By Henry Ehrlich
Occasionally a new story appears on the allergy horizon that just cries out for instant comment, although at least this one gives anxious parents a few years of breathing room before they have to actively worry. The newest indignity inflicted on the food allergic is in the new issue of Annals of Allergy, Asthma & Immunology in an article called “Anaphylaxis to gold tequila.” The authors are a pair of MDs named Brett D. Coons and Kevin White, who work, appropriately, in San Antonio, Texas and they are to be commended for their detective work.
I don’t know how much medical literature you follow, but as a lay reader, I am both appreciative and annoyed at the formality of it. This one was almost a parody. It begins: “Tequila is a distilled liquor first produced in the city of Tequila, Mexico, in the 16th century using the blue agave plant. The Aztec people were producing a fermented drink from agave called pulque long before the Spanish arrived in 1521. With the continued stay of the Spanish conquistadors, they began to want to distill agave, because they had run out of their brandy supply. Thus agave became 1 of North America’s first indigenous distilled liquors. Tequila is bottled in 1 of several categories; the first is blanco (‘white’), which is clear tequila with little to no aging and bottled immediately. The other categories, such asreposado (‘rested’) or anejo (‘aged’), are the tequilas aged in oak barrels for months to years. This aging process imparts the golden color that is seen in Gold tequila.”
Still, while the background information is almost comical, what follows is first-class medical investigation.
Drs. Coons and White recount the case of a 47-year old woman with a history of allergies, notably to bee-sting venom, who had a progression of allergies starting with hives after drinking a margarita made with gold tequila. She reported no problems with margaritas made with the white version, nor to any individual ingredients of the tasty cocktail. “Immediate skin prick testing was performed using a sample of liquid gold tequila and a lyophilized extract of gold tequila. Of note, the lyophilized tequila had a distinct smell of wood. In addition to the patient, 4 control subjects were tested for comparison.” The observation was supposed to last 15 minutes, but was discontinued when she showed “full body itching, shortness of breath, and generalized erythema of the face, arms, and trunk.” Anaphylaxis was assessed and epinephrine given.
The authors concluded this was likely an IgE–mediated reaction to gold tequila. They say there are documented cases of anaphylaxis to beer and wine, but “an exhaustive literature review did not reveal any previously reported cases of anaphylaxis to distilled liquor. The most interesting aspect of this case is that this patient’s reactions were confined to gold tequila. Because this patient also has oak pollenosis, we propose that during the aging process in oak barrels, perhaps a reaction takes place while imparting the tequila color and mellowing of flavor that generated reactivity in this patient. The blanco tequila does not go through this barrel aging process. Because of the patient’s recurrent anaphylaxis to gold tequila, it was recommended that the patient continue to avoid gold tequila and any distilled liquors aged in oak barrels.”
(Our readers may remember that agave was implicated in another medical mystery, The Case of the Body-Wide Rash. It should be noted that we have nothing against agave. Or tequila.)
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