Alcohol use is widespread and can result in adverse reactions, alcohol allergy is commonly reported in patients.
The prevalence is unknown, but some studies have showed adverse reactions, alcohol intolerance or alcohol allergy in up to 7% of the population.
Flushing after ingestion can commonly occur and it is potentiated by certain medications. In patients with rosacea, ingestion can worsen the condition. Alcohol dehydrogenase deficiency (ALDH) occurs in persons of Asian descent and its due to an alteration of a protein.
Hives can be worsened by alcohol, and it is a trigger in some patients.
Asthmatic exacerbations have been reported as well in select populations.
The most severe scenario, is anaphylaxis which affects multiple organ systems.
Reactions to beer range from isolated hives to anaphylaxis. Reactions can be due to grains that are formed after fermentation. There are no cases showing hops as a causative agent. Isolated reactions can be due to prior sensitization to grains, yeasts or molds.
Wine production starts with the harvest of grapes. Tannins are molecules in grape skins and stems involved in the aging process. Potential triggers in wine can be ethanol and metabolite reactions, contaminants, sulfites and clarifying agents. Contaminants have been show to have bee venom in some products.
Histamine and tyramine are found in food and can be produced by fermentation.
Additives in wine are commonly used to preserve the products. Sulfur dioxide is an antioxidant and prevents bacteria overgrowth. Other studies have shown prostaglandins and leukotrienes.
Grape is a very rare cause of reactions to wines.
Spirits are produced by distillation, reactions have ranged from hives to anaphylaxis.
The primary treatment for alcohol reactions or alcohol allergy is avoidance. Medicines for the prevention of reactions have been unsuccessful to date. Antihistamines are effective for prophylaxis of urticaria and alcohol dehydrogenase deficiency related bronchoconstriction.
Epinephrine is the treatment of choice for anaphylaxis.
Conclusion: Adverse reactions can present in different ways and many causes exist. Evaluation requires a detailed history, exam, lab work and possible oral challenges.