Do I Have a Beer Allergy or Wine Allergy?
Allergens like sulfites, histamine, pesticides, and fining agents could be hiding in your favorite drink.
[Updated January 29, 2016]
Karen Lin isn't much of a drinker but she does enjoy the occasional glass of wine. When she does, real problems begin.
"My throat closes up and my face puffs up when I drink wine or beer," she says. "It's full-out anaphylactic shock."
The first time it happened, she headed to the emergency room. "They couldn't believe it had anything to do with alcohol," she says. "They claimed there are no proteins in alcohol to trigger that kind of shock." However, it's now known that there are several ingredients hiding in many drinks that trigger a beer allergy or a wine allergy.
Her experience is hardly unusual. Though anaphylaxis is rare (alcohol accounts for only a small percentage of the United States' 150 annual food-related anaphylaxis fatalities), wine allergy and beer allergy are both relatively common. The causes of these allergic reactions range from sulfites to sturgeon swim bladders. A single bottle of beer, for example, can contain more than 10 allergens, including preservatives, histamines, animal products, pesticides, wheat, yeast and corn.
Why are these allergens added and what symptoms do they cause? What is it about these additives that alcohol producers consider essential enough to risk the well-being of millions of American food allergy sufferers? As it turns out, it depends on the allergen. Some are simply more dangerous than others.
Sulfite Sensitivities for Allergic Asthmatics
Sulfites caused a major outcry in the 1980s. After several studies found that inhaling and ingesting sulfites could be deadly to asthmatics, the FDA began a regulation campaign that successfully curbed annual sulfite deaths to the single digits. All wines and beers containing more than 10 parts per million of sulfites are required to mention them on their product label.
According to the FDA, roughly 1 percent of people in the United States are sulfite-sensitive, almost all of them asthmatic. It's estimated that 5 percent of all asthmatics have sulfite sensitivities.
Taylor Richardson, a 28-year-old office manager from Boise, Idaho, is an allergic asthmatic who exhibits a bad reaction to wine. "I get bright red blotches down my neck and chest, like hives," she says. "My face gets red, hot and a little itchy. After about a third to a half glass of wine, my throat starts to close."
Her reaction may be caused either by sulfites which occur naturally during winemaking or by sulfites, such as sodium metabisulfite (SMB) and potassium metabisulfate (PMB), which are artificially added to conventional wines and beers. SMB, a common beer preservative, causes reactions in about 4 percent of people with sulfite sensitivities. PMB is used as a preservative in both beer and wine, and is preferred because it doesn't add to a drink's sodium content. Both PMB and SMB are known to trigger reactions in sensitive people, ranging from runny nose to anaphylaxis.
Organic and biodynamic wines, produced using no artificial pesticides or preservatives, are only allowed 100 ppm of naturally-occurring sulfites—and no added sulfites. Most conventional wines contain up to 350 ppm.
No big deal, according to Mimi Gatens, director of sustainability at Benziger Winery. "The levels of sulfites found in a bottle of wine are less than those found in a bottle of prescription medication," she says. "Without the use of sulfites, flavors can move quickly from fruit to nutty to cardboard to vinegar."
Both naturally-occurring and artificial sulfites essentially dissipate over time, says Fred Freitag, D.O., of the Diamond Headache Clinic in Chicago. "The sulfites naturally produced in organic wines are so volatile in a corked bottle that most of them will escape during storage." The same goes for artificial preservatives PMB and SMB. "In solution, these turn into hydrogen sulfite or other salts and dissipate…becoming essentially stale within three months," Freitag says.
For that reason, and because of how rare sulfite allergies are, doctors are quick to discount them during diagnosis. "I'll ask a patient complaining of an adverse reaction what he or she ate and drank when (the reaction) occurred," says Dan Atkins, M.D., pediatrician at the National Jewish Center for Immunology and Respiratory Medicine in Denver, Colorado. "If beer or wine doesn't seem to be the problem, I tend to dismiss sulfite sensitivity."
Histamines and Tannins Could Be Causing Your Headache
If you're not sensitive to sulfites, a host of other factors could be causing your wine or beer reaction. Histamines and tannins are two naturally occurring elements commonly indicted in reactions, especially headaches.
Ahna Olana, a 61-year-old therapist from Louisville, Colorado, gets such bad headaches from wine that she now drinks sparkling pear juice instead. "When I drink wine…I will almost always get a killer migraine either later that day or the next," she says.
Headaches are hardly uncommon. As many as 80 percent of migraine sufferers' symptoms are triggered by red wines.
Tannins are flavenoids that add a bitter flavor to red wine and also prevent oxidation as wine ages. They're found in grape skins, stems and seeds, and sometimes they leach into wine from oak storage barrels. Tannins increase the amount of the feel-good chemical serotonin in the blood, but it also can induce headaches.
Histamines, which come from grape skins, are strongly indicted in red wine headaches. They're part of a family of known migraine triggers called amines, which include common migraine culprits, such as cheese, chocolate and cured meat. Histamines also form during the beer-making process. Dark beers, such as porters, are often rich in the compound.
People who react to the histamine in alcohol may also have low levels of an intestinal enzyme called diamine oxidase, which normally processes histamine without causing symptoms. Insufficient quantity of this enzyme causes people to experience strong headaches, a runny nose or flushing—symptoms similar to a seasonal allergy. In fact, if you have seasonal allergies, the histamines in alcohol might make them worse.
"I have a bad allergy to mold and cannot drink red wine when I'm in moldy climates,"
says Tamara Greenleaf, a 40-year-old marketing executive from Portland, Oregon.
"I get a very strong histamine reaction."
