Headaches, nausea, and facial redness and swelling are common for some after drinking alcohol. But these symptoms cannot always be blamed on the hangover or the last beer. Do you suffer from an alcohol allergy if these symptoms occur even after a small amount of alcohol?
We have researched extensively for you what alcohol allergy is all about, how it manifests itself and what you can do about it. You will also find out what exactly happens in your body when you consume alcohol and what triggers the immune system.
the essentials in brief
- There is an allergy to ethanol, commonly known as alcohol, and its breakdown products. However, this is a rarity and occurs only very, rarely, as does alcohol intolerance, which is mainly found in East Asian people.
- If people suffer from allergy-like symptoms after consuming alcohol, this is usually due to other allergens and ingredients such as histamine. Symptoms include redness, swelling, nausea, vomiting, and asthmatic reactions.
- You can prevent this by avoiding or eating small amounts of foods and drinks that contain histamine or other allergens.
Alcohol Allergy: What you should know
We have researched and compiled the basic facts and connections for you so that you do not have to complete half a medical degree yourself when looking for information on the subject of alcohol allergies. Here you can find out about alcohol allergies in a simple and understandable way.
What is alcohol and how does it work in the body?
By alcohol, you probably mean alcoholic beverages like beer, wine, liqueurs, and other spirits. The alcohol in it is called ethanol or ethyl alcohol.
In addition to ethanol, there are other substances that belong to the alcohol family and have a similar chemical structure. In general usage, however, alcohol always means ethanol.
When ethanol enters the body through food and drink, it is absorbed in small amounts through the oral mucosa, about 20 percent through the stomach and the remaining amount through the small intestine and transported through the bloodstream.(1)
The absorption of alcohol can be accelerated by warm drinks containing carbon dioxide, such as grog, mulled wine or sparkling wine, and inhibited and delayed by fat. (2)
Most of the alcohol is broken down in the liver. But around 2 to 10 percent is also excreted directly through sweat, urine or the air we breathe.(3) In the liver, the enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) ensure that ethanol is broken down into acetaldehyde and then into acetic acid. (4)
This is then broken down via the respiratory chain and the citric acid cycle, which you probably remember from biology class, and metabolized into carbon dioxide.(5)
Can you be allergic to alcohol?
Yes, there is an allergy to alcohol. However, this is very rare and more of a rarity. The body reacts to ethanol and its derivatives supplied by foods such as alcoholic dishes and drinks.
Acetic acid, a breakdown product of ethanol, is particularly suspected of causing allergic reactions such as reddening of the skin, itching, swelling of the face and throat, and a drop in blood pressure.(6,7)
In almost all cases of such reactions after the consumption of alcohol, however, other allergenic substances are the trigger. These are contained in the alcoholic beverages as leftovers from the manufacturing process or as part of the ingredients.
You can see which allergens these can be and where they are contained in the following table:
|Lipid Transfer Protein (LTP)||grapes, wine, champagne|
|Fish gelatin and swim bladder||wine, beer|
|casein||wine, dairy products|
|Mold||Red wine, cheese, ham|
|Yeast||beer, blue cheese|
|quinine(sulphate)||Bitter lemon, tonic water|
|histamines||Red wine, beer, aged foods such as cheese and sausage|
Since the symptoms that occur are similar to those of an allergy, but are not triggered by the alcohol itself, it is referred to as a pseudo-allergy.
Most often, an alleged alcohol allergy is a histamine intolerance
Medicine also distinguishes between a genuine allergic reaction, which is caused by the immune system, and a hypersensitivity reaction or intolerance, which is only caused by faulty degradation or excessive doses of a specific substance.(8)
In addition, alcohol consumption increases sensitivity to environmental allergens and promotes an immunological response to histamine.(11)
Alcohol consumption leads to increased sensitivity, especially in asthmatics.
