Happy St. Patrick’s Day! For those of you that are going out and wonder why you might be having issues, I am hoping to shed some light with this beer allergy and intolerance primer.
Beer is made of several different items, malt barley, wheat, sorghum, hops, brewer’s yeast, known as Saccharomyces cerevisiae, colorings, flavorings, and preservatives. You can be allergic to any of them.
As far as beer goes about 0.4 % of adults in the United States are allergic to wheat. It is uncommon but possible to be allergic to barley and other grains if you are allergic to wheat. In China, sorghum was found to be a more common cause. However, if patients are allergic to wheat or other grains, reaction to other foods that also contain the grain are also expected.
Alcohol is a common cause of flushing, so much so that the reaction is called an alcohol flushing reaction. Alcohol flushing is an intolerance caused by an inherited inability to metabolize alcohol as efficiently. When alcohol is metabolized, it is converted to acetaldehyde and then to other substances that are less toxic. If acetaldehyde is not metabolized, it causes the release of histamine. Medications can alter the breakdown of acetaldehyde as well. Patients with rosacea have an exaggerated flush with alcohol, which does have vasodilatory properties on blood vessels. Finally, acetaldehyde is a byproduct of yeast metabolism. It is also largely responsible for the “hangover”.
Beer allergy causes the same symptoms as any other allergy and may include:
There are also intolerances which may be as concerning as allergy. These may seem the same or even have the same symptoms but the process leading up to the symptoms is different.
Flushing from alcohol is a typical example of intolerance. The most important implication for patients who flush due to alcohol is that acetaldehyde is toxic and can increase the predisposition for developing esophageal and breast cancer. Acetaldehyde may be the byproduct of alcohol that causes patients with rosacea to flush more.
Biogenic amines such as agmatine, histamine, cadaverine, putrescine, 2-phenylethylamine, tyramine, spermine, and spermidine are byproducts of beer fermentation. You know about one of these chemicals, histamine, because it is also released by allergic cells during an allergic reaction and the antidote is antihistamine. Unfortunately, there is not much we can do about the other biogenic amines, which cause many of the same symptoms as an allergic reaction (see above). The amount produced is dependent on many factors. For example, Saccharomyces cerevisiae, the “tame” yeast that is typically used to ferment wine, has been “bred” to minimize toxic byproducts, “off” flavors and odors, and the quantity of biogenic amines produced during fermentation. The hygienics of the brewery can be a major factor and whether the winery uses filtration, which can minimize wild yeast or bacteria from invading and increasing the undesirable byproducts. They cause similar bodily reactions, depending on the amount ingested. However, we only have an antidote to one, that is antihistamines for histamine.
Patients taking drugs in the classes monamine inhibitors and diaminooxidase inhibitors which treat a variety of conditions, should be mindful of the presence of biogenic amines because these inhibitors prevent breakdown of the biogenic amines and when the biogenic amines are present in excess amounts, they can precipitate a hypertensive crisis.
There are medications that can decrease alcohol flush. These include the H2 blockers such as cimetidine (Tagamet) and famotidine (Pepcid). You will recognize these medications as those that are typically used to treat heartburn. However, these medications have no effect on the levels of acetaldehyde and therefore no decrease in the risk of cancer.
Otherwise, if true allergy is at play or if intolerance is caused by a necessary medication, complete avoidance is recommended.
If you think you need help controlling allergies and would like to be tested or treated for your allergies and believe you may be a good candidate for allergen immunotherapy, Dr. Wendt and her team staff at Relieve Allergy, Asthma & Hives would love to help.
Relieve Allergy Asthma & Hives is located near Kierland Commons, Scottsdale Quarter, DC Ranch and Grayhawk at 21803 N. Scottsdale Road Ste. 200, on the corners of Deer Valley and Scottsdale Roads, and has convenient evening and early morning hours to accommodate your schedule.
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