Allergy. A small number of people are allergic to pure ethanol, but the bigger culprits behind true allergic responses are base ingredients, including barley, hops, yeast and grapes. Agents that are derived from foods such as egg and seafood are often used to clarify wine, but in such minuscule quantities that many question whether they pose a serious risk. Symptoms of true allergic reactions can include congestion, runny nose, swelling, hives, asthma, and in rare cases, anaphylaxis.

Allergy-like reactions. A person who reacts to alcohol may have classic allergy symptoms, but it may not be a “true” allergy. For example, reactions to sulfites in wine are not considered true allergic responses because the underlying physiological mechanism is different – and yet the sulfite-sensitive may experience asthma and even anaphylaxis. Glycoproteins are suspected of producing either allergy or allergy-like reactions.

Intolerance. Substances commonly found in wine including histamine (more often in reds than whites) can lead to sneezing, flushing, headache, diarrhea, skin itch and shortness of breath. Other amines such as tyramine and tryptamine, may play a role in alcohol intolerance; and salicylate, a chemical found in grapes, yeast, wine, beer and many foods, can lead to hives and eczema.

Asian Flush. Many people of Asian descent experience flushing, rapid heart rate, and reduced blood pressure because of a genetic incapacity to properly metabolizing alcohol. So-called “Asian Flush” is thought to be caused by the deficiency of enzymes called aldehyde dehydrogenases (ALDH).

Migraine. Red and white wines have been implicated in these headaches.

Sources: The Auckland Allergy Clinic and The Australasian Society of Clinical Immunology and Allergy.

See: Scientist Discovers Big Clue in Wine Reactions

First published in Allergic Living magazine.
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© Copyright AGW Publishing Inc.

Reprinted from Allergic Living magazine, 2011

The baseball game hadn’t even started when Kishari Sing began to feel that something was seriously wrong. She knew that, like her father, she reacted badly to alcohol; even a small taste of Irish Cream in high school had made her wheeze. Still, in the parking lot outside the San Diego stadium, her college friends tried to convince Sing that she could build up a tolerance to alcohol, and specifically to their drink of choice – a cheap boxed rosé. She drank one glass and remembers little after that.

“It completely whacked me out. I was sick the entire time,” recounts Sing, now a marketing executive in Los Angeles with a well-known blog called The Food Allergy Queen.

“There’s a picture of me at the game, and there’s this row of fraternity guys cheering – but I’m all red and puffy and trying to sleep on someone’s shoulder. I was completely incapacitated.”

Fortunately, the reaction to the cheap vino didn’t progress any further – but it was serious enough to keep Sing away from wine for good. “It made me so ill,” she says. “So it really wasn’t worth it.”

Sing is not alone. In fact, roughly 8 percent of people worldwide suffer from allergic-type responses to wine, and even relatively small amounts of the age-old drink can lead to symptoms including redness, itching, swelling, runny nose, headaches and asthma flare-ups.

Some people have true allergic reactions to wine ingredients – in rare cases to the point of anaphylactic shock.

But a new study out of Denmark may be the first step in turning those avoiders into connoisseurs who can sip hardy cabernets and oaky chardonnays with impunity. Until now, sulfites – which are used as a preservative in many wines and also can occur naturally  – have borne the brunt of the blame for the allergy-related reactions.

Yet only a fraction of people who are sensitive to wine are sensitive to the common preservative. Yeast, tannins and grapes in the vintages are also known to set off allergy symptoms, while histamines and salicylates are linked to intolerance.

Next: A surprising new allergy culprit

“With the constantly increasing use of spices in the American diet and a variety of cosmetics, we anticipate more and more Americans will develop this allergy,” says Bahna, who is chief of allergy and immunology at Louisiana State University.

Due to the wide use of spice in makeups, lotions and fragrances, Bahna says that women are more likely to develop spice allergy.

Spice allergy has no treatment except for avoidance, which is challenging. In the U.S., food manufacturers are allowed to use a category term in their ingredients list if the item takes up less than 2 percent of the product’s total weight and is not one of the top food allergens. Because of this, manufacturers tend to simply use the word ‘spices’, without any explanation of which spices are used or how much of each is used.

Bahna told Allergic Living that companies should be required to list all ingredients used (with quantities), but he says there is resistance from the food industry.

Adding to the difficulty of avoidance, spices such as curry are actually blends of several spices – and the ingredients in these blends can vary. As Bahna notes: “The name of a spice may mean more than one thing.”

Spice allergy is also difficult to diagnose. There are no tests designed for spice allergy and “when a patient gets symptoms after eating a certain meal, we don’t suspect the spice,” he says.

Bahna says it is important to spread awareness of spice allergy both to the food industry to change current labeling practices, and to the medical community in order to develop testing and treatment options. “Most allergists test for 20 to 40 foods, but there are hundreds of spices,” says Bahna. “The difficulty in identifying spice allergies is remarkable.”

