AERD and Alcohol Don't Mix

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Unfortunately, another way that AERD (Samter's Triad) impacts quality of life is by causing adverse reactions to alcohol.

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A 2014 study done by Brigham & Women’s and Scripps found that 83% of AERD (Samter's Triad) patients reported respiratory reactions to alcohol. Of those who had reactions, 75% had a sinus reaction (runny nose, nasal congestion) and 51% had a lower respiratory reaction (wheezing, shortness of breath). Other research has found that reactions to alcohol are more common in AERD patients than in patients with only nasal polyps or other types of sinusitis. 

 

The cause of these reactions is not fully understood. Most patients reacted regardless of the type of alcohol, though many reported that wine caused the most forceful reactions. Often, reactions occurred after taking only a few sips. Because of this, intoxication is not thought to be the cause. Researchers noted that sulfite sensitivity exists in some asthma patients, but most patients reported that even alcohol with little to no sulfites produced a reaction.  

 

Furthermore, researchers found that patients reacted similarly to alcohol and aspirin. Those who developed wheezing in response to alcohol were more likely to develop wheezing during an aspirin challenge. Those who only had sinus reactions to alcohol were more likely to have a sinus reaction. In general, those who had more severe reactions to aspirin also had more severe reactions to alcohol.

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Aspirin Desensitization Can Reduce Reactions to Alcohol

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A 2018 study published by researchers at the Penn Medicine AERD Center found that aspirin desensitization significantly reduced reactions to alcohol for most patients. Following aspirin desensitization, 86.5 percent of patients said they could drink alcohol without experiencing  symptoms and 70 percent of patients described the desensitization as “very helpful” or “extremely helpful” for their ability to tolerate alcohol. Only four patients noted no improvement in their alcohol related symptoms. Patients also reported it took more alcohol or a longer period of time for symptoms to occur.

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What Type of Alcohol Can I Drink?

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The current theory is that reactions to alcohol may be related to certain polyphenols in alcoholic beverages, which have been shown to inhibit the COX-1 enzyme. Inhibition of COX-1 is the mechanism by which aspirin and NSAIDs cause AERD (Samter's Triad) reactions, so this is a plausible explanation. Polyphenols are found in red wine, where they come from the grape skin, and in beer, where they come from barley and hops. White wine and liquor can also contain polyphenols, derived from the oak barrels in which they are sometimes aged. In general, hard liquor contains fewer of these substances than wine or beer. A 2017 study found that alcohol sensitive patients reacted to catechins (a type of polyphenol) in red wine, but not to resveratrol. Follow-up research confirmed that alcohol itself does not provoke a reaction, but the specific component in wine that causes a reaction could not be identified. More research on this is underway.

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Many AERD (Samter's Triad) patients report that they have worse reactions to red wine or beer than a clear liquor, like vodka. If the theory that the polyphenols in alcohol cause these reactions is correct, experts have said that steel fermented white wines and clear liquors may cause less of a problem for AERD patients than other types of alcohol. Doctors should warn patients that alcohol can contribute to their symptoms and patients who have reactions should limit their alcohol intake or avoid alcohol altogether.

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