Alcohol & Allergies: Is it the Wine or is it a Sulphite Sensitivity?

A glass of wine that leaves you flushed, congested, or reaching for painkillers the next morning is easy to write off as a hangover. But for some people, the symptoms that follow a drink may point to something more specific — a sulphite sensitivity, an intolerance to histamine, or, less commonly, a genuine IgE-mediated allergy to an ingredient in the drink itself.

This article explains the difference between a true alcohol allergy, sulphite sensitivity, and other common reasons why alcoholic drinks may cause symptoms. It is written for UK readers and draws on guidance from the NHS, Allergy UK, BSACI, and the Food Standards Agency. It is not a substitute for medical advice. If you have ever experienced difficulty breathing, throat swelling, or collapse after drinking alcohol, treat this as a medical emergency and call 999.

Why Alcohol Can Trigger Symptoms Even Without a ‘True’ Allergy

Most people who feel unwell after drinking do not have a classical IgE-mediated allergy. Instead, several overlapping mechanisms may be at work:

• Histamine content. Alcoholic drinks — particularly red wine, champagne, and certain beers — naturally contain histamine, a chemical also produced by the body during allergic reactions. When histamine from food or drink adds to the body's own baseline level, some people may experience flushing, headache, nasal congestion, or gastrointestinal discomfort. The NHS notes that histamine is one of the chemicals responsible for many common allergy symptoms (NHS, 2023).
• Vasoactive effects of ethanol. Alcohol is a vasodilator. It widens blood vessels, which can cause facial flushing and nasal congestion regardless of whether an allergy or sensitivity is present. This effect is more pronounced in people with certain genetic enzyme variants, particularly aldehyde dehydrogenase deficiency, which is more common in people of East Asian heritage.
• Additives and preservatives. Sulphites, fining agents (such as egg white, casein, or isinglass), and artificial colourings may all contribute to adverse reactions. These additives are not always obvious to the consumer.
• Co-factors. Exercise, stress, non-steroidal anti-inflammatory drugs (NSAIDs), and concurrent food allergen exposure may lower the threshold at which a reaction occurs. This means that a drink tolerated on one occasion may provoke symptoms on another.

Understanding that alcohol-related symptoms have multiple possible causes is the first step toward working out which mechanism may be relevant in your case.

Sulphite Sensitivity vs IgE Allergy: What Is the Difference?

Sulphites — technically sulphur dioxide (SO₂) and its related compounds (E220–E228) — are among the most widely used preservatives in the food and drink industry. They help prevent oxidation and inhibit microbial growth, which is why they have been used in winemaking for centuries.

What Is Sulphite Sensitivity?

Sulphite sensitivity describes an adverse reaction to sulphite preservatives. It is not, in most cases, driven by the IgE antibody pathway that defines classical allergy. The precise mechanism is not fully understood, but it is thought to involve irritant effects on the airways and, in some cases, changes in leukotriene metabolism.

The link between sulphites and asthma is well documented. According to BSACI guidance and Allergy UK factsheets, sulphite sensitivity is estimated to affect around 3–10% of people with asthma, and it is particularly associated with poorly controlled or severe asthma. Symptoms may include wheezing, chest tightness, cough, and nasal congestion. In rare cases, more severe bronchoconstriction can occur.

How Does This Differ from a True IgE Allergy?

A true IgE-mediated allergy involves the immune system producing specific IgE antibodies against a particular protein — for example, a protein found in grapes, barley, or yeast. When that protein is encountered again, the IgE antibodies trigger mast cells to release histamine and other inflammatory mediators, causing symptoms that can range from mild (hives, lip tingling) to severe (anaphylaxis).

Because sulphites are small chemical compounds rather than proteins, they do not typically trigger a classical IgE response. This distinction matters for testing: standard specific IgE blood tests are designed to detect protein-specific antibodies and are unlikely to identify sulphite sensitivity directly. However, they can be valuable for ruling in or out sensitisation to protein-based ingredients in alcoholic drinks.

