Allergies: Symptoms, Reaction, Treatment & Management

Are You Allergic Or Intolerant To Alcohol?

Do you suffer from terrible hangovers or feel unwell after drinking just a small amount of alcohol? You may be intolerant – or even allergic – to alcoholic drinks. Sue Quinn explores the telltale signs of intolerances and allergies, the difference between them and what to do if you think you're affected.

What we understand as a 'hangover' is made up of a particular set of symptoms – usually a thumping headache, nausea, intense thirst, tiredness and brain fog. This is all happens as a result of drinking alcohol, or more specifically, the series of bodily processes it sets in motion.

Alcohol is toxic and must be converted by the body into non-toxic substances. This takes time, which is why the symptoms can last for a whole day or more. The length and severity of hangovers can vary, depending not just on the strength and quantity of alcohol consumed, but also the rate our body can process it at, which varies from person to person.

Dehydration is a key component of a hangover, as it can be responsible for many of the other typical symptoms, from headaches and fatigue to anxiety and sensitivity to light and sound, says Dr Timothy Watts, a consultant physician in adult allergy at The London Clinic.

Genetic Intolerance

Anyone who drinks in excess will likely experience these adverse effects to some extent. People who have an intolerance to alcohol, though, often suffer from particularly severe hangover-like symptoms due to a genetic metabolic disorder which "causes the body to process or metabolise alcohol incorrectly," Dr Watts says.

When we drink alcohol, an enzyme in our bodies called alcohol dehydrogenase (ADH) breaks it down into a compound called acetaldehyde. Another enzyme, aldehyde dehydrogenase (ALDH), then turns acetaldehyde into non-toxic acetic acid (vinegar).

Older adults have less than average ALDH, which explains why our response to alcohol seems to worsen as we age. But those with a genetic intolerance have a mutated version of ALDH, says Dr Watts. "The mutation in this crucial enzyme leads to the accumulation of acetaldehyde in the body, and then various unpleasant symptoms. Typically, these include extensive skin flushing and other features such as nausea, vomiting, palpitations, headache and fatigue."

Research suggests this is one of the most common hereditary disorders in the world, affecting 560 million people, or eight percent of the global population. The highest prevalence (35-40 percent) is among in people of East Asian descent.

In other cases, people can be intolerant to the chemicals that give alcoholic drinks their flavour and colour, not the alcohol itself. Histamine (found in red wine) and salicylates (found in wine, beer, rum, and sherry), are common examples.

Some people are intolerant to the preservatives in alcohol called sulphites, and find that consuming them can trigger symptoms including a stuffy or runny nose, bad headache, hives, itchiness, wheezing and tummy upset.

Research suggests that up to 10 percent of asthmatics are sensitive to sulphites, with the severity of reactions varying from mild to life-threatening. "The wheezing and nasal/sinus symptoms in particular are due to the release of sulphur dioxide gas causing airway irritation," Dr Watts explains.

Alcoholic drinks high in sulphites and/or histamine include wine (red, white, rosé and sparkling), cider and beer. Some varieties of gin and vodka, as well as 'natural wines' are low in sulphites. However, asthma experts warn sufferers to choose their drinks carefully, because even low-sulphite wines will contain some sulphites.

Related stories Alcohol allergies

"A true allergy to alcohol is rare," says Dr Fiona Sim, chief medical adviser for alcohol charity Drinkaware. "Rather than alcohol itself, a person is much more likely to be allergic to one of the ingredients in their alcoholic drink, such as wheat, barley or another grain."

Another type of allergen, lipid transfer protein (LTP), is found in fruits, vegetables, nuts, seeds and cereals, and can also be present in some alcoholic drinks.

Symptoms of an allergic reaction to LTP usually appear within 15-30 minutes and include swelling, itchiness, digestive problems, breathing difficulties and, in extreme cases, anaphylaxis. LTP is not destroyed by heat.

