title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Cardet
authors.affiliation: Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: White
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
authors.forename: Nora A
authors.initials: NA
authors.lastname: Barrett
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Feldweg
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
authors.forename: Paige G
authors.initials: PG
authors.lastname: Wickner
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
authors.forename: Jessica
authors.initials: J
authors.lastname: Savage
authors.affiliation: Department of Surgery, Harvard Medical School, Boston, Mass; Division of Otolaryngology, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
authors.affiliation: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass. Electronic address: tlaidlaw@partners.org.
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Laidlaw
mesh_terms: D000328:Adult; D000368:Aged; D055963:Asthma, Aspirin-Induced / Q000150:complications*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000139:chemically induced; D004417:Dyspnea / Q000139:chemically induced; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017999:Leukotriene E4 / Q000652:urine; D008297:Male; D008875:Middle Aged; D012120:Respiration Disorders / Q000139:chemically induced*; D012135:Respiratory Sounds / Q000187:drug effects
chemical_list: D000431:Ethanol; D017999:Leukotriene E4
keywords: AERD; Alcohol; Aspirin exacerbated respiratory disease; Aspirin intolerant asthma; Aspirin triad; Asthma; Leukotriene; Nonsteroidal anti-inflammatory drug; Samter Triad; Wine