Greenleaf's symptoms are indicative of something allergists call cross-reactivity. "With some foods, an allergy to one food or substance may render sensitivity to other foods or substances in the same classification," says Clifford Basset, M.D., of Allergy and Asthma Care of New York. Histamine-rich red wine, therefore, might make some peoples' seasonal allergies worse. "If you have seasonal allergies, avoiding red wine might be a good idea," says Seif Shaheen, M.D., Ph.D, of King's College, London.
Wheat and Gluten in Beer and Wine: Cause for Concern?
For the estimated 3 million Americans with celiac disease, beer must be avoided to keep their health in check. "The problem in beer," says USDA representative Don Kasarda, "is the presence of peptides from wheat, rye or barley." Beer is usually made with barley, yeast, and hops. However, beers made with millet, oats, sorghum and other alternative grains are generally gluten free. Hops, a flower, does not contain gluten.
The answer for celiacs is to look for a beer made with alternative grains. The 0.1 percent of Americans with allergies to wheat alone can drink most beers, since barley, not wheat, is usually the main ingredient. Specialty wheat beers, such as Hefeweizen or Weissbier, are exceptions.
Wine can also present an issue for those with wheat or gluten sensitivities. A paste of flour and water is often used to seal new oak barrels. Barrels are hosed out before filling, but some people claim that traces of hardened flour remain, contaminating the wine. Contact the manufacturer to ascertain whether glutinous barrels are used when making the beer you drink.
Fining Agents: More Hidden Allergens in Your Beer and Wine
A fining agent is a substance mixed into wine or beer during production, then removed by filtration or sedimentation. Three potentially allergenic fining agents are egg whites, casein, and isinglass, a fish derivative.
Egg whites are added to wine as a binding agent for tannins. They latch onto tannins and then settle at the bottom of the barrel, removing harsh taste from the wine while maintaining its color. Milk-derived casein is a protein used to clear up discoloration in white wines. Isinglass, a substance made from the swim bladders of sturgeon fish, is also used as a fining agent in both beers and wines.
Each of these substances can potentially unleash severe allergies. People with egg allergies might react with asthma, hives and even anaphylactic shock. Parvalbumin, the main allergen found in scaled fish, can cause anaphylaxis to those sensitive to fish.
Casein, a common allergen found in milk products, sets off headaches, runny nose and gastric distress.
Wine and beer producers claim that allergen levels are too low to cause reactions. They state that fining agents are removed almost entirely by gravity and filtration after use. "One could say the egg whites cleaned the wine and disappeared," says D. Mic, a representative for The Organic Wine Company.
Studies have shown that allergen levels from fining agents are extremely low. One European Safety Authority study estimated the maximum amount of parvalbumin found in beer to be roughly 0.005 micrograms per liter. The levels in other processed foods tend to be as high as 0.006 ounces per pound of food. Two additional studies confirmed that 21 people with known fish allergies were able to drink isinglass-fined beer without problems. A 2006 Nutrition study concluded that wines fined with casein, egg whites or isinglass neither activated the immune system nor induced anaphylaxis in sensitive subjects.
If you find fining agents still aren't worth the risk, look for names like albumin and caseinate on the label of your libation and steer clear. Some, but not all, unfined wines either state "unfined" or list ingredients on the label. The best way to know for sure is to contact the manufacturer.
Yeast, Pesticides, and More Hidden Ingredients in Beer and Wine
Yeast, a fungus, ferments the sugars in beer and wine, turning them into alcohol and carbon dioxide. There's no such thing as yeast-free beer or wine, although one beer, Sapporo, claims it comes close. If you suffer from candidasis, colitis or Crohn's disease, experts recommend staying away from beer and wine entirely.
Corn, another common cause of migraines, is sometimes added to beer to increase its alcohol content. Allergic symptoms might include headache, swelling of the face, stomach upset and, in serious cases, anaphylaxis. Corn is more prevalent in low-cost or homebrewed beers, especially those with high alcohol content.
Ethanol itself can be an allergen to some people or make people more sensitive to other allergens. BHA, a preservative added to conventional beers, has been shown to trigger hives.
Pesticides in conventional grapes are also an issue. Winemakers generally don't wash grapes before pulping them, so any of the 13 different kinds of pesticides found on the average grape might end up inside your wine glass.
Wines can be chock-full of allergens, from unwashed grapes to tannins to added sulfites. Organic and biodynamic ("green") wines are grown without pesticides or artificial additives, making them safer, if not allergen free. Fining agents and sulfites, however, are still added to green wines.
"We do use egg whites and the wines are likely to have glutinous materials in the barrels," says Benziger's Gatens. The real difference lies in the farming. By using composting and soil rotation in place of pesticides, green growers avoid use of synthetic chemicals, reducing the list of variables for allergy sufferers.
Still, the days of trial and error are far from over. Rini Twait's case is typical. Twait, 60, always felt sick after she drank a glass of wine. She figured out on her own how much to drink. "A few sips seems to be okay but a full glass is strictly off-limits."
To mitigate the challenging process of figuring out what triggers your symptoms, find out in advance the ingredients in your beer or wine. Then visit your allergist for a skin test involving those ingredients. If everything comes out negative, your allergist can help steer you in the right direction in terms of what to try drinking next.
Allergen-free Beer and Wine
Fortunately, there is a bright side. The more than 12 million Americans suffering from food allergies are demanding wines and beers that they can drink safely. California, the nation's biggest producer of organic wines, increased its sustainable practices by 24 percent between 2004 and 2006, raising the number of low-sulfite, pesticide-free wines on the shelves. Bard's Tale, a gluten-free beer brewed in New York, just added three more states to its distribution area, an increasingly common move for the growing list of gluten-free beer producers.
As more consumers become aware of their options, those options, in turn, will increase, promising a future where more libations can be savored the way they were meant to be—slowly, deliciously and sans headaches or allergic reactions.