Allergen

Where It Hides

Alternate Names

Other Foods

• alcohol
• artificial flavorings and sweeteners (like aspartame and xylitol)
• baking powder
• confectioner’s sugar (corn starch)
• margarine
• Olestra/Olean cooking oil

• acetic acid
• citric acid
• alpha tocopherol
• ascorbates
• ascorbic acid
• dextrose (also found in IV solutions in hospitals)
• fumaric acid
• gluconate
• glucose
• glycerol
• xantham gum
• MSG
• Saccharin
• maltodextrin
• maize (this is another name for corn)

• broth/bouillon
• sauces
• products containing meat flavoring
• imitation meat products
• soups
• tomato sauces

• soup mixes
• prepared soups
• dips
• chips
• crackers
• sauces
• prepared meat products like sausages
• spice mixes

• most likely these will be hidden under “spices” or “flavoring”

• juices
• syrups
• spirits
• fruit shakes
• fruit cocktails
• mixed dried fruits
• ice cream
• yogurt
• pudding
• breakfast flakes
• energy bars
• flavoring powders or essences
• fruit sauces
• candy

• Chinese gooseberry

Sources:
-ImmunoCAP
-Canadian Food Inspection Agency

Allergen

Where It Hides

Alternate Names

• alcoholic and non-alcoholic beer and cider
• vinegar and wine vinegar
• wine
• baked goods with dried fruits
• bottled lemon/lime juices
• canned/frozen fruits, vegetables
• cereal, cornmeal, cornstarch, crackers
• condiments: horseradish, ketchup, mustard, pickles, relish and sauerkraut
• dehydrated potatoes, and frozen French fries
• dried fruits and vegetables, e.g. apricots, raisins, sweet potato
• dried herbs, spices
• deli meats, hot dogs and sausages
• dressings, sauces, soups
• fresh grapes
• fruit syrups, gelatin, jams, jellies, preserves, molasses and pectin
• fruit and vegetable juices
• starches, (e.g. corn starch, potato starch)
• sugar syrups: glucose, syrup dextrose, corn syrup, table syrup
• tomato pastes, purées
• fish, crustaceans and shellfish
• granola bars, especially with dried fruit
• Noodle and rice mixes
• Snack foods
• Soy products

• E 220, E 221, E 222, E 223, E 224, E 225, E 226, E 227, E 228 (European designations)
• potassium bisulphite or metabisulphite
• sodium bisulphite
• dithionite
• sulfite or sufites
• sulphur dioxide
• sulphiting agents
• sulphurous acid

Sources:
-ImmunoCAP
-Canadian Food Inspection Agency

Reading labels is a way of life when you or a member of your family has an allergy to sulphites, the food additive. Before eating anything in a package, be sure to read the label carefully. Look for hidden sources of sulphites and alternate names for it.

If you are ever uncertain about whether a food product is safe for you, call the manufacturer to confirm. When in doubt, don’t eat it.

In Canada, new regulations have been proposed that would require food manufacturers disclose if sulphites are present in a product at a level of 10 parts per million or higher.

More on Canada’s New Food Allergen Regulations.

In the United States, the Food Allergen Labeling and Consumer Protection Act went into effect in 2006. FALCPA requires manufacturers to use plain language when listing priority allergens, and to declare all allergens either in the ingredient list, or in a “Contains:” statement at the end of the list.

The new regulations also apply to food allergies, and require that allergens are declared in plain language, and are disclosed when they are components of other ingredients (i.e. mustard as a component of “spices.”

More on Canada’s Food Allergen Regulations

In the United States, the Food Allergen Labeling and Consumer Protection Act, which went into effect in 2006, requires manufacturers to use plain language when listing priority allergens, and to declare all allergens either in the ingredient list, or in a “Contains:” statement at the end of the list.

The allergens included in this regulation are milk, eggs, fish, shellfish, tree nuts, wheat peanuts and soybeans. These regulations do not include sesame and mustard, unlike the proposed Canadian regulations.

Separate legislation requires companies to declare sulphites if they are present at more than 10 parts per million, or if they had a technical or functional effect in the food.

You’re sitting there eating and all of a sudden, your lips (or tongue and palate) begin to swell.

There might tingle or itch at the back of your throat, or you might start to sneeze, have the urge to blow your nose or rub your eyes because of tearing.

While that is usually the end of it, symptoms do cover the spectrum, from what looks like a fat lip all the way to vomiting, diarrhea and, on rare occasions, anaphylactic shock.

Who’s at Risk?

Those who have allergies to pollen from trees (such as birch and alder), and/or  ragweed and grass pollen.

