Many patients experience acute reactions after drinking beverages containing alcohol. In my own experience, the most frequently described adverse effects of alcohol can be attributed to alcohol intolerance, with exaggeration of the expected physical effects. The symptoms of alcohol intolerance may include headache, rapid heartbeat, nausea, vomiting, heartburn, abdominal pain, nasal congestion, and flushing. These last two symptoms, nasal congestion and flushing, are almost universally due to the vasodilating effects of alcohol in the nasal mucous membrane and skin. A higher-than-expected percentage of people of Asian descent appear to be more susceptible to this flushing effect, and it is believed to be caused by an inability to metabolize alcohol completely. As this syndrome does not represent an IgE-mediated allergic reaction, there is no diagnostic test, such as a skin or blood test, that can be performed for confirming this disorder.
Occasionally, people will experience systemic reactions with hives, wheezing, and/or throat swelling. In these cases, the most likely explanation would be intolerance of sulfites, which are usually found in white wine. Less commonly, allergy to other ingredients, such as grapes in wine, grains in beers (such as hops, barley, rye, corn, or wheat), and yeast, may be present. In cases of possible allergy to a component in the alcoholic beverage, an allergy skin or blood test can be performed. A last possible explanation for some of these symptoms, particularly flushing and headache, is histamine in red wine. While there is a variable amount of histamine in red wine, it is debatable whether this chemical is the cause of these symptoms. Irrespective of which type of alcohol is consumed or which mechanism is at play, the only reliable solution to all of these problems is to avoid alcohol.