Alcohol Allergies and Intolerance

When a Hangover Is Actually Something Else

If drinking alcohol—also known as ethanol—gives you food allergy symptoms such as flushing, itching, and diarrhea, you may have an allergy or an intolerance to alcohol. A food allergy is an abnormal immune reaction to things we eat, while a food intolerance is an adverse reaction to food that does not involve the immune system.

Although true allergies to alcohol are rare, alcoholic beverages have ingredients that can cause symptoms of allergy or intolerance. These include:

  • Gluten (proteins found in some cereal grains like wheat, barley, and rye)
  • Histamine (an organic compound found in fermented foods)
  • Sulfites (a sulfur-containing compound found in beer, cider, and wine)
  • Yeast (commonly used for alcohol fermentation)

Some people may even have reactions to grapes or corns used to make wine and distilled liquors.

Group of friends toasting with drinks
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This article looks at some of the possible causes of alcohol allergy or intolerance. It also offers tips on how to drink alcohol safely if you have an allergy or intolerance to any ingredient used to make wine, beer, or distilled spirits.

Gluten Sensitivity

Gluten, the protein that triggers celiac disease symptoms, is mainly found in three grains: wheat, barley, and rye.  Celiac disease is an immune reaction to eating gluten, triggering inflammation in the small intestine and symptoms like diarrhea and bloating.

Malted barley is used to make beer other bottled drinks. Some beers also contain wheat and/or barley. Therefore, if you have celiac disease or non-celiac gluten sensitivity, you'll need to steer clear of conventional beer.

If you have a wheat allergy, you can drink beer that is made with barley but not wheat.

Things get more complicated when it comes to distilled alcohol. Gin, vodka, and whiskey are all made from gluten-containing grains such as wheat, rye, and barley. Even so, the American Dietetic Association (ADA) considers these distilled spirits safe for people with celiac disease.

Unless gluten-containing flavorings are added after the distillation process, distilled spirits are considered gluten-free. The same applies to distilled alcohol made from wheat if you have a wheat allergy.

Even so, many people with celiac disease or gluten sensitivity report reactions to distilled spirits made from gluten grains. If this is you, you can consider drinking potato-based or grape-based vodka. There are also certain whiskeys made from sorghum (a gluten-free grain).

Wine and most brandies are also gluten-fee.

Recap

People with celiac disease, non-celiac gluten sensitivity, or a wheat allergy may need to steer clear of conventional beer. Wine and distilled spirits are generally considered safe.

Histamine Intolerance

Many foods, including red wine and aged cheese, are high in histamine. This is the same chemical involved in allergic reactions in the body.

A reaction to high-histamine foods could be a sign of histamine intolerance. Your body has two enzymes that are supposed to break down histamine, but sometimes they don't work as well as they should.

If they don't, you may experience a so-called "red wine headache" and other symptoms. These include itchy or flushed skin, red eyes, facial swelling, runny nose, and congestion. 

Although red wine is especially high in histamines, all alcoholic beverages have high levels of histamine.

Antihistamines like Allegra (fexofenadine) and Zyrtec (cetirizine) can help alleviate histamine intolerance symptoms. However, the best treatment is the avoidance of histamine in the foods we consume, including alcohol.

Recap

If you experience headache, flushing, itching, or congestion after drinking red wine, it may be because you have histamine intolerance.

Sulfite Allergies

A group of sulfur-containing compounds known as sulfites occurs naturally in wine and beer. They help inhibit the growth of harmful bacteria. Some vintners add more sulfites to wines because they act as preservatives.

While most people can tolerate sulfites in foods, there are some who are especially sensitive to them and may experience an asthma attack. In rare instances, exposure to sulfites has been known to cause a potentially life-threatening, whole-body allergy known as anaphylaxis.

Because of this, labeling laws in the United States require any food with sulfite concentrations greater than 10 parts per million (ppm) to include the words "contains sulfites" on their label.

There is no such thing as a sulfite-free wine. While organic wines cannot add sulfites to their products by law, some contain enough natural sulfites to trigger a reaction in sensitive people.

If you have an extreme sulfite sensitivity or are at risk of anaphylaxis, you will need to carry an EpiPen to self-inject yourself with epinephrine (adrenaline) in the event of an emergency.

