Every now and then I see a patient who is concerned about alcohol allergy. To an Allergist, an “allergy” means that you have specific allergic antibodies or “IgE” to something like peanut, cat or penicillin. True IgE-mediated allergy to alcohol is rare but alcohol intolerance is quite common. Alcohol acts as a vasodilator or a substance that causes the blood vessels in your skin and nasal passages to open up. This causes facial flushing and sometimes even itching or heat as well as nasal congestion. For patients with rosacea this effect on the skin can be very brisk and alarming which mimics an allergic reaction but is not associated with the other signs and symptoms of anaphylaxis (hives, angioedema, bronchospasm, hypotension). Some patients are sensitive to certain kinds of alcohols and can develop GI symptoms (nausea, vomiting, diarrhea) or headaches even if they have not had a significant amount of alcohol. While intolerances to alcohol are not well understood biochemically, there are some common patterns I’ve found over the years such as patients with migraines being sensitive to sulfites in wine or just wine in general. I have a single patient in my 12 years of practicing Allergy/Immunology who had an acute allergic reaction to alcohol that was reproduced during a controlled challenge in the office requiring Epinephrine to reverse. As usual, when in doubt, see a Board-Certified Allergist to get the right diagnosis.
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