Beer allergy J45.0

Food allergy of the immediate allergy type (IgE-mediated type I allergy), the symptoms of which occur within a few minutes after drinking beer. It is caused by substances contained in beer such as: malt, barley, wheat, yeast and maize. Less frequent are contact urticaria and contact allergies caused by type IV sensitisation (see also wine allergy).

The clinical manifestations and their severity vary and range from an oral allergy syndrome with swelling of the lips and tongue to acute urticaria, angioedema or, in rare cases, anaphylactic shock. Wheat and barley allergy sufferers may also react to beer (see case history). In addition to the substances described above, yeasts and various enzymes can also be considered as causes of allergic reactions. Contact allergies to malt and yeast have been described.

Remark: Hops (see also hop picker dermatitis) play only a minor role as allergen. The histamine contained in beer can (in rare cases) cause itching in histamine sensitive persons (see also wine allergy).

Since childhood, the 39-year-old brewery worker has had allergic bronchial asthma with reactivity to oats, barley, peach and apricot kernels. An oral allergy syndrome to apples is also known. The clinical symptoms led to the fact that he had to give up his original job as a warehouse worker in a brewery. Later he developed an oral allergy syndrome combined with asthmatic complaints immediately after drinking beer.

Serologically multiple sensitizations to malt, oatmeal, barley, barley flour, oats were observed. Furthermore on: hazel, mugwort, wheat, wheat flour, birch, timothy grass and rye.

Remark: This broad cross-reactivity is explained by a proven high degree of sensitization to lipid transfer proteins (see there).

Lipid transfer proteins are characterized by an extraordinary chemical stability. They are not destroyed in the gastrointestinal tract.

1. Rainer-Längle C et al. (2015) Severe beer allergy of a brewery owner - Severe immediate type allergy to food and beer based on sensitization to non-specific lipid transfer proteins (nsLTP) JDDG 13: 112 (Poster 48.DDG-Tagung Berlin 29.4.-2.5. 2015)