"LTP allergy is an increasingly recognised cause of food allergy in the UK, certainly in the last five years," Dr Watts says. "Alcoholic drinks can be the trigger for reactions in some cases, alongside other food groups."

It's very difficult for consumers to know whether an alcoholic drink contains allergens or ingredients they're intolerant to. That's because in the UK, alcoholic drinks manufacturers don't have to put an ingredients list or nutrition information on the label. So, Dr Sim urges anyone who knows they're allergic to certain foods, particularly grains, to be aware they could be in drinks, too.

"This is a hazard that should be recognised. Someone with a serious allergy, which can be life-threatening, may be best advised to request the ingredients of a drink from the manufacturer before trying it." This is particularly important if you drink cocktails or other mixed drinks, which will have large and varied lists of components: "Think about all of the ingredients in order to avoid anything to which you are allergic."

Alcoholic drinks can also trigger an allergic reaction to food if you consume the two together, as alcohol can interfere with the gut lining. For example, someone with a wheat allergy may only react after eating wheat followed by drinking alcohol or exercising. "This is known as food-dependant cofactor induced anaphylaxis," Dr Watts says.

Image caption,

Jack Monroe's stewed steak ragu includes red wine but the recipe offers an alternative

Many savoury and sweet recipes contain alcohol, including red wine-based stews and casseroles, and liqueur-laden puddings. Is it OK to eat them if you have an alcohol intolerance or allergy?

"Alcohol and sulphites tend to evaporate away during cooking, so the potential for intolerances is certainly reduced," Dr Watts says. However, if you're allergic to an ingredient found in certain alcoholic drinks, dishes which contain that drink are not safe to eat.

Advice

It's relatively simple to recognise the difference between a hangover and an alcohol intolerance, Dr Watts says. "Hangovers are usually in full effect the morning after a night of heavy drinking. Metabolic genetic intolerances, however, happen more quickly, generally within an hour of drinking."

It's harder to distinguish between an intolerance and an allergy, because the symptoms can overlap. Some allergic reactions are almost instant, but not all. "If in any doubt, always consult a healthcare professional," Dr Watts says. "Investigations for alcohol reactions normally consist of specialised allergy blood tests, skin prick tests and potentially even a food challenge."

Dr Sim advises those with any type of intolerance to alcohol to avoid drinking it altogether, "although many people are willing to put up with the discomfort of skin flushing and perhaps mild abdominal symptoms in order to continue to have an occasional alcoholic drink," she admits.

It's especially important to not drink alcohol if you have a genetic intolerance, as it will "increase your risk of alcohol-related organ damage, including some cancers and liver disease."

When it comes to allergies to any component of an alcoholic drink, you must never consume it. "It can be life-threatening," Dr Sim says.

Originally published August 2022.

KalVista Pharmaceuticals Presents New Sebetralstat Data At The Western Society Of Allergy, Asthma & Immunology 2025 Annual Meeting

– Claims data show 40% of patients on long-term prophylaxis have gaps in prescription refills, leading to greater on-demand use and higher rate of LTP discontinuation-

-Data from KONFIDENT-S show patients on LTP average 1.7 HAE attacks per month and symptom relief for treated attacks in median 1.3 hours -

–Results confirm sebetralstat effective for on-demand treatment of attacks regardless of type of LTP therapy used, including an all-oral regimen–

CAMBRIDGE, Mass. & SALISBURY, England, February 10, 2025--(BUSINESS WIRE)--KalVista Pharmaceuticals, Inc. (NASDAQ: KALV), today announced the presentation of novel data related to long-term prophylaxis and sebetralstat at the Western Society of Allergy, Asthma & Immunology (WSAAI) 2025 Annual Meeting taking place in Waimea, HI from February 9-13, 2025.

Raffi Tachdjian, MD, MPH, Associate Clinical Professor of Medicine and Pediatrics in the Division of Allergy and Clinical Immunology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), presented data on the Impact of Long-Term Prophylaxis (LTP) Adherence in Hereditary Angioedema Patients: Results of a Claims Database Analysis.

