What is an Alcohol Allergy?
An alcohol allergy is a toxic reaction to alcohol (ethanol). Allergies to alcohol are relatively uncommon but can be life-threatening. As a central nervous system (CNS) depressant, the effects of alcohol on the body are hardly beneficial. In addition to mental and physical impairment, nausea flushed skin, and headaches are specific bodily reactions to alcohol consumption . Unfortunately, these symptoms lead most people to misdiagnose themselves with an alcohol allergy – instead of alcohol intolerance. What is commonly believed to be alcohol allergy is actually alcohol intolerance. Some individuals are also allergic to other components of alcoholic drinks.
Alcoholic drinks are capable of triggering a wide range of allergic and allergic-like responses, including rhinitis, itching, facial swelling, headache, cough, and asthma. In surveys  of asthmatics, over 40% reported the triggering of allergic or allergic-like symptoms following alcoholic drink consumption, and 30 – 35% reported worsening of their asthma.
Wine is clearly the most commonly reported trigger for adverse responses. Sensitivities to wine appear to be due mainly to pharmacological intolerances to specific components, such as biogenic amines and sulfite additives. The sulfite additives in wine have been associated with triggering asthmatic responses. Clinical studies have confirmed sensitivities to the sulfites in wine in limited numbers of individuals, but the extent to which the sulfites contribute to wine sensitivity overall is not clear.
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What Causes An Alcohol Allergy?
An allergy is a problematic natural response to a specific substance. Substances that cause an allergic response are called allergens. They make the immune system overreact, causing a variety of side effects.
Experts don’t fully understand how alcohol affects the body’s response to allergens. Many individuals say their allergy symptoms worsen when they drink, and research shows that individuals who suffer from allergies are more likely to experience symptoms after consuming alcohol.
Individuals with an alcohol allergy experience a reaction after as little as one milliliter of pure alcohol or a mouthful of wine or beer (about 10 milliliters). Why some individuals experience allergic reactions to alcohol – when small amounts are already produced by the body naturally – is yet unknown to researchers. However, in some circumstances, severe reactions to alcohol are mistaken for allergies when the culprit is Hodgkin’s Lymphoma, a cancer of the lymph nodes.
Other foods that may cause an alcohol allergy are:
- Food marinades
- Tomato puree
- Overripe fruit that has fermented
- Cough syrup
Physicians are able to diagnose an allergy based on the production of antibodies. Antibodies known as immunoglobulin E (IgE) cause an allergic reaction in the body accompanied by common allergic reaction symptoms. Also, blood and skin tests are able to measure immune system responses to certain substances.
Alcohol Allergy vs Intolerance
To an Allergist (a doctor who is an expert in the treatment of allergies), an “allergy” means that you have specific allergic antibodies or “IgE” to something like peanut, cat, or penicillin. True IgE-mediated allergy to alcohol is rare, but alcohol intolerance is quite common. Alcohol acts as a substance that causes the blood vessels in your skin and nasal passages to open up (vasodilator). This causes facial flushing (red face) and sometimes even itching or heat and nasal congestion.
For individuals with rosacea, this effect on the skin can be very brisk and alarming, which mimics an allergic reaction but is not associated with the other signs and symptoms of anaphylaxis (hives, angioedema, bronchospasm, hypotension). Some individuals are sensitive to certain kinds of alcohol and can develop gastrointestinal symptoms such as nausea, vomiting, diarrhea, or headaches even if they have not had a significant amount of alcohol.
Most people who have a reaction to alcohol aren’t allergic to it. They have an intolerance. They don’t have one of the active enzymes needed to process alcohol – alcohol dehydrogenase (ADH) or aldehyde dehydrogenase (ALDH). This is often called alcohol intolerance.
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Alcohol Allergy Symptoms
The symptoms of alcohol allergy are usually more serious. Signs of an alcohol allergy include:
- Trouble breathing
- Stomach cramps
- Anaphylaxis, which is a severe reaction that can include a rapid, weak pulse, nausea, and vomiting.
With respect to anaphylaxis, it is important to note that this is a potentially life-threatening condition characterized by rapid onset – often within a few seconds or minutes that must be addressed immediately. If you experience this or witness someone experiencing it, it is crucial to call 911 and administer first aid, and any applicable emergency medicine available.
Alcohol Intolerance Symptoms
If you have alcohol intolerance, you may get:
- A red, flushed face
- A hot feeling
- A rash
- A fast heartbeat or palpitations
- Low blood pressure
- A stuffy nose
- Stomach pain, which may include nausea or vomiting
- Trouble breathing
- If you have asthma, your symptoms get worse
In a few cases, alcohol intolerance can be a sign of a more serious problem. If you think you have it, talk with your doctor and find out what’s causing it.
