The Truth about Alcohol Allergy

Beer can cause an allergic reaction. Volanthevist/Getty Images

Alcohol allergy is rare, but it is a real allergy. Alcohol intolerance, however, is more common. Let’s tease out the difference between the two, so you have a handle on how to recognize your symptoms and manage them.

Alcohol allergy

Alcohol allergy is rare. It is a real immune reaction to alcohol involving immunoglobulin E (IgE), which is produced to protect the body, setting off a series of symptoms similar to those of any other food allergy.

Symptoms include swelling of the lips, tongue or throat; hives; difficulty breathing; and anaphylaxis. Most people with an alcohol allergy have inherited it. For those who are allergic to alcohol, it only takes a small amount (less than an ounce) to cause anaphylactic shock. The treatment for alcohol allergy is complete avoidance of alcohol, along with carrying emergency epinephrine in the event of an allergic reaction.

Alcohol Intolerance

Most individuals who have reactions to alcohol are intolerant to one or more ingredients contained within the alcohol. It can also be caused by a genetic condition in which the body is unable to break down alcohol. Alcohol intolerance can cause immediate, unpleasant reactions after it is consumed. The most common signs and symptoms of alcohol intolerance are nasal congestion and skin flushing. This condition is sometimes mislabeled as an alcohol allergy.

 The only way to prevent alcohol intolerance is to avoid alcohol altogether.


The symptoms of alcohol intolerance may include:

  • Facial redness (flushing)
  • Warm, red, itchy bumps on the skin (hives)
  • Worsening of pre-existing asthma
  • Runny or stuffy nose
  • Headache
  • Low blood pressure
  • Nausea
  • Vomiting

Several common ingredients found in alcohol or alcoholic beverages may cause intolerance and a reaction:

Gluten and Wheat

Gluten, the allergen avoided with celiac disease, is found in malted barley, which is used to make beer and some hard ciders. Some beers also contain wheat, causing a problem for those individuals with a wheat allergy

Alcoholic beverages may be distilled, having been condensed and evaporated. Distilled beverages may be made from wheat, rye, or barley and include vodka, whiskey, gin, and bourbon. For a good recap on whether distilled spirits are safe for those with celiac disease, read this article

Because the gluten-free commercial market has grown so much, many manufacturers make alcoholic beverages that are free from wheat and barley. Some other beers are wheat-free but not gluten-free, so always check the label for clarity on ingredient content.

Some alcoholic beverages are naturally gluten-free including wine, sake, and most brandies. Most liqueurs and some wine coolers are gluten-free as well, but again, check the labels or manufacturer websites to make sure they are safe for consumption.

Histamine Intolerance

Many foods, such as aged cheese and red wine, are high in histamine, the same chemical involved in a number of allergic reactions within the body. Those who have problems with histamine-containing foods may have malfunctioning or absent enzymes that break down histamine when it is eaten.

These enzymes are called diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT). They bind to the histamine in food and help break it down in the body. In some individuals, these enzymes don't work properly due to genetic disorders or gastrointestinal diseases.

While red wine is especially high in histamine, all alcoholic beverages are histamine-rich. Antihistamines may be useful in treating histamine intolerance symptoms when they occur, but the best treatment for histamine intolerance is a histamine-free diet (no alcohol or other histamine-containing foods). Other histamine-rich foods include cured meats, spinach, tomatoes, and fermented foods like kefir.

Sulfite Allergies

A group of sulfur-containing compounds known as sulfites occur naturally in wine and beer. Their function is to inhibit the growth of harmful bacteria. Vintners sometimes add additional sulfites to wine as a preservative. In susceptible individuals, sulfites can trigger asthma attacks or even anaphylactic shock.

For most sulfite-sensitive people, the asthmatic response is dose-sensitive and very low amounts of sulfites typically are not problematic. U.S. labeling laws require any food with sulfite concentrations greater than 10 parts per million (ppm) be listed on the label using the term "contains sulfites." Generally, for most people, low sulfite concentration levels don’t require this warning and won't cause problems for sulfite-sensitive individuals.

If your allergist has alerted you that you may be at risk for anaphylaxis or other systemic reaction due to sulfites, you should avoid all wine. There is no such thing as a truly sulfite-free wine. While organic wines are not allowed to include added sulfites, by law, some do include enough natural sulfites to be problematic for some asthmatic individuals.

Risk factors

Certain factors increase the risk for alcohol intolerance:

Being of Asian descent. Some people of Asian descent have flushing and other symptoms after drinking alcohol.

Having an allergy to grains or to another food.

Having Hodgkin lymphoma.

Taking certain antibiotic or antifungal medications.

Taking disulfiram (Antabuse) for alcohol abuse or alcohol dependence. When alcohol is consumed, disulfiram can cause reactions such as flushing, racing heartbeat, nausea and vomiting.

Alcohol can irritate the stomach lining and may increase the rate at which a food allergen is absorbed, therefore causing a quicker onset of symptoms. 

Also, when alcohol is consumed, judgment, timing, and muscle coordination are adversely affected. People may take chances they should not, may misjudge at risk situations, and may mishandle food, allowing cross-contamination.


History, physical exam, skin test, and blood test are the traditional means of diagnosing an alcohol allergy or intolerance.


Avoid alcohol or the particular beverage or ingredients that cause symptoms.

For a minor reaction, an over-the-counter or prescription antihistamine may help reduce symptoms, such as itching or hives. If you've had a severe allergic reaction to alcohol, wear a medical alert bracelet or necklace that lets others know that you have an allergy in case you have a reaction and you're unable to communicate.


Food Allergy Research and Education:

Mayo Clinic:

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