Alcohol and its breakdown products release histamine from the mast cells in the body. The resulting histamine levels, especially in conjunction with histamine intolerance, lead to allergy-like symptoms.(12)
Asthmatics in particular should monitor their alcohol consumption, as alcohol leads to increased sensitivity to aeroallergens, i.e. allergens in the air we breathe.(13)
What are the symptoms of an alcohol allergy?
Now that we have clarified that in the vast majority of cases it is not an allergy to alcohol, but allergies and intolerance to other ingredients in alcoholic beverages, we now turn to the symptoms.
Headaches are caused by breakdown products of ethyl alcohol. This is particularly the case for people with alcohol intolerance. (Image source: Usman Yousaf/ Unsplash)
The most common symptoms after drinking alcoholic beverages include:
- Flushing: Blushing of the skin, especially on the face, occurs due to vasodilatation and increased production of the alcohol breakdown product acetaldehyde. This is particularly pronounced in East Asian people with alcohol intolerance.(14) However, this symptom is non-threatening.
- Urticaria: This means skin changes such as itching, redness and wheal formation.(6,16)
- Swelling: This mainly occurs on the face, around the eyes and in the neck area. Especially in the neck, this can lead to shortness of breath and subsequent loss of consciousness or even respiratory arrest.(7)
- Drop in blood pressure: A drop in blood pressure can also have serious consequences for the circulatory system.(7,16)
- Nausea: This means all occurrences such as nausea and vomiting. These also occur particularly in people with alcohol intolerance.(14,15,16)
- Headache and increased heart rate: These alcohol-related hangover-like symptoms are caused by a breakdown product of ethanol and also affect people with alcohol intolerance.(14,16)
- Other symptoms: diarrhea, asthma, cough, nasal mucosa related symptoms, arrhythmias.(16)
Which symptoms appear depends on many factors. On the one hand, the substance or allergen to which the body reacts determines what symptoms occur as a result of the immune or hypersensitivity reaction. On the other hand, intolerances and other previous illnesses also play a major role in the occurrence of the various symptoms.
Do I suffer from an alcohol allergy or do I have a hangover?
If you ask yourself this question alone, there is probably more to it than one glass of wine too many in the evening. The classic hangover is caused by a breakdown product of ethanol and causes well-known symptoms such as headaches, nausea and digestive problems.(12)
This is triggered by large amounts of alcohol, the consumption of large amounts in a short period of time or the consumption of various alcoholic beverages such as beer, wine, schnapps and liqueurs.
Humans can break down around 0.15 per mil per hour, with men having an advantage over women as they can only break down around 0.13 per mil per hour.(19)
However, if you suffer greatly from the symptoms described or if they occur after consuming a small amount of alcohol, then other factors besides the pure alcohol may also play a role. Signs of an intolerance or allergy are:
- Rapid reaction: Rapid onset of reddening, itching, headaches, nausea and difficulty breathing after drinking alcohol can indicate an allergy or intolerance reaction
- Occurrence with certain foods: If the symptoms also develop after eating other foods, such as citrus fruits, salami or tomatoes, there is probably a histamine intolerance. Even if symptoms only occur with certain alcoholic beverages, this can be a sign of an intolerance.(17)
If the symptoms are similar to the symptoms of an allergy, you should also be alarmed and consult a doctor if necessary. As a first step, you can use small amounts to try which foods cause symptoms and find out which substances your body reacts to.
As people age, their tolerance for alcohol decreases. This is a normal aging process and nothing to worry about. So if you're a few decades old and find that you can tolerate less alcohol than you used to, that's normal. If the hangover is a little stronger the next morning despite fewer alcoholic drinks, this is due to advanced age and not to an alcohol allergy.
What can you do about an alcohol allergy?
If you experience the symptoms described above after drinking alcohol, the first thing you should do is find out exactly what you are sensitive to. On the one hand, you can try out for yourself which foods and drinks cause the symptoms, or you can go to an allergist, who will then test you for various substances.
