The Headache of Wine Intolerance
New Zealand’s latest master of wine Sophie Parker-Thomson, delves into the reasons why some people are intolerant to wine. As Sophie mentions, this is an area fraught with misinformation and is well worth a read.
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Please note this was originally published in the World of Wine Winter edition 2021.
Above: Sophie Parker Thomson MW
Wine is an incredibly complex product. With over 600 components currently identified in any one wine, it is unsurprising that adverse reactions to it occasionally occur which are not attributable to excess alcohol consumption. For some people it is a frustrating and mystifying issue which has perhaps resulted in them abstaining from the beverage altogether. With symptoms such as headaches, nausea, red rashes, flushing and stomach upset experienced, who would blame them? However as both a wine lover and wine professional, it is upsetting that these individuals are missing out on what I think is one of the greatest pleasures in life – discovering the history, culture and stories of wines from all over the world and continually developing one’s sensory appreciation skills. This is a significant reason why I chose to research wine intolerance, an area that is fraught with misinformation, in the hope that consumers may more readily navigate any vinous troubles.
Allergy versus Intolerance
If you experience side-effects after wine consumption (beyond over-indulgence in alcohol as the cause), the chances are you are not genuinely allergic to wine. A medically defined allergic response is mediated by Immunoglobulin E (IgE), and these reactions are both rare and potentially life-threatening, often involving anaphylaxis. These individuals are typically acutely aware of their condition and must actively avoid that allergen in their daily life. Examples of things that would cause an IgE-response are egg-derived products like albumin or milk products like casein which are occasionally used as fining agents in wine. Because of their allergenic nature these must be legally listed on the label. Some people are allergic to grape proteins which means all wine and grapes are off the menu. Very rarely there are some people who are allergic to wine components such as ethanol, acetic acid or sulphites but again they must avoid all products that contain the allergen. A simple skin prick test can confirm these allergies. Conversely, wine intolerance is a generic term that embodies all non-IgE mediated responses. These are not genuine allergies but because the symptoms triggered are allergy-like they are frequently described as ‘pseudoallergic’ responses. So, what can cause these?
Aldehyde Dehydrogenase (Aldh-2) Deficiency
This is commonly referred to as Asian flush syndrome and results from a deficiency of the enzyme ALDH-2, preventing the breakdown of acetaldehyde, a compound found in wine. People of East Asian descent have a genetic predisposition to this hereditary enzymatic deficiency.
Flavanoids
Flavonoids are naturally occurring phenolic compounds. There is some evidence that suggests a build-up of flavonoids can trigger a headache/migraine in sensitive individuals but there are few conclusive studies on this.
Sulphites
Some people would have you believe that sulphur dioxide (SO2 or sulphites) is to blame for wine intolerance reactions. After all, it is the only universal declaration that is mandatory on wine labels and there is lots of emotive discussion about its purported nastiness. Medical research shows that SO2 is concerning for some, but that its danger to health is overwhelmingly confined to people who experience acute asthma; those who are steroid dependent and require an inhaler daily. The reaction to SO2 is nearly exclusively respiratory and no link has been established between SO2 and headache. Only 3-10% of acute asthmatics have SO2 sensitivity, and it is serious. They need to avoid all the products that contain it – many contain far higher levels than the average bottle of wine. To put it in perspective, three dried apricots contain more SO2 than a whole bottle of wine. If you need to take the day off work after eating a few dried apricots then you could pinpoint SO2 as your kryptonite. If not, read on. Revealingly, white wines contain higher levels of SO2 than red wines as they have less phenolic content: phenolics protect against oxidation. Anecdotally, most wine intolerance complaints are about red wines rather than white wines, which turns this theory on its head.
Biogenic Amines
This group of chemical compounds, produced by bacteria, are most likely public enemy number one when it comes to wine intolerance, and red wines typically have higher biogenic amine (BA) levels than white wines. BAs have charming names such as putrescine, cadaverine, spermine, spermidine and the most commonly known, histamine. While our bodies ordinarily maintain a certain level of BAs to assist with everyday functions such as circadian rhythm and neurotransmission, if this is exceeded, an immune-like response is triggered with a diverse array of reactions possible from nasal congestion through to migraines, cramps and tachycardia. What makes BAs more significant in wine is that alcohol suppresses the enzymes that allow our bodies to get rid of them. Individual sensitivity is further apparent as some people, especially women or genetically predisposed people, tend to have less of these detoxifying enzymes. In wine, there are certain things that influence the accumulation of BAs, but my research established the most crucial was whether SO2 had been added. Ironically, the addition of SO2 significantly reduced the BA levels in wine, while the complete absence of it meant very high and often toxic BA levels. This is because SO2 is antibacterial and the addition of even a small amount before fermentation was enough to stop the bacteria responsible for producing BAs. Presently there is no regulations around BA levels, but I’m confident it is an area that will be looked at closely in the near future. In the meantime, if you do suspect you are sensitive to BAs, try these tips below:
Keep up your water intake high when drinking wine – dehydration increases your natural histamine levels.
Avoid other high-BA foods when drinking wine: examples are bacterially-ripened cheeses like blue vein or Epoisses, charcuterie, aubergine, sauerkraut and other fermented vegetables.
Avoid wines that have had no or low-SO2 added, and wines that have spent years on lees with no or low SO2 such as vintage traditional method sparkling wine.
Choose wines that are youthful, crisp and fruity like classic-style Sauvignon Blanc, Riesling and Pinot Gris. These are likely to have low BA levels due to their production methods.