Recap

Sulfites naturally found in wine and beer can cause asthma symptoms in people who are sensitive to sulfites. In rare cases, a reaction can be severe and lead to anaphylaxis.

Yeast Allergies

The type of yeast used to ferment many alcoholic beverages is known as brewer's yeast. It is the same yeast that is used to make bread rise.

Allergies to brewer's yeast have been well-documented in the medical literature. They are most likely to occur in people who have mold allergies. Brewer's yeast is used in all fermented alcoholic beverages. This includes beer, wine, hard cider, and sake. People with yeast allergies should avoid these.

Distilled liquor is not made with brewer's yeast. Distilling a drink usually removes any naturally occurring yeast or yeast by-products from the liquid. Because of this, distilled spirits are generally safe for people with yeast allergies.

Recap

People with mold or yeast allergies may have an allergic reaction to the brewer's yeast used to make fermented beverages like beer, wine, and hard cider.

Grape Allergies

Grape allergies are rare, but they have been reported in some medical journals. In addition to wine, people with grape allergies may need to avoid Armagnac, cognac, ouzo, vermouth, port, and champagne. Most wine coolers and packaged martini mixes should also be struck from the list.

Possible alternatives to wine and grape-based spirits include Japanese plum wine, which has an appealingly sweet taste. Calvados, an apple brandy, is another option.

Recap

People with grape allergies need to avoid wine and distilled spirits made with grapes, including cognac, ouzo, and vermouth.

Corn Allergies and Intolerances

It is unclear if distilled alcohol made from corn is safe for people with corn allergies. To date, there is little strong evidence of this.

For its part, the European Food Safety Authority stated that distilled alcohol derived from corn is "probably safe" for people with corn allergies. This is because the distillation process removes most of the corn protein that might cause a reaction.

Even so, if you have a severe corn allergy, you may want to avoid corn-based spirits, most especially bourbon. Gin, whiskey, brandy, and some vodkas may also use corn as an ingredient or flavoring, so be sure to check the label.

Beer and wine are considered safe.

There is little evidence that distilled spirits made from corn, including bourbon, pose a risk to people with corn allergies or intolerance.

Summary

While an allergy to alcohol is rare, an allergy or intolerance to ingredients used to make wine, beer, or distilled spirits can.

These include grains like wheat, barley, and rye used to make beer, which can affect people with celiac disease, non-celiac gluten sensitivity, and wheat allergies. Red wine contains high levels of histamine and may cause headaches, congestion, and itching in people with histamine intolerance.

People with sulfite allergies will likely need to avoid red wine. Similarly, those with a mold or yeast allergy may need to steer clear of fermented beverages made with brewer's yeast, including beer and wine.

While rare, people with grape allergies should avoid wine and grape-based liquors, including brandy. Even less common is an allergy or intolerance to corn-based liquors like bourbon.

A Word From Verywell

If you have any type of food allergy, it is important to be careful about the alcoholic beverages you drink. It helps to read the product label, although many ingredients used in the fermentation or distillation process may not be included.

If in doubt, ask your allergy specialist for advice about the types of alcoholic beverages you can or cannot drink.

Frequently Asked Questions

  • What are the key differences between alcohol allergy and alcohol intolerance?

    Alcohol intolerance is a genetic metabolic disorder that does not allow the body to process alcohol properly, whereas alcohol allergy is an immune response to an ingredient in the alcohol.

  • Can alcohol allergies or intolerance be cured?

    No, there is no cure for alcohol allergies or intolerance, but it is possible to manage symptoms.

  • How is alcohol allergy diagnosed?

    Your healthcare provider may perform an ethanol patch test in which a drop of alcohol (ethanol) is placed on a piece of gauze and taped to the skin. If you have a skin reaction such as a rash, itching, or swelling, it is an indication that you are allergic to alcohol, whether you drink it or come into contact with it.

  • Can I still consume alcohol if I experience alcohol intolerance?

    It is not recommended. If someone with alcohol intolerance consumes alcohol, they are at greater risk for head and neck cancer, liver disease, and Alzheimer's disease.

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