According to a US commercial claims analysis, nearly 40% of HAE patients who initiated LTP had substantial refill gaps in claims over 12 months, with more than half of those discontinuing LTP.

For patients with substantial refill gaps, which increase the likelihood of non-adherence, on-demand claims remained unchanged before and after one year of starting LTP.

"Despite guidelines emphasizing regular assessment of patients using LTP to confirm efficacy and safety of their therapy, these data suggest many patients experience substantial lapses in refilling their LTP, which may reflect non-adherence," said Dr. Tachdjian. "We saw no decrease in on-demand claims for patients with LTP refill gaps. These findings are important as most HAE patients in the US now receive LTP, and a greater focus on monitoring appears warranted, as LTP effectiveness is not a given. These data may also help to explain why on-demand treatment volumes in HAE have remained steady despite the advent of several effective subcutaneous and oral LTP options since 2017."

Marc A. Riedl, MD, Professor of Medicine and Clinical Director, US Hereditary Angioedema Association Center at the University of California, San Diego, presented data on the Safety and Effectiveness of Sebetralstat in Patients with Hereditary Angioedema Receiving Long-Term Prophylaxis: Interim Analysis from the KONFIDENT-S Open-Label Study.

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Participants receiving LTP treated 382 attacks with sebetralstat (mean 1.7 attacks per month), of which more than half involved the abdomen and/or larynx.

Sebetralstat enabled early treatment (median 6 minutes) and early symptom relief (median 1.3 hours), and was well-tolerated, regardless of LTP mechanism of action or route of administration.

"Treatment guidelines recommend that patients with HAE should consider treating all attacks regardless of LTP use and should treat attacks as early as possible," noted Dr. Riedl. "These interim results suggest that, if approved, sebetralstat could be a safe and effective oral on-demand treatment for breakthrough attacks, regardless of severity, location, or type of LTP used."

Michael E. Manning, MD, allergist-immunologist at Allergy, Asthma and Immunology Associates, Ltd., Scottsdale, Arizona and Past President of WSAAI, presented Sebetralstat for the Treatment of HAE Attacks in Patients Receiving Berotralstat: Interim Analysis from the KONFIDENT-S Open-Label Study.

Participants receiving berotralstat treated 178 attacks with sebetralstat (mean 1.8 attacks per month).

Sebetralstat enabled early treatment (median 20 minutes), early symptom relief (median 1.3 hours), and was well-tolerated with no increase in gastrointestinal side effects.

"In general, patients prefer oral treatments over injectables, underscoring the strong interest in oral options for HAE," said Dr. Manning. "These results demonstrate that sebetralstat, when used as an oral on-demand treatment for attacks occurring among patients receiving berotralstat for LTP, enabled rapid treatment and symptom improvement. If approved, sebetralstat could transform the treatment landscape for physicians and patients who prefer to manage HAE without needles."

"Injectable on-demand treatments have side effects and logistical obstacles that hinder adequate disease control and drive an over-reliance on LTP," said Paul Audhya, MD, MBA, Chief Medical Officer of KalVista. "LTP does not, however, always yield the anticipated reductions in attacks, possibly due to adherence issues in a chronic lifelong setting. Sebetralstat has the potential to enable early treatment of attacks, thereby halting progression at an early stage and reducing morbidity, even among patients on LTP. By overcoming the barriers imposed by current injectable on-demand therapies, sebetralstat could shift the treatment paradigm and become the foundation of HAE management."

Links to all presentations can be found on the KalVista website under Publications.

About the KONFIDENT Phase 3 TrialThe KONFIDENT phase 3 clinical trial was a randomized, double-blind, 3-way crossover trial evaluating the safety and efficacy of sebetralstat 300 mg and 600 mg versus placebo for the on-demand treatment of HAE in adult and pediatric patients aged 12 years and older. The trial randomized 136 HAE patients from 66 clinical sites across 20 countries, making it the largest clinical trial ever conducted in HAE. In the trial, participants treated each eligible attack with up to two doses of study drug and treated up to three attacks over the course of the study. The trial included Type I and Type II HAE patients who had at least two documented HAE attacks 90 days prior to randomization and also included patients receiving long-term prophylaxis.

