Reactions to alcohol are not unusual, although they are not common either. The symptoms you describe can arise from several different sources, not all of which are allergic. I have listed some possible explanations below. After each possibility, I’ve included in italics some questions that you can ask yourself to see if that explanation might apply to you. One point about safety before we start: I cannot say with confidence that this reaction could not worsen suddenly and turn into anaphylaxis (a reaction involving several parts of the body that can be life-threatening). If you have had this problem for most of your adult life and it hasn’t worsened, then you can probably relax and experiment a bit with it. However, if this is a new problem and you’ve only had the symptoms a few times, then I would advise you NOT to experiment and see an allergist instead. With that in mind, here are some causes to consider:
Wine, more than other alcoholic drinks, contains natural histamine-like chemicals that can cause flushing and hives in susceptible people. Do only certain alcoholic beverages have this effect on you, such as red wine or beer but not vodka or gin? Are you prone to getting hives or flushing from other causes?A person can be allergic to some component of the beverage — the fruit itself, the hops (in beer), or something else. Do you have any pollen allergies? If so, then you may be reacting to some plant component in the beverage. Can you eat grapes and various grains without symptoms? People who lack the natural chemical alcohol dehydrogenase, which breaks down alcohol, can have severe flushing when they drink alcohol. Other symptoms include getting intoxicated very easily and developing nausea or vomiting with drinking. Do any family members have similar problems with alcohol? Are you of Asian descent? (The deficiency is more common in Asian populations.) People taking certain medications (niacin, Protopic or Elidel creams for eczema, metronidazole, disulfiram) can flush severely when they drink alcohol. Review all the medications you take, including anything herbal or over-the-counter. Did you begin taking any new medications at the same time the problem started? People can react to the sulfites in wine, although a more common reaction is wheezing and a stuffy or runny nose. Sulfites are used to prevent discoloration. Other foods items that contain sulfites include dried fruit that has not browned, vinegar, some shrimp, commercially prepared potato products, sauerkraut, and pickles. Do any of these foods cause symptoms? If you buy wine that is labeled sulfite-free, do you still get symptoms? People with the common skin condition rosacea can flush severely when they drink. Do you have very red cheeks, while the skin around your eyes is pale? Do you break out frequently, especially on the lower face? Do you blush easily? If so, ask your primary-care provider about rosacea, as most PCPs are very familiar with this common skin ailment.People can be allergic to hidden allergens in wines and beers. Fish products, for instance, are used in some wines as clarifying agents. This is a rather unusual cause, but do you have any other known food allergies? Finally, there are some rare but serious diseases that can cause flushing from a variety of causes. However, if your symptoms occur only after drinking alcohol, then you can probably cross this off the list of possibilities.
