New Alcohol Sensitivity in Patients With Post-acute Sequelae of SARS-CoV-2 PASC: A Case Series, 2023, Eastin, Bonila et al.

New Alcohol Sensitivity in Patients With Post-acute Sequelae of SARS-CoV-2 PASC: A Case Series
Ella F. Eastin; Anushri Tiwari; Tom C. Quach; Hector F. Bonilla; Mitchell G. Miglis; Phillip C. Yang; Linda N. Geng; Ella F. Eastin; Anushri Tiwari; Tom Quach; Hector Bonilla; Mitchell Miglis; Phillip Yang; Linda N. Geng

Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID, is characterized by persistent symptoms after acute SARS-CoV-2 infection that can vary from patient to patient.

Here, we present a case series of four patients with a history of SARS-CoV-2 infection referred to the Post-Acute COVID-19 Syndrome (PACS) Clinic at Stanford University for evaluation of persistent symptoms, who also experienced new-onset alcohol sensitivity. Alcohol reactions and sensitivity are not well characterized in the literature as it relates to post-viral illness. While there have been some anecdotal reports of new alcohol sensitivity in PASC patients in the media, there is a paucity of published data in the medical literature about this topic.

During their medical consultation, the patients self-reported new changes in their symptoms or behaviors following the use of alcohol. A new onset of alcohol sensitivities should be assessed along with other post-COVID-19 symptoms and may provide novel avenues to explore the pathobiology of illness and potential interventions.

Link | PDF (Cureus)

 

Interesting that alcohol sensitivity has been picked up by researchers/medics recently for ME and now Long Covid, rather than any systematic attempt to address the wider issues of food sensitivities in general.

I agree the alcohol sensitivity is of interest, but given the variability we see in people with ME in relation to food sensitivities I suspect that asking about wider intolerance issues is more like to produce helpful answers. I suspect given the variability we see in the various ME related intolerances that they are happening well down stream from the underlying biomedical issues.

 

Also, hypersensitivity to meds, vitamins, lights, noise etc.

 

I was able to drink alcohol for many years after getting ME but I haven't been able to drink alcohol since being vaccinated. It causes throat swelling and I need swift administration of antihistamines.


edit: I should add that I may be able to drink whisky without throat swelling. I just haven't tried it very often.

 

I can tolerate a drink or two of alcohol. I finished my mini bottle of Brandy that I bought last week and felt fine.

My issue is coffee.

 

I was also able to drink for many years after onset.

I did frequently get a hangover about halfway through the first pint tho.....but I never let such things get in the way, at least for many years.

I eventually pretty much stopped drinking at some point in the first decade of this millennium, due to not just hangover symptoms but also feeling pretty severely poisoned, untenable myalgia of the leg muscles etc.

In short drinking became much more 'trouble' than it was worth to me.

These days, since I moved and alcohol being much more of a thing in my sisters family life, I probably consume one to two cans a month.

Sometimes, but not often, without notable consequences.

My current project is a bottle of johnnie walker black. In 3 weeks I've managed about 6 to 8 measures.

Just canny be bothered with all the rigmarole of chilling things to make it actually taste nice, when I can only really get away with about a double.

ETA - my last bottle took me around 5 years to drink.

ETA - after testing I can confirm that a triple JW results in feeling poisoned with painful legs - so it's still a thing for me. I also purchased some ice to try a comparison between chilled with a granite lump, and chilled with ice, and the whole dilution thing, is a real thing. Dilution caused by melted ice takes a moderately okay whisky and makes it 'orrible.

So having a drink is now at least a 3 hour process, due to needing to freeze the glass and cooling stone before I can start.

Chances of me being bother to do this are minimal.

 

I'm going out this week to buy a larger bottle of Brandy b/c I enjoyed it very much. It relaxes me.

 

Ah, yes, ye old "I'm not aware of it and therefore it doesn't exist".

Then again, it's somewhat true that the medical literature has very little on it, but it only reflects to how it is severely lacking, since this has been widely reported for decades, and yet again from the start with Long Covid.

It just shows how the process of documenting illness is not systematic, heavily suffers from perception bias in what clinicians and researchers choose to record, since they choose not to systematically record everything to make sure they don't miss anything.

And of course they miss smaller stuff like this, when they literally miss everything all the time. Medical research seems to follow the same model as clinical differential diagnosis: which of those things we know of, and accept exist, is this? It doesn't allow to acknowledge what isn't already known.

Almost no one in the profession saw Long Covid coming, even though we tried to warn them about it and research it from the start. But even worse, the dominant model didn't just miss its defining feature, PEM, it literally dismisses it, preferring an obviously wrong interpretation.

You couldn't build a more perfect system to fail if you tried. It's built to resist new knowledge and to dismiss anything that doesn't fit into existing knowledge. At least without definitive proof, which only comes from the scientific method in a replicable process, which effectively cuts out everything clinical, and makes so-called evidence-based medicine irrelevant.

 

Alcohol intolerance kicked in immediately after the infection that first triggered my ME and has remained ever since.

I stopped drinking altogether as even half a glass of wine will lead to unpleasant symptoms the following day which include large, itchy, hives, usually on the chest and stomach. These take a day or two to disappear.

 

I don’t know how this could be a fruitful direction of research, especially when something has 0 influence on the quality of life since it can easily be avoided. Furthermore people with LC or ME often have some form of brain dysfunction and/or gut problems and often even headaches so it wouldn’t be too surprising that substances that are rather bad w.r.t. to these, cause a worsening of some sort.