Wine, Beer, Spirits: What Differs?

Not all alcoholic drinks are equal when it comes to triggering symptoms. The type and concentration of potential irritants vary considerably across categories.

Wine

Wine — especially red wine — is the drink most commonly associated with adverse reactions beyond simple intoxication. Red wine tends to contain higher levels of histamine than white wine because of differences in the fermentation process (specifically, the extended contact with grape skins and the malolactic fermentation step). Red wine also contains tyramine and other biogenic amines that may contribute to wine headache in susceptible individuals.

White wine and rosé often contain higher concentrations of sulphite preservatives than red wine, because sulphites are added in greater quantities to lighter wines to prevent discolouration and spoilage. This means that someone with sulphite sensitivity may paradoxically tolerate red wine better than white.

Fining agents used during wine production — such as egg white (albumin), casein (from milk), or isinglass (from fish swim bladders) — are generally removed before bottling. However, trace amounts may remain, and this can be relevant for individuals with a confirmed IgE allergy to egg, milk, or fish proteins. Under UK and EU regulations, wines that use certain allergenic fining agents must declare this on the label (Food Standards Agency).

Beer and Cider

Beer is brewed from cereal grains — most commonly barley, but sometimes wheat or rye. A person with a specific IgE sensitisation to barley or wheat proteins may experience alcohol allergy symptoms specifically from beer but not from wine or spirits. Yeast is another component of beer that can occasionally be implicated.

Cider, made from fermented apples, may be relevant for individuals with known sensitisation to apple proteins, although fermentation and processing typically reduce allergenic protein content.

Spirits

Distilled spirits (vodka, gin, whisky, rum) generally contain fewer allergenic proteins than wine or beer because the distillation process removes most large molecules. However, some spirits include added flavourings, botanicals, or colourings that may cause reactions in sensitive individuals. Whisky is grain-based (barley, corn, rye), but the distillation process means that residual protein levels are usually very low.

Congeners — chemical by-products of fermentation — are found in higher concentrations in darker spirits (bourbon, brandy, dark rum) than in lighter ones (vodka, white rum). Congeners are associated with worse hangovers but are not typically linked to allergic mechanisms.

Symptoms: Flushing, Wheeze, Hives, and Migraine-like Headaches

Alcohol allergy symptoms and intolerance symptoms can overlap significantly, making it difficult to identify the cause without professional input. Common symptoms reported after drinking include:

• Facial flushing or redness
• Nasal congestion or a runny nose (congestion after drinking)
• Headache or migraine-like pain — especially with red wine
• Itchy skin, hives, or worsening of eczema
• Nausea, abdominal pain, or diarrhoea
• Wheezing or chest tightness, particularly in people with asthma

Many of these symptoms can also be caused by the pharmacological effects of alcohol itself or by histamine in the drink, rather than by a true allergy. The pattern of symptoms — which drinks trigger them, how quickly they appear, and whether they respond to antihistamines — can help distinguish between mechanisms.

Testing: What IgE Blood Tests Can Help With (and What They Cannot)

When symptoms suggest a possible allergy to an ingredient in an alcoholic drink, specific IgE blood testing can provide useful clinical information. However, it is important to understand both the strengths and limitations of this type of testing.

What Testing Can Show

• Sensitisation to specific proteins. If you suspect that a particular ingredient — such as grape, barley, wheat, yeast, or egg white (a common fining agent) — is responsible for your symptoms, a specific IgE blood test can measure whether your immune system has produced IgE antibodies against that protein. A raised level indicates sensitisation.
• Component-level testing. In selected cases, component testing (which identifies IgE against specific protein fractions within an allergen source) may help clarify the picture — for example, distinguishing between a primary wheat allergy and cross-reactive sensitisation from grass pollen.
• Ruling out. A negative specific IgE result for a suspected ingredient makes a true IgE-mediated allergy to that protein less likely, which can help narrow down the cause of symptoms.