Alcohol Allergy Risk Factors
You may experience symptoms of alcohol intolerance if you are actually allergic to:
- Gluten – because barley, wheat, hops, and rye are often used to make beer, vodka, whiskey, gin, and bourbon.
- Histamines – which are found in red wine, and produced by the yeast in some types of alcohol.
- Grapes – which rarely contain proteins that can trigger reactions after the consumption of wine, champagne, Armagnac, cognac, vermouth, port, pre-mixed martinis, wine coolers, and some premium vodkas.
- Fining agents – such as egg, milk, or fish proteins used in the removal of small particles from wine.
- Sodium metabisulfite – which are also known as additives 220 and 221. Used as preservatives in beer and wine since ancient times, they are known to trigger asthmatic episodes in about 10 percent of people who suffer from asthma.
- Tree nuts – this is because some bourbons and whiskeys are fermented in oak (or other tree) barrels, which are known to trigger reactions. Many distillates and extracts also contain nuts.
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Alcohol Allergy Diagnosis
If you develop symptoms after drinking alcohol, make an appointment with your doctor. Depending on your symptoms, they might refer you to an allergist for testing and treatment. An allergist is a special type of doctor that focuses on allergic conditions.
Your doctor will probably start by asking you questions about your symptoms and medical history, such as:
- What alcoholic beverages trigger your symptoms?
- What symptoms do you experience?
- When did you start getting symptoms?
- Do you have relatives with allergies?
- Do you have any other medical conditions?
If they suspect you have a true allergy to alcohol or another ingredient in alcoholic beverages, they will likely conduct allergy testing. The most common type of allergy testing is the skin prick test. During a skin prick test, your doctor will use a lancet to prick or scratch your skin. They will apply a drop of allergen extract to the pricked or scratched area. Your skin’s reaction can help them learn if you have an allergy.
In some cases, they might use an oral challenge test to diagnose an allergy or intolerance. In this procedure, they will ask you to consume a sample of your suspected trigger. They will observe any symptoms you develop. They may also conduct blood tests.
Alcohol Allergy Treatment
If you have a true alcohol allergy, the only way to avoid symptoms is to avoid alcohol completely. Even a small amount of alcohol can trigger a severe reaction. Read the ingredient lists of foods and drinks, ask the restaurant staff for information about menu items, and avoid products that contain alcohol. Some foods contain alcohol as an added ingredient.
If you’re allergic to another ingredient contained in certain alcoholic products, switching to a different drink might be an option. For example, barley is typically found in beer but not wine. Ask your doctor for guidance.
If you experience a mild allergic reaction, over-the-counter (OTC) oral antihistamines may be enough to treat it. If you develop any signs of a severe reaction, you should receive one or more doses of epinephrine. This medication is also called adrenaline. It’s available in preloaded syringes, known as epinephrine auto-injectors (e.g., EpiPen). If your doctor prescribes an epinephrine auto-injector, you should carry it with you at all times. Use it at the first sign of a severe allergic reaction. Then go to your nearest emergency department for follow-up care.
If you have a non-allergic intolerance to alcohol, histamine, sulfites, or other components of alcoholic beverages, your doctor might encourage you to limit or avoid certain types of alcohol. In some cases, over-the-counter (OTC) or prescribed medications might help alleviate symptoms.
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How Can I Prevent Alcohol Intolerance?
You cannot prevent alcohol intolerance from developing. It is an inherited disorder, so it was passed down to you from your parents. However, you can take steps to avoid the symptoms. Alcohol intolerance is a lifelong condition. It won’t go away, but by taking some precautions, you can avoid the symptoms and enjoy a healthy, active life.
The best way to live with this condition is to avoid alcohol as much as possible. Try nonalcoholic beverages as substitutions for your favorite alcoholic drinks. Avoiding alcohol will allow you to live an active, enjoyable life without unpleasant symptoms.
Alcohol abuse can still develop if someone has an alcohol allergy. Some individuals continue to drink through adverse reactions to feel the pleasurable effects of alcohol.
Heavy drinking and alcohol allergy may increase the risks of developing specific alcohol-related problems, such as:
- High blood pressure
- Cancer of the mouth and throat
- Esophageal and gastric cancer
- Higher rates of liver disease (cirrhosis)
- Late-onset Alzheimer’s disease
If you or a loved one is struggling with alcohol allergy and alcoholism, a specialized treatment program will be recommended. Depending on the severity of the condition, an inpatient program may be the most effective course of treatment.
Patients who attend our alcoholic recovery treatment facilities can benefit from some of the following treatment methodologies:
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