Especially if you have problems with the airways and swelling, you should see a doctor immediately!
If you know what ingredients you are allergic or intolerant to, avoid consuming them. If you have allergies, you should avoid consumption altogether. In the case of intolerance, the body can usually still process small amounts and only reacts with defense reactions from an increased dose.(11,17)
In the case of allergies, medications are often used that inhibit an immune reaction and can thus alleviate the symptoms or stop them altogether.
What is the difference between an alcohol allergy and an alcohol intolerance?
We have already used the term alcohol intolerance more frequently, but have not yet differentiated it precisely from the pseudo-allergy to alcohol. As already described, an allergy is a reaction caused by the immune system to an actually harmless substance. This reaction often occurs via antibodies, which are also detectable in the body in the event of an allergic reaction.(8)
Alcohol intolerance is based on a gene variation that is responsible for the synthesis of the alcohol-degrading enzyme alcohol dehydrogenase 2. (Image source: Adam Wilson/ unsplash)
On the other hand, intolerance occurs most frequently in East Asian people and is due to a genetic component. Those affected do not develop the ADH 2 enzyme, which is responsible for breaking down alcohol, properly or not at all and therefore react very strongly to even the smallest amounts of alcohol.
In addition to nausea and vomiting, other symptoms include headaches, skin irritation, asthma, and an aversion to alcohol and alcoholic foods and drinks.(14,18"> As a European, you are very unlikely to be alcohol intolerant or allergic.
What alcohol can you drink with a histamine intolerance?
Since histamine intolerance is the most common cause of suspected alcohol allergy, you should avoid foods and drinks containing histamine. Although the body produces histamine itself, the consumption of foods containing histamine reaches a critical dose of histamine, which then leads to physical defense reactions due to the intolerance.
Red wine in particular contains a lot of histamine and sulphites and can cause symptoms. White wine, on the other hand, is often well tolerated. (Image source: Alasdair Elmes/ unsplash)
You can find out from this table whether you have to completely avoid certain foods or alcoholic beverages:
|Sausage||fresh, unprocessed meat|
|aged cheese||Fresh cheese, young Gouda, butter cheese|
|processed fish||fresh or frozen fish|
|Citrus fruits, spinach, tomatoes, strawberries, avocado, mushrooms, sauerkraut, pickles, legumes||all other fruits and vegetables|
|yeast baked goods||baked goods prepared with baking soda or baking powder|
|Red wine, beer, wheat beer||white wine, sparkling wine|
|Coffee, cocoa, black tea||other types of tea, best prepared with fresh ingredients such as mint|
In general, you should avoid stored, aged, and processed foods. Hot spices and heavily marinated meat and vegetables, as well as vinegar, also contain a lot of histamine and cause symptoms. However, it is best to try what works for you and what doesn't, even in small doses.
If you experience symptoms such as headaches, redness and nausea even after consuming small amounts of alcohol, these are very likely signs of an allergy or intolerance. However, there is a very high probability that you are not allergic to alcohol itself. The most widespread is an intolerance to histamine, which can trigger your symptoms.
Above all, asthmatics and those affected by food allergies react more strongly to environmental allergens after consuming alcohol and react more quickly, since alcohol increases sensitivity to aeroallergens. So here is an underlying disease to blame for the malaise.
As a European, there is a very high probability that you are not alcohol intolerant and do not suffer from alcohol allergy, as this disease is very, very rare.
- H. Lüllmann, L. Hein, K. Mohr, M. Wehling: Pharmacology and Toxicology. 16th edition, Georg Thieme Verlag, 2006, ISBN 978-3-13-368516-0, p. 521
- Klaus Roth: The chemistry of hangovers: alcohol and its consequences. In: Chemistry in our time. 41, 2007, pp. 46–55, doi:10.1002/ciuz.200700409.
