Mild allergy symptoms with margarita, mixed drinks, champagne

Treatment of alcohol based mild reactions like what your patient is experiencing is consistent with a histaminic mechanism and I would treat it with H1 antihistamines, and although there is not data in the literature on efficacy, H2 antihistamines like famotidine are appropriate if necessary. Since these reactions are due to histamine release, mast cell stabilizers have also been proposed as treatment, although studies are lacking. (1,2) If reflux symptoms occur, evaluation would be appropriate by a gastroenterologist or ENT.

Alcoholic drinks are capable of triggering a wide range of allergic and allergic-like responses, including rhinitis, itching, facial swelling, headache, cough and asthma. Limited epidemiological data suggests that many individuals are affected and that sensitivities occur to a variety of drinks, including wine, beer and spirits. Sensitivity to ethanol itself can play a role in triggering adverse responses, particularly in people of Asian decent, which is due mainly to a reduced capacity to metabolize acetaldehyde. In people of Caucasian background, specific non-alcohol components are the main cause of sensitivities to alcoholic drinks. (1)

Beer contains less alcohol, 5-6% Alcohol by volume (ABV), a measure of how much alcohol is in a given volume, than wine (12%), champagne (12%) or margaritas (33%). (3-5) Sensitivities to wine appear to be due mainly to pharmacological intolerances to specific components, such as biogenic amines and the sulphite additives. Histamine in wine has been associated with the triggering of a wide spectrum of adverse allergy to grains and yeast have been suggested as a cause of sensitivity to beer. A study of a histamine free diet was performed where fish, cheese, hard cured sausages, pickled cabbage and alcoholic beverages had to be avoided. In 45 intolerant adults after 4 weeks on the diet 33/45 patients improved considerably (P < 0.01), and eight of them had total remission. The authors hypothesized a deficiency of diamine oxidase in patients. (6) Diamine oxidase (DAO) is the main enzyme for the metabolism of ingested histamine. It has been proposed that DAO, when functioning as a secretory protein, may be responsible for scavenging extracellular histamine after mediator release. (7)

References
1. Vally H, Thompson PJ. Allergic and asthmatic reactions to alcoholic drinks. Addict Biol. 2003 Mar;8(1):3-11. doi: 10.1080/1355621031000069828. PMID: 12745410.
2. https://my.clevelandclinic.org/health/diseases/histamine-intolerance, Accessed December 5, 2024
3. https://www.drinksurely.com/a/blog/champagne-alcohol-content#:~:text=without%20the%20buzz?-,Alcohol%20Percentage%20of%20Champagne,the%20resulting%20bottle%20of%20wine, Accessed December 5, 2024
4. https://www.medicalnewstoday.com/articles/how-much-alcohol-is-in-beer#:~:text=Alcohol%20content%2C%20or%20alcohol%20by,specific%20beer%20on%20their%20body., Accessed December 5, 2024
5. https://www.pennsylvania-dui-lawyer.com/blog/alcohol-content-different-drinks/#:~:text=How%20Much%20Alcohol%20is%20in%20a%20Margarita?,margaritas%20have%20about%2033%25%20ABV., Accessed December 5, 2024
6. Wantke F, Götz M, Jarisch R. Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy. 1993 Dec;23(12):982-5. doi: 10.1111/j.1365-2222.1993.tb00287.x. PMID: 10779289.
7. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007 May;85(5):1185-96. doi: 10.1093/ajcn/85.5.1185. PMID: 17490952.

Carla M. Davis, MD, FAAAAI