What Testing Cannot Show

• Sulphite sensitivity. Because sulphite reactions are generally not IgE-mediated, standard IgE blood tests will not detect sulphite sensitivity. Diagnosis typically relies on clinical history and, in some specialist centres, a supervised challenge.
• Histamine intolerance. Histamine intolerance — where the body struggles to break down histamine from foods and drinks — is not an IgE-mediated process and will not be detected by standard allergy blood tests. Learn more about histamine in our guide on how to clear histamine from the body.
• Enzyme deficiency. Conditions such as aldehyde dehydrogenase deficiency, which causes alcohol flush reaction, are metabolic rather than immune-mediated and are not assessed through IgE testing.
• Clinical allergy confirmation. A positive IgE result indicates sensitisation, not necessarily a confirmed clinical allergy. Whether a sensitisation is clinically relevant depends on the individual's symptom history. Results should always be interpreted by a qualified clinician — such as a GP, allergist, or immunologist — in the context of the patient's history.

A Safer Approach to ‘Figuring It Out’

It can be tempting to experiment with different drinks to identify what you do and do not tolerate. While this may be reasonable for mild symptoms such as a slight flush or headache, it is important to approach this carefully.

Do Not Self-Challenge After a Severe Reaction

If you have ever experienced breathing difficulty, significant swelling, a drop in blood pressure, or any symptoms suggestive of anaphylaxis after consuming an alcoholic drink, you should not re-expose yourself to the same drink without specialist guidance. The NHS advises that re-exposure after a severe allergic reaction can carry significant risk and should be managed under medical supervision.

Keep a Drink and Symptom Log

A structured diary can be remarkably useful. Record:

• The type of drink (brand, grape variety, brewing method if known)
• The amount consumed
• Any food eaten at the same time
• Symptoms experienced, including timing and severity
• Any medications taken that day (including antihistamines or NSAIDs)
• Activity level — for example, whether you had exercised that day

Over time, this log may reveal patterns that help you and your clinician narrow down the most likely mechanism.

Discuss with a Clinician

If your symptoms are recurrent, worsening, or have ever been severe, a conversation with your GP or an allergy specialist is worthwhile. They can review your history, request appropriate tests, and advise on whether any avoidance measures are needed. Allergy UK and BSACI provide patient resources that can help you prepare for this discussion.

Questions to Ask After You Receive Your Report

If you have had an allergy blood test, the laboratory report will show your specific IgE levels for each allergen tested. Understanding what those numbers mean in the context of your symptoms is essential. Here are some questions you may wish to discuss with your GP or specialist:

• Which of my specific IgE results are clinically significant given my history?
• Could any of my positive results be due to cross-reactivity rather than a true allergy?
• Should I avoid the implicated ingredient entirely, or is the risk level-dependent?
• Do I need a supervised challenge test to clarify whether I am truly allergic?
• Are my symptoms more consistent with sulphite sensitivity or histamine intolerance than an IgE allergy?
• Do I need to carry an adrenaline auto-injector?
• Should I be referred to a specialist allergy service?

Frequently Asked Questions

Can you be truly allergic to alcohol itself?

True allergy to ethanol (alcohol) is extremely rare. Most adverse reactions to alcoholic drinks are caused by other ingredients — such as grapes, barley, yeast, hops, or additives like sulphites — rather than the alcohol molecule itself. Some people also lack the enzymes needed to metabolise alcohol efficiently, which can cause flushing and nausea.

What is sulphite sensitivity?

Sulphite sensitivity is an adverse reaction to sulphur dioxide and related preservatives in alcohol and food (E220–E228). It is more common in people with asthma and may cause wheezing, chest tightness, or nasal congestion. It is generally not IgE-mediated and is considered an intolerance rather than a classic allergy.

Why does red wine give me a headache but white wine does not?

Red wine typically contains higher levels of histamine and other biogenic amines than white wine due to differences in fermentation. Some individuals may be less efficient at breaking down histamine, which can contribute to wine headache, flushing, and nasal congestion. However, the exact mechanism is still debated in the medical literature.