- W. Gerok, C. Huber, T. Meinertz, H. Zeidler, Henning (eds.): Internal medicine: Reference work for the specialist. 11th edition, Schattauer Verlag, 2006, ISBN 978-3-7945-2222-4, pp. 644-646.
- Provost JJ, Colabroy KL, Kelly BS & Wallert MA The Science of Cooking; Understanding the biology and chemistry behind food and cooking. Wiley, Hoboken, New Jersey 2016, ISBN 978-1-118-67420-8, p. 430 f.
- Hans-Konrad Biesalski, Olaf Adam: Nutritional medicine: According to the curriculum of nutritional medicine of the German Medical Association. 3rd edition, Georg Thieme Verlag, 2004, ISBN 978-3-13-100293-8, pp. 520-528.
- Añíbarro B, Seoane FJ. Ethanol-induced urticaria caused by sensitization to acetic acid. Ann Allergy Asthma Immunol. 2018 Mar;120(3):337-338. doi: 10.1016/j.anai.2017.12.020. PMID: 29508725.
- Fernando SL, Clarke LR. Two Case Reports of Life-Threatening Ethanol-Induced Anaphylaxis. Case Rep Dermatol. 2009 Apr 29;1(1):1-6. doi: 10.1159/000209154. PMID: 20508822; PMCID: PMC2875848.
- Wuthrich B. Allergic and intolerance reactions to wine. Allergol Select. 2018 Sep 1;2(1):80-88. doi: 10.5414/ALX01420E. PMID: 31826033; PMCID: PMC6883207.
- Bansal RA, Tadros S, Bansal AS. Beer, Cider, and Wine Allergy. Case Reports Immunol. 2017;2017:7958924. doi: 10.1155/2017/7958924. Epub 2017 Mar 15. PMID: 28396809; PMCID: PMC5371212.
- Liptak, J. Anaphylactic reactions after ingestion of mixed alcohol drinks. Allergo J 21, 425-427 (2012). https://doi.org/10.1007/s15007-012-0394-z
- Gonzalez-Quintela A, Vidal C, Gude F. Alcohol, IgE and allergy. Addict Biol. 2004 Sep-Dec;9(3-4):195-204. doi: 10.1080/13556210412331292235. PMID: 15511713.
- Zimatkin SM, Anichtchik OV. Alcohol-histamine interactions. AlcoholAlcohol. 1999 Mar-Apr;34(2):141-7. doi: 10.1093/alcalc/34.2.141. PMID: 10344773.
- Linneberg A, Hertzum I, Husemoen LL, Johansen N, Jørgensen T. Association between alcohol consumption and aeroallergen sensitization in Danish adults. Clinic Exp Allergy. 2006 Jun;36(6):714-21. doi: 10.1111/j.1365-2222.2006.02507.x. PMID: 16776671.
- Aoki Y, Wehage SL, Talalay P. Quantification of skin erythema response to topical alcohol in alcohol-intolerant East Asians. Skin Res Technol. 2017 Nov;23(4):593-596. doi: 10.1111/srt.12376. Epub 2017 May 17. PMID: 28513003.
- P. Schauder, G. Ollenschläger: Nutritional Medicine: Prevention and Therapy. Elsevier Germany, 2006, ISBN 978-3-437-22921-3.
- Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952.
- Sabine Jossé, histamine intolerance: juice, milk drinks, alcohol - what can you drink?; 2015 May 29; https://www.mein-allergie-portal.com/histaminintolerant/617-histaminintolerant-saft-milchgetraenke-alkohol-was-kann-man-trinken/all-pages.html (last accessed on December 31, 2020)
- Matsuse H. Mechanism and management of alcohol-induced asthma. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2016 Jun;51(3):214-220. English, Japanese. PMID: 30480906.
- German Head Office for Addiction Questions eV; Gabrielle Bartsch Christa Merfert-Diete. alcohol basic information; 16th edition, 2020 16.40.06.20