HomeAsk the allergist – December 2023

Ask the allergist – December 2023

December 1, 2023

Ask the allergist is a regular feature in our newsletters where Canadian allergists answer your questions! 

Please note: The allergists featured in this series answer questions on general topics, please talk to your doctor if you have questions about your own health or the health of your child. 

This month Dr. Julia Upton answers questions about allergy to alcohol. 

Can someone have an allergy to alcohol? 

Alcohol, also known as ethanol, or EtOH, is produced by the body naturally in small amounts from normal digestion. It is not a protein, so it is unusual for it to be an allergen. There are case reports which suggest it is a very rare cause of allergic symptoms. Acetic acid has also been implicated. EtOH or acetic acid as a cause of a true allergic reaction is likely very rare. 

Alcoholic beverages 

However, alcoholic beverages contain more than just EtOH and acetic acid, and these substances can certainly cause allergic reactions. Many beers or spirits contain enough protein of the fermented grain to lead to an allergic reaction in those with an allergy to that grain. For example, a wheat beer would contain gluten and wheat proteins. Wine can contain grape proteins, and multiple different ingredients for fining such as allergens derived from seafood (fish gelatin or isinglass), hen’s egg (ovalbumin), and/or cow’s milk (casein). There are also liqueurs which contain allergens, such as almond, hazelnut, walnut, or milk, as an ingredient.

Additionally, there are other substances in alcoholic beverages which can cause reactions that mimic allergy. For example, sulphites cause predominantly breathing symptoms, typically in persons with asthma. Some alcohol, most likely red wine, may contain enough histamine or other substances to cause symptoms. Chemicals like salicylates can also cause adverse reactions.  

Intolerance to alcohol 

There are some people who have alcohol intolerance which can be mistaken for an allergy. They have low amounts of enzymes which break down alcohol leading to flushing, nausea, headaches and can lead to heart and breathing symptoms. Persons with an enzyme deficiency would not be expected to experience hives or swelling.  

Too much alcohol 

Keep in mind that alcohol is a toxin and at high concentrations, it can be lethal. It is possible to confuse the symptoms of a hangover with that of allergy to alcohol. The toxicity and dehydration from imbibing too much can result in headaches, vomiting, and generally feeling terrible.  

There are others who may be sensitive to alcohol. People with mast cell disorders may find alcohol worsens their symptoms, as one example. 

If you’re concerned about the symptoms that occur after drinking alcohol beverages, speak to your doctor about it.

Dr. Julia Upton is on staff at the Hospital for Sick Children in the Immunology and Allergy Department and an Associate Professor in the Department of Paediatrics at the University of Toronto. She is the past Section Chair of the Anaphylaxis and Food Allergy Section of the Canadian Society of Allergy and Clinical Immunology. Dr. Upton is also a member of our Healthcare Advisory Board.  

Please note: Dr. Upton is answering as an individual allergist and her answers do not constitute an official position of her affiliated organizations. Her responses are for informational purposes only and do not constitute specific medical advice, recommendations, diagnosis, or treatment. Please talk to your doctor about any concerns or questions you may have regarding your own health or the health of your child.  

Do you have a food allergy-related question you’d like to ask an allergist in the months to come? If so, send it along to us at info@foodallergycanada.ca

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