I’d be very intrigued if there was a very specific finding of something universally considered healthy causing a specific worsening in a larger set of people, at best something that isn’t purely reliant on self-reported symptoms (I suppose a blinded experiment with "placebo alcohol" would also be possible, but who would care to do that?), rather than “people that are ill say they can respond badly to something that is unhealthy”. Unfortunately, whilst new sensitivities to different things seem to be common in people with LC and/or ME (and the amount of things I’m able to eat/drink is extremely reduced) these sensitivities appear to be extremely heterogeneous and typically rely on non-objective self-reported symptoms.

Unfortunately, an alcohol sensitivity is completely different to an alcohol allergy where possibly something immunologically useful could be learnt. I'm not able to tell how this would lead anywhere or if it would just lead to headlines such as “CBT cures alcohol sensitivity in LC”.

 

I can't drink a drop of alcohol. Instant nausea, vertigo, general malaise/weakness. I also can't drink coffee. Instant tachycardia.

 

Given the evidence of ER stress in WASF3 disrupts mitochondrial respiration and may mediate exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome (2023, PNAS) I'd investigate down the path of alcohol contributing to an already compromised ER stress / UPR system.

Spoiler: Refs

Pathogenic mechanisms and regulatory factors involved in alcoholic liver disease (2023, Journal of Translational Medicine)

Targeting Endoplasmic Reticulum Stress as an Effective Treatment for Alcoholic Pancreatitis (2022, Biomedicines)

Endoplasmic reticulum stress and autophagy dysregulation in alcoholic and non-alcoholic liver diseases (2020, Clinical and Molecular Hepatology)

Binge ethanol exposure induces endoplasmic reticulum stress in the brain of adult mice (2018, Toxicology and Applied Pharmacology)

Exercise Mitigates Alcohol Induced Endoplasmic Reticulum Stress Mediated Cognitive Impairment through ATF6-Herp Signaling (2018, Nature Scientific Reports)

Endoplasmic Reticulum Stress and Ethanol Neurotoxicity (2015, Biomolecules)

Insulin Resistance, Ceramide Accumulation and Endoplasmic Reticulum Stress in Experimental Chronic Alcohol-Induced Steatohepatitis (2013, Alcohol and Alcoholism)

STING-IRF3 pathway links endoplasmic reticulum stress with hepatocyte apoptosis in early alcoholic liver disease (2013, Proceedings of the National Academy of Sciences)

 

Absolutely; for decades.

 

Alcohol intolerance started early with ME for me.

Would be interesting to know what's going on with this. Not sure how this could be studied, if at all.

 

Would love to know what citation you can come up with.

The thing with the history of ME is that we have suffered from dreadful stigma and poor to very poor research funding which leads to poor to very poor objective evidence with adequate power to prove evidence. A self selected, self reported kind of study will not yield much interest unless physicians and researchers who are well funded and based on academia (as opposed to money making private practice of a generalist) are publishing papers and basing their research on quantifiable experiments which can be verified and reproduced.

(I have not read the paper)

It is interesting that all authors come from Stanford including Dr Bonilla who is well versed in ME. I am very sure he would have heard anecdotes of alcohol intolerance in pwME.

 

Both true. Plenty of reports, yes, but they're typically vague and poorly characterised

I don't think the term alcohol intolerance is helpful without further definition. Alcohol intolerance has been discussed here and elsewhere on and off for yonks but the only conclusion that can reasonably be drawn is that people mean very different things when they say alcohol intolerance. Anecdotal reports cluster into at least 5 groups, at least some of which have different mechanisms:

• histamine/anaphylactic type reactions
• normal reactions to alcohol - i.e. feeling drunk and/or hungover - occur more quickly and/or after only minimal alcohol intake
• abnormal reactions to alcohol that superficially look a little like Asian flushing (genetic) or Carcinoid syndrome (neuroendocrine)
• ME symptoms increase after alcohol consumption, either immediately or delayed
• people get the same symptoms from alcohol they always did but are no longer prepared to tolerate them because feeling alcohol-lousy on top of feeling ME-lousy is one level of lousy too much

It would be interesting to investigate these - but separately. And also separately from the settings in which we often consume alcohol because these often involve other exposures to potentially problematic substances and exertion, just the thing to mess up your observations

Then there's the issue of how to create a non-alcoholic control substance that people can't tell from real alcohol

 

A very useful break down, but on top of that I have very variable symptoms which may (or may not) relate to different types of alcohol, for example the only time I had a rash over much of my torso followed a glass of red wine, but then I had a migraine a couple of hours after a bottle of wheat beer (or was this a gluten reaction)?), whereas a glass of white wine may just add to the fatiguing effect of a social event. Alcoholic drinks is a very large and varied group.

Also I wonder if like the sensory hypersensitivities to light, sound or smell, alcohol intolerance interacts with the current ME level. For example I struggle much more with light and sound when in PEM than I would do on a ‘good day’.

Though, if as @Ravn indicates we ask the right questions, some form of survey might be a useful first step to set out the natural history of alcohol intolerance in ME, as with other intolerances the best way to systematically investigate this would be some form of elimination challenge: to completely remove alcohol from the diet for a period of time then reintroduce it in a controlled way.

Personally with gluten or caffeine I get very predictable results in relation to reintroduction following elimination, but I have never established a clear pattern in relation to alcohol, however as I have never been much of a drinker it easiest for me just to avoid it completely. I now only have a quarter of a glass of champagne every few years at significant toasts.