title: Risk of allergic reactions to wine, in milk, egg and fish-allergic patients.
abstract: BACKGROUND
  European legislators and wine producers still debate on the requirement for labeling of wines fined with potentially allergenic food proteins (casein, egg white or fish-derived isinglass). We investigated whether wines fined with known concentrations of these proteins have the potential to provoke clinical allergic reactions in relevant patients.
  
  
  METHODS
  In-house wines were produced for the study, fined with different concentrations of casein (n = 7), egg albumin (n = 1) and isinglass (n = 3). ELISA and PCR kits specific for the respective proteins were used to identify the fining agents. Skin prick tests and basophil activation tests were performed in patients with confirmed IgE-mediated relevant food allergies (n = 24). A wine consumption questionnaire and detailed history on possible reactions to wine was obtained in a multinational cohort of milk, egg or fish allergic patients (n = 53) and patients allergic to irrelevant foods as controls (n = 13).
  
  
  RESULTS
  Fining agents were not detectable in wines with the available laboratory methods. Nevertheless, positive skin prick test reactions and basophil activation to the relevant wines were observed in the majority of patients with allergy to milk, egg or fish, correlating with the concentration of the fining agent. Among patients consuming wine, reported reactions were few and mild and similar with the ones reported from the control group.
  
  
  CONCLUSIONS
  Casein, isinglass or egg, remaining in traces in wine after fining, present a very low risk for the respective food allergic consumers. Physician and patient awareness campaigns may be more suitable than generalized labeling to address this issue, as the latter may have negative impact on both non-allergic and allergic consumers.
authors.affiliation: Allergy Research Centre, 2nd Department of Pediatrics, University of Athens, Greece. emivasil@hotmail.com.
authors.forename: Emilia
authors.initials: E
authors.lastname: Vassilopoulou
authors.forename: Athanassios
authors.initials: A
authors.lastname: Karathanos
authors.forename: George
authors.initials: G
authors.lastname: Siragakis
authors.forename: Stavroula
authors.initials: S
authors.lastname: Giavi
authors.forename: Athanassios
authors.initials: A
authors.lastname: Sinaniotis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Douladiris
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fernandez-Rivas
authors.forename: Michael
authors.initials: M
authors.lastname: Clausen
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Papadopoulos