Can an allergy blood test tell me if I am allergic to wine?

There is no single IgE test for "wine" as a whole. However, specific IgE blood tests can assess sensitisation to individual ingredients found in alcoholic drinks — such as grape, barley, wheat, yeast, or egg white (sometimes used as a fining agent). A positive result indicates sensitisation, not necessarily clinical allergy, and should be interpreted alongside your symptom history by a qualified clinician.

Is congestion after drinking alcohol normal?

Mild congestion after drinking is relatively common and may be related to the vasodilatory effects of alcohol, histamine content, or sulphite sensitivity. However, if congestion is persistent, severe, or accompanied by wheezing or facial swelling, it may warrant further assessment.

Should I avoid all alcohol if I react to one type of drink?

Not necessarily. Different alcoholic drinks contain different ingredients, preservatives, and levels of histamine. Someone who reacts to red wine may tolerate clear spirits, for example. However, you should never self-challenge with a drink that has previously caused a severe reaction. A clinician can help you determine what may be safe based on your history and any test results.

Are sulphites only found in wine?

No. Sulphites are used as preservatives in alcohol and a wide range of foods, including dried fruits, fruit juices, pickled foods, and some processed meats. In the UK, any product containing sulphites at levels above 10 mg/kg or 10 mg/L must declare this on the label under allergen regulations enforced by the Food Standards Agency.

What is the difference between alcohol allergy and alcohol intolerance?

Alcohol allergy typically refers to an IgE-mediated immune response to a specific ingredient in an alcoholic drink (e.g., grapes, wheat, barley). Alcohol intolerance usually describes a metabolic issue — often an enzyme deficiency — that makes it harder for the body to process ethanol. The alcohol allergy symptoms can overlap with intolerance symptoms, but the mechanisms are different.

Can I get tested for sulphite sensitivity through a blood test?

Sulphite sensitivity is generally not IgE-mediated, which means standard specific IgE blood tests are unlikely to detect it. Diagnosis usually relies on clinical history and, in some specialist centres, a supervised challenge test. However, IgE testing may still be useful to rule out allergy to specific ingredients in alcoholic drinks, such as grape, wheat, or yeast.

When should I call 999 after drinking alcohol?

Call 999 immediately if you experience difficulty breathing, throat tightness or swelling, a rapid or weak pulse, widespread hives with dizziness, collapse, or any signs of anaphylaxis after consuming alcohol. These symptoms require emergency treatment and should never be managed at home.

Considering an Allergy Blood Test?

If you experience recurring symptoms after drinking and would like to explore whether a specific ingredient allergy may be involved, IgE blood testing can help assess sensitisation to proteins found in alcoholic drinks — such as grape, barley, wheat, yeast, or egg white. At Allergy Clinic, we offer nurse-led venepuncture and laboratory-analysed specific IgE testing for individual allergens and multi-allergen panels.

Please note that IgE tests are not designed to detect sulphite sensitivity or enzyme-based alcohol intolerance, which are assessed through different clinical pathways. Our service provides a diagnostic blood sample and a detailed laboratory report. We recommend taking your results to your GP, allergist, or immunologist for clinical interpretation and personalised guidance.

View available allergy tests and book an appointment →

Sources

• NHS — Allergies overview, Anaphylaxis, Alcohol misuse. Available at: nhs.uk/conditions/allergies
• Allergy UK — Factsheets on food allergy, sulphite sensitivity, and histamine. Available at: allergyuk.org
• British Society for Allergy and Clinical Immunology (BSACI) — Patient resources and clinical guidelines on food allergy and drug allergy. Available at: bsaci.org
• Food Standards Agency — Allergen labelling guidance and regulations on sulphite declaration. Available at: food.gov.uk
• Anaphylaxis UK — Guidance on recognising and managing anaphylaxis. Available at: anaphylaxis.org.uk
• NICE — Clinical Knowledge Summaries on anaphylaxis and urticaria. Available at: nice.org.uk