ASK THE DOCTOR: A glass of wine makes me wheezy 

Over the past year, a patient has developed an allergic reaction to anything alcoholic

Over the past year, I have developed an allergic reaction to anything alcoholic. Even a few sips of wine can bring on what feels like an asthma attack - my breathing becomes wheezy and my chest feels tight. It can feel quite scary. I used to enjoy a drink before my evening meal. Why has this happened, and is there anything I can do about it?

Mrs D. F. Hansen, Bristol.

This is an unfortunate turn of events. But three possible explanations spring to mind.

The most likely is that it is a component of the wine, rather than the alcohol content itself, that's causing you this asthmatic symptom - and the two possible culprits are sulphites and histamines.

Sulphites are preservatives that are added to wine and beer to kill bacteria and fungi during production, and to prevent the overgrowth of yeasts.

They are added to many foods, too, including pickles, dried fruit (such as apricots and raisins), vegetable juices, bottled lime juice, some condiments and some processed meat products.

As preservatives, they work by releasing sulphur dioxide.

This is generally harmless but, in some people, it can be an irritant, triggering symptoms such as wheezing, sometimes even if the person has not previously been diagnosed with asthma.

(I should mention that wine that does not contain added sulphites may still have this effect in particularly sensitive people, as grapes naturally contain small quantities of sulphites anyway.)

Histamines are chemicals found naturally in fermented drinks such as beer or wine (red wine contains rather more than white), as well as in fermented foods such as certain cheeses or sauerkraut.

Histamines also occur naturally in the body, and are released during allergic or inflammatory reactions. Those found in drinks or food may, in people who are sensitive to them, cause the kind of reaction you experience when you sip a glass of wine.

As well as wheezing, other typical reactions may include facial flushing and nasal congestion.

Another possible, but far less likely, cause of your symptom might be gastro-oesophageal reflux. This is when acid leaks out of the stomach and travels up the oesophagus (or gullet).

It's likely a component of the wine, rather than alcohol content itself, that's causing this asthmatic symptom

It is typically associated with heartburn and acid reflux, but it can also, less commonly, cause coughing and wheezing.

Alcohol can make the condition worse - it can cause the stomach to produce more acid and can make the muscle valve between the gullet and the stomach less effective. But I think this is the least likely of the three options, as your asthmatic sensations occur after even just a sip or two of wine, which is probably not enough to cause significant acid reflux.

I would be interested to know if this only happens when you drink wine, or whether you've managed to experiment with other types of alcoholic drink.

I would suggest you try a small dose of vodka - no sulphite preservatives are used in its production and it contains no histamine naturally.

You could perhaps try this with a small amount of freshly squeezed orange juice (as there will be no chance of sulphites in this).

Drinking a spirit may not be quite such a delight for you as a glass of wine - but at least the experiment may help you to clarify the cause of your symptoms.

PLEASE help me with my restless feet. As soon as I go to bed, the restlessness begins, and I can't sleep. During the day, I have no problem, but when I take my socks off, it feels as if the skin over my feet is being stretched. I massage and wriggle my feet before bed, but to no avail.

Coral Charles-Dunne, Sutton Coldfield, Warks.

WHAT you are describing is, I'm certain, a variant of restless legs syndrome. Also known as the Willis-Ekbom syndrome, the condition was first described by Dr Thomas Willis in the 17th century and, some 70 years ago, Dr Karl-Axel Ekbom published a study about it.

The condition is where there are strange and unpleasant sensations in the legs (or, in your case, the feet), which nearly always start in bed at night and are only relieved by kicking and moving the legs.

While the cause is not fully understood, nor why it occurs at night, in more than 40 per cent of cases there is a family history of the disorder.

Also, studies have consistently shown that patients who have the syndrome have low levels of ferritin - a protein that stores iron - in the blood.

Certain drugs, including some antidepressants, anti-sickness medicines and sedating antihistamines, seem to make the condition worse, too - though we don't know exactly why.

When the symptoms are as chronic and persistent as yours, a form of drug treatment may be appropriate. Restless legs syndrome is a treatable condition that responds well to correctly chosen therapy, and there are a number of medicines that have proved helpful.

First, it might be a good idea to have a blood test to check your ferritin levels - if you are found to be deficient in iron, oral iron supplements might be a good first-line treatment.

In terms of additional medications, the best is probably a class of drugs called dopamine agonists, which stimulate brain receptors that respond to the chemical dopamine.

The theory is that the condition may be linked to low levels of dopamine, which plays a role in controlling movement.

The drugs pramipexole, ropinirole and rotigotine are all used in treating this condition and, at small doses, can be remarkably effective.

Side-effects are minimal and usually occur only at the beginning of treatment. They may include slight nausea and light-headedness, but I have not seen this in any patients I have treated for this condition.

I recommend you talk to your doctor again - ask about treatment and about having your iron stores tested.

It could mean, ultimately, that you finally get a comfortable night's sleep.

By the way ... We can learn a lot from the Three Wise Men

More than ever this past year, patients and doctors alike have been urged to avoid antibiotics, unless for treating proven bacterial infections.

Patients must learn to accept that most respiratory illnesses are due to viruses and not bacteria: just because a cold has continued for seven or eight days, or a cough has disturbed sleep for weeks, a potent antibiotic may not be the answer.

We doctors must also restrain ourselves from cutting corners and prescribing unwisely.

I was thinking about how to put this to my patients in the lead-up to Christmas, when illness seems to flourish.

Last year at this time, I had the extreme good fortune of spending a few days in Dubai with friends, who took me to the ancient but preserved part of the city, Old Deira.

This is home to the souks - the spice souk in particular caught my attention, with its tiny trading shops closely packed together: historic, romantic and atmospheric.

Shop after shop was crammed with neatly piled sacks overflowing with herbs, spices -including saffron - and, most intriguing of all, frankincense.

My friends called this 'chewing gum', though mostly it is burned as an aromatic incense. But this resin, collected from cuts made in the bark of a species of tree, also has value as a medicine - in particular, it can be used to relieve arthritis, as it has been found to reduce inflammation.

Our next stop was the gold souk, which makes Hatton Garden in London look trivial. At that point - it was the day before Christmas - I thought of the Magi, the Three Wise Men who arrived in Bethlehem after the birth of Jesus, bearing gifts of gold, frankincense and myrrh for the Christ child.

Myrrh is also a resin, a natural gum, used since time immemorial in Chinese medicine for arthritis, circulatory problems, menstrual pain and the menopause.

In Western medicine, it is used as an antiseptic, for the treatment of gum disease and to protect skin wounds from infection.

Recent research has found that it kills human breast cancer cells in lab experiments.

Such was the value of the gifts carried by the Three Wise Men to the newborn, and this history reminds us that, for minor illness, time-honoured traditional medicines may give comfort and relief.

Without doubt, most are less damaging than the unnecessary and irresponsible use of antibiotics.

Often, in fact, what's needed are even simpler, traditional remedies - rest, healthy eating, plenty of sleep and a little TLC. I wish you and your loved ones a Happy - and healthy - Christmas.