Alcohol-induced respiratory symptoms are common in patients with aspirin exacerbated respiratory disease

Abstract

Background: A large percentage of patients with aspirin exacerbated respiratory disease (AERD) report the development of alcohol-induced respiratory reactions, but the true prevalence of respiratory reactions caused by alcoholic beverages in these patients was not known.

Objective: We sought to evaluate the incidence and characteristics of alcohol-induced respiratory reactions in patients with AERD.

Methods: A questionnaire designed to assess alcohol-induced respiratory symptoms was administered to patients at Brigham and Women's Hospital and Scripps Clinic. At least 50 patients were recruited into each of 4 clinical groups: (1) patients with aspirin challenge-confirmed AERD, (2) patients with aspirin-tolerant asthma (ATA), (3) patients with aspirin tolerance and with chronic rhinosinusitis, and (4) healthy controls. Two-tailed Fisher exact tests with Bonferroni corrections were used to compare the prevalence of respiratory symptoms among AERD and other groups, with P ≤ .017 considered significant.

Results: The prevalence of alcohol-induced upper (rhinorrhea and/or nasal congestion) respiratory reactions in patients with AERD was 75% compared with 33% with aspirin-tolerant asthma, 30% with chronic rhinosinusitis, and 14% with healthy controls (P < .001 for all comparisons). The prevalence of alcohol-induced lower (wheezing and/or dyspnea) respiratory reactions in AERD was 51% compared with 20% in aspirin-tolerant asthma and with 0% in both chronic rhinosinusitis and healthy controls (P < .001 for all comparisons). These reactions were generally not specific to one type of alcohol and often occurred after ingestion of only a few sips of alcohol.

Conclusion: Alcohol ingestion causes respiratory reactions in the majority of patients with AERD, and clinicians should be aware that these alcohol-induced reactions are significantly more common in AERD than in controls who are aspirin tolerant.

Keywords: AERD; Alcohol; Aspirin exacerbated respiratory disease; Aspirin intolerant asthma; Aspirin triad; Asthma; Leukotriene; Nonsteroidal anti-inflammatory drug; Samter Triad; Wine.

Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Prevalence of alcohol-induced respiratory symptoms. Rates of alcohol-induced (A) upper, (B) lower, and (C) upper and/or lower respiratory reactions among survey respondents with AERD, ATA, CRS, aspirin-tolerant subjects with nasal polyps (NP), and healthy controls. *P<0.001 for all four rates compared to the AERD group in A-C.

Figure 2

Alcohol types that provoke reactions most forcefully. Among participants who reported alcohol-induced respiratory reactions, the type of alcohol they identified as eliciting reactions most forcefully is shown. Significantly more patients with AERD (39%) identified red wine as the most forceful trigger than did patients with CRS (7%) (P=0.02). No other comparisons were significantly different across patient groups.