In Europe and Asia, those allergic to mugwort pollen, also commonly get symptoms to certain fruits, vegetables, spices and seeds.

See Also: Chart on Cross Reactors

Roughly one-third of North Americans with pollen-related allergies are thought to be affected. It’s not clear why the other two-thirds of hay fever sufferers are not similarly affected.

Managing the Condition

Unlike pollen-related hay fever, OAS does not go away because the offending allergens – stress-related proteins that begin to build up as soon as the food is harvested – continue to multiply.

To avoid or mitigate its effects, doctors recommend you manage your hay fever symptoms through antihistamines, an intranasal steroid or seasonal allergy shots.

Do Not: Eat any of the fruits or vegetables on your list of offenders in their raw form. Bake them, broil them or even microwave them for one minute at between 80 to 90 degrees Celsius. Make a pie or make preserves.

Do: Try peeling fruit because scientists say the allergens tend to concentrate in the skin. Others slice fruit and leave it exposed for half an hour before eating it.

Do Not: avoid all foods on the lists, only the ones you have reactions to.

Be aware: You may increase the severity of an OAS reaction by drinking alcohol or exercising after consuming an allergenic food.

More serious cases
In more severe OAS cases, a regimen of year-round allergy shots can help, allergists suggest carrying an epinephrine auto-injector (the brands are EpiPen or Twinject). Consult your doctor for more information on your own case.

A less severe form of food allergy, called oral allergy syndrome, is a reaction to proteins in common raw fruits, vegetables, nuts and seeds. It’s called “oral allergy” syndrome or OAS because its symptoms are usually limited to the lips, mouth, tongue and throat.

Estimated to affect about one-third of pollen allergy sufferers*, oral allergy sydrome (sometimes called pollen allergy syndrome) is more widespread than the higher profile – and more dangerous – allergies to peanuts, dairy and eggs.

If you have oral allergy syndrome, chances are that you also have allergies to pollen from trees such as birch and alder, and/or to pollens from ragweed and grass.

Think of it as an allergy by association – or a cross-reaction – because your immune system, already primed to attack tree, plant and grass pollens, does not recognize the subtle differences between their proteins and those contained in foods as basic as an apple.

Not Usually Life-Threatening

One reason for oral allergy syndrome’s lower profile is that, unlike other food allergies, its symptoms are not usually life-threatening. Another is that it is relatively easy to avoid.

“You may eat something that contains traces of peanut, dairy or egg, but you aren’t going to unknowingly bite into a raw apple,” notes Dr. Antony Ham Pong, an allergist and based in Ottawa.

High Incidence of Oral Allergy Syndrome

About 10 per cent of the population**, or roughly one-third of North Americans with pollen-related allergies, are thought to be affected by OAS.

Ham Pong says he usually first sees patients when they’re between 8 to 10 years old. It’s not clear, however, why no more than one-third of hay fever sufferers are affected.

Next: More Serious Oral Allergy Symptoms

But the tenth name on the list may surprise: sulphites. These are the chemical additives used to stop food from browning or spoiling. In 1 per cent of the population, mostly those with asthma, even tiny amounts of sulphites can cause reactions. An estimated 4 per cent of asthmatics are sensitive to them.

In Canada, there have been reports of more than 100 sulphite-related reactions, ranging from nausea and abdominal pain to anaphylactic attacks. At least one Canadian has died.

Although sulphites are known to trigger symptoms in susceptible individuals that appear to be allergic reactions, including anaphylaxis, scientists still don’t know how they do this. Unlike the other food groups on the list, sulphites are chemicals, not proteins.

Researchers don’t yet know whether sulphites cause the immune systems of some people to respond abnormally or whether they set off some other mechanism that causes allergic-like reactions. The researchers also haven’t figured out why sulphites pose a threat to some people and not to others.

One theory is that people sensitive to sulphites have a genetic abnormality that hinders the body’s breakdown of these chemicals. However, Dr. Susan Tarlo, a respiratory physician at Toronto’s University Health Network and a specialist in lung disease and allergic response, says her extensive research does not confirm that theory. Another theory links sulphite sensitivity to a lack of B12 vitamins, but that research is still riot conclusive.

If you develop hives or have trouble breathing after a restaurant dinner and a glass of wine and suspect you may have this sensitivity, the first step is to see an allergist and confirm what is causing your reaction.

The only way to be sure that it is a sulphite sensitivity is to undergo an oral challenge in a hospital setting. In such a test, doctors will give you a glass of juice with sulphites to see whether you respond. (For sulphites, Tarlo says a skin test is riot reliable enough.)

The food inspection agency has added sulphites to its top 10 allergens list because they cause allergic-like reactions in such a significant number of people. (One per cent of the Canadian population equates to about 320,000 individuals.) But there is no scientific evidence that the prevalence of sulphite sensitivity has actually increased over the past years.