Beer: an uncommon cause of anaphylaxis
Beer is one of the most consumed alcoholic beverages worldwide but allergic reactions to this beverage are uncommon.

The authors present a case report of a 32-year-old male patient, sent to our Allergy and Immunology Department due to anaphylaxis minutes after Franziskaner beer ingestion. He tolerates all other alcoholic beverages. Prick tests to cereals were positive to wheat, corn and barley, as well as to peach. Prick-to-prick tests were performed with nine beer brands, all positive. Immunoglobulin (Ig)E to Pru p 3 was 14.8 kU/L.

Sodium dodecyl sulfate polyacrylamide gel electrophoresis inhibition immunoblotting was performed with the Franziskaner beer extract in solid phase and both cereal extracts (wheat, barley and corn) and Pru p 3 as inhibitors.

Extracts from wheat, barley and corn, and Pru p 3 purified protein were able to inhibit almost totally the IgE-binding to the Franziskaner beer extract. It seemed likely that the IgE-binding bands detected in the Franziskaner beer extract could be an LTP from cereals.

Learning Points:-
- Lipid-transfer protein (LTP) is a major allergen in beer.

- Alcohol is an important cofactor in this case report and enhances allergen absorption.

- Patients sensitised to non-specific LTPs should be alerted to the fact that they can have an allergic reaction when exposed to beer

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