Anaphylaktische reaktionen nach genuss von alkohol-mixgetränken

Background: Quinine is a bitter tasting crystalline powder which is extracted from the bark of the cinchona tree. As a flavouring agent it is added to diverse beverages. It is found e.g. in tonic water, bitter lemon and aperol. Quinine allergy is rarely mentioned in literature. Case report: A 19 year old female patient has been suffering from 6 anaphylactic reactions after consumption of various mixed alcoholic drinks within one year, ranging in intensity from solely prickling hands to urticaria, angioedema, nausea and dyspnea. The symptoms occurred after consumption of beverages such as gin tonic, vodka lemon and Aperol Spritz. In the skin prick tests there were positive reactions to bitter lemon and tonic water as well as to quinine sulfate. Oral provocation test with tonic water resulted in flush, urticaria, abdominal pain and dyspnea. An IgE-mediated type-I-allergy to quinine was diagnosed. Conclusion: In patients with suspected alcohol intolerance, the components of potentially consumed/ mixed soft drinks should be considered for additional testing. Declared ingredients deserve diagnostic attention, although it must be considered that not all ingredients have to be declared. Quinine can easily be tested by skin prick test.