About the KONFIDENT-S TrialKONFIDENT-S is an open-label extension trial with numerous real-world elements evaluating the long-term safety and efficacy of sebetralstat for the on-demand treatment of HAE attacks in adults and pediatric patients aged 12 years and older with HAE Type I or Type II. KalVista is transitioning ongoing trial participants to a novel oral disintegrating tablet (ODT) formulation to support a planned 2026 sNDA filing. If approved, the ODT formulation would provide people living with HAE with an alternative, novel option for oral, on-demand treatment.

About SebetralstatSebetralstat is an investigational, novel oral plasma kallikrein inhibitor for the treatment of hereditary angioedema (HAE). We have filed multiple regulatory applications seeking approval of sebetralstat as the first oral, on-demand treatment for HAE in individuals aged 12 and older, with ongoing studies exploring its use in children aged 2 to 11. If approved, sebetralstat has the potential to become the foundational therapy for HAE management worldwide.

About Hereditary AngioedemaHereditary angioedema (HAE) is a rare genetic disease resulting in deficiency or dysfunction in the C1 esterase inhibitor (C1INH) protein and subsequent uncontrolled activation of the kallikrein-kinin system. People living with HAE experience painful and debilitating attacks of tissue swelling in various locations of the body that can be life-threatening depending on the area affected. All currently approved on-demand treatment options require either intravenous or subcutaneous administration.

About KalVista Pharmaceuticals, Inc.KalVista Pharmaceuticals, Inc., is a global biopharmaceutical company dedicated to developing and delivering life-changing oral therapies for individuals affected by rare diseases with significant unmet needs. Our lead investigational product is sebetralstat, a novel, oral, on-demand treatment for hereditary angioedema (HAE). Sebetralstat is under regulatory review by the U.S. FDA, with a PDUFA goal date of June 17, 2025. In addition, we have completed Marketing Authorization Applications for sebetralstat to the European Medicines Agency and multiple other global regulatory authorities.

For more information about KalVista, please visit www.Kalvista.Com or follow us on social media at @KalVista and LinkedIn.

Forward-Looking StatementsThis press release contains "forward-looking" statements within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995. Forward-looking statements can be identified by words such as: "anticipate," "intend," "plan," "goal," "seek," "believe," "project," "estimate," "expect," "strategy," "future," "likely," "may," "should," "will" and similar references to future periods. These statements are subject to numerous risks and uncertainties that could cause actual results to differ materially from what we expect. Examples of forward-looking statements include, among others, timing or outcomes of communications with the FDA, our expectations about safety and efficacy of our product candidates and timing of clinical trials and its results, our ability to commence clinical studies or complete ongoing clinical studies, including our KONFIDENT-S and KONFIDENT-KID trials, and to obtain regulatory approvals for sebetralstat and other candidates in development, the success of any efforts to commercialize sebetralstat, the ability of sebetralstat and other candidates in development to treat HAE or other diseases, and the future progress and potential success of our oral Factor XIIa program. Further information on potential risk factors that could affect our business and financial results are detailed in our filings with the Securities and Exchange Commission, including in our annual report on Form 10-K for the year ended April 30, 2024, our quarterly reports on Form 10-Q, and our other reports that we may make from time to time with the Securities and Exchange Commission. We undertake no obligation to publicly update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.

View source version on businesswire.Com: https://www.Businesswire.Com/news/home/20250210755734/en/

Contacts

Jenn SnyderVice President, Corporate Affairs(617) 448-0281jsnyder@kalvista.Com

Ryan BakerHead, Investor Relations(617) 771-5001ryan.Baker@kalvista.Com

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