer have become a popular part of weddings, hot pot dinners and gatherings of friends in Hong Kong. Asthma patients should be alerted to the possibility of “wine-induced asthma”. Since there is no prevention, don’t take a sip given a high prevalence of 50% in Hong Kong.
Mr. Chung, 49 years old, IT worker, has asthma since he was 7. He had his first beer at the age of 15. A single sip was enough to make him breathless and wheezy. He did not dare to drink again. While studying in Canada, he however could not resist his friends’ temptation to try drinking beer and red wine again. History repeated itself; he found himself breathless again and he was quite sure of the association with wine. After returning to HK, he needs to go back to the mainland and work frequently. He is well aware of his health condition and has always tried to avoid alcohol as much as he can to replace with tea or soft drink. Since he sometimes cannot avoid the embarrassment, he has always with him his bronchodilator for rescue. But he knows that, even a morsel of “wined- chicken” can trigger his asthma.