Alcohol and Histamine: What to Know About Wine, Beer and Tequila
Looking for the alcohol with the least histamine? You may have seen advice to swap red wine for white or choose tequila instead. Less histamine does not necessarily mean fewer symptoms. Alcohol itself and other ingredients in the drink can also play a role.
Why alcohol can cause symptoms
Histamine can form through microbial activity during fermentation. It occurs in drinks such as wine and beer, but the amount varies between products. The type of drink alone cannot tell you its exact histamine content.
A 2021 guideline from European allergy societies also notes that drinking alcohol may interfere with the breakdown of dietary histamine. This means a drink containing little histamine could still contribute to symptoms.
Wine, beer or tequila?
According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), red wine generally contains more histamine than white wine. However, white wine may cause reactions for other reasons—for example, sulfites can trigger asthma symptoms in susceptible people.
Beer can also contain histamine, but describing every beer as “high histamine” oversimplifies the evidence. Laboratory analyses have found differences between individual samples.
What about tequila, vodka or gin? The available evidence does not provide a reliable ranking that identifies one universally suitable option. Without laboratory results for a particular product, it should not be assumed to be histamine-free. These spirits also contain ethanol, so even a low histamine content does not guarantee that a drink will be well tolerated. This is because ethanol directly inhibits the enzyme diamine oxidase (DAO), preventing the body from breaking down ingested histamine, and additionally acts as a so-called histamine liberator in the body – promoting the release of the body's own histamine from mast cells.
Is alcohol-free beer also histamine-free?
Not necessarily. A study published in Foods in 2023 detected histamine in the alcohol-free beers tested. An “alcohol-free” label therefore does not establish that a drink contains no histamine. Finding histamine in a product does not, by itself, mean it will cause symptoms in everyone.
What to do if alcohol causes symptoms
If symptoms recur, avoid alcohol and record the drink, amount consumed, symptoms and when they started. These details can help you discuss possible causes with a healthcare professional.
As ASCIA explains, reactions to alcoholic drinks can have several causes. Flushing, a blocked nose or a headache after drinking does not, on its own, confirm histamine intolerance. Symptoms may also relate to how your body breaks down alcohol or to other ingredients in the drink.
Sources
- ASCIA: Alcohol Allergy — reactions to alcohol, histamine in wine and other potential triggers.
- Guideline on suspected adverse reactions to ingested histamine, 2021 — evidence limitations and the potential influence of alcohol.
- Laboratory analysis of biogenic amines in wines and beers, 2017 — differences between tested samples.
- Analysis of biogenic amines in alcohol-free beers, 2023 — detection of histamine in tested products.