The evidence is pretty compelling.

As the holidays approach, we embark upon a time of revelry and feasting, of traveling to see friends and loved ones, and of honoring traditions. In many cases these celebrations may include imbibing alcoholic beverages for those who partake, and even an occasional beverage for those who usually do not. If you have food allergies, sensitivities, or intolerances, holiday seasons can be filled with landmines of food and drink that may trigger reactions. Even if you’ve never been diagnosed with food allergies and sensitivities, you may still find yourself reacting to something in a food or drink without knowing it, or at the least, without being able to identify the exact trigger. Why? 

When celebrating, you may not be preparing the food or drink yourself. Many celebratory foods and drinks can be more elaborate than what’s usually on the dinner table. This means they may contain ingredients that you knowingly or unknowingly react to that you typically don’t consume. Some traditional foods and drinks may contain unusual ingredients that you rarely come in contact with. Even at a restaurant, a holiday party may be served buffet style or food passed around which isn’t clearly identified for allergens.

Unlike food allergies, symptoms of food sensitivities can take up to 72 hours to show up. Will you really be able to identify by memory which of the 15 different offerings you tried caused your reaction? This is especially true if you have no idea what all of the ingredients are, or whether you react to them. On top of that, food sensitivity symptoms can vary greatly from food allergy symptoms, and from person to person. Symptoms like fatigue, brain fog, being stopped up, skin flushing, etc., that occur days later may not be thought of as food sensitivities at all by the majority of people, especially with the hustle, bustle, and travel of the holidays.

Alcohol and the feeling of a special occasion can help you make decisions you wouldn’t always make regarding food choices. After a couple of glasses of wine, you might decide that one glass of Aunt Fanny’s famous eggnog won’t hurt, despite the fact that you’re dairy intolerant and sensitive to nutmeg. Alcohol decreases inhibitions and decreases attention to detail. You may not ask after allergens in each dish after a few at the holiday party.

Histamines also have a complex role to play in their interactions with allergies and sensitivities. Generally, when an IgE reaction (an allergic reaction) is triggered by a food, one of the initial responses is a release of histamines into the body as part of the overall immunological response. These histamines serve the role of mounting a quick and powerful immune response but can have the side effect of symptoms ranging from congestion and itchiness to hives and anaphylaxis. Repeated allergic attacks can even trigger chronic inflammation. It can work the other way around as well. Consumption of food and drink that is high in histamines can not only duplicate the symptoms of an allergic response but can actually make existing allergies and sensitivities worse, especially those of us with histamine intolerance or  Mast Cell Activation Syndrome, which can cause histamine intolerance. Many foods and drinks contain high histamines, especially the sort of special foods we consume at holiday parties. Smoked fish and meats, like smoked salmon, sausages, BBQ, salamis, prosciutto, etc. are high in histamines. So are aged cheeses, some fruits, spinach, eggplant, and tomatoes. Other foods can trigger histamine reactions even though they aren’t high in histamines themselves, like citrus, strawberries, and cherries. Shellfish can also be high in histamines, as can most fermented foods like sauerkraut, soy sauce, and vinegars. Some spices like cinnamon, cloves, and chili powders can also be high in histamines. Taken together, many of these foods find their way to our holiday tables and are found in the traditional foods of many different cultures. Generally, foods high in umami (the savory flavor) are high in histamines, and exactly what we crave in a festive setting.

Alcohol plays a special role, both as far as histamines go, and as far as interacting with food allergens and sensitivities. To begin with, as a group, we tend to imbibe more frequently and heavily during the holidays. Studies have found that people on average double their alcohol consumption over the holidays compared to normal times. Many alcohols that we might consume over the holidays are high in histamines. Beer, red wines, and any dark liquor is going to have higher histamines, rum, brandy, and whisky especially. Fortified wines like port and sherry are also high in histamines and sometimes make their appearance during the holidays. Wines get their histamines from their tannins, which come both from the skins of the grape (kept on during pressing in red wines), and from the wood in the barrels they age in. Ditto the darker spirits. Their color (if not artificially colored) comes from the barrels they rest in. Longer-aged spirits, like more expensive whiskeys, brandies, and some dark rums have higher histamines. Bourbon tends to have higher histamine because by law it has to use freshly charred new oak barrels. Brandies are not only made from grapes but rest in oak as well. These high histamines play a big role in exacerbating existing food allergies, driving food sensitivities and intolerances, and can trigger chronic inflammation and intestinal permeability.

Histamine is very complicated, but it’s thought that bombarding your body with histamine-laden foods might drive the entire process of food sensitivity and intolerance by degrading diamine oxidase, which itself usually breaks down histamine in the body. Essentially- either ignoring existing food sensitivities and allergies and continuing to eat foods that are triggers or consistently consuming foods that are high in histamines risk degrading diamine oxidase, raising overall histamine levels in the body, and creating chronic and systemic inflammation as both the link above explains and as we have written about as well. Now, that’s just the process of how histamine exposure may eventually trigger histamine intolerance and eventually systemic inflammation.

Alcohol can independently drive this same pathway to food sensitivities and chronic inflammation. As alcohol breaks down in the body, it converts to acetaldehyde, sometimes called the hangover metabolite, as it is that substance that can cause pain the next day. Unfortunately:

“Alcohol and histamine metabolic pathways in the body have the common enzymes aldehyde dehydrogenase and aldehyde oxidase. The metabolite of ethanol, acetaldehyde, can effectively compete with the metabolites of histamine, methylimidazole acetaldehyde, and imidazole acetaldehyde. At the periphery, alcohol and acetaldehyde liberate histamine from its store in mast cells and depress histamine elimination by inhibiting diamine oxidase, resulting in elevated histamine levels in tissues.” 

And:

“In addition, alcohol affects histamine levels in the brain by modulating histamine synthesis, release, and turnover. Histamine receptor antagonists can affect ethanol metabolism and change the sensitivity of animals to the hypnotic effects of alcohol.”

(S M Zimatkin, O V Anichtchik, Alcohol and Alcoholism, Volume 34, Issue 2, March 1999)

This means that when you drink- especially alcohol with high histamines, and/or while eating high histamine foods or those that trigger histamine release, you are much more likely to degrade diamine oxidase, which usually acts as a check on histamines. So, it’s a double whammy. Not only are you degrading diamine oxidase, which is independently bad, especially if it reoccurs to the point that the decrease is chronic, but it means that the histamines that might normally be checked by diamine oxidase run rampant in the body. Interrelated mechanisms whereby alcohol may induce or aid in the creation of food allergies and sensitivities, or damage the gut in ways that food sensitivities can be a cofactor in intestinal permeability and inflammation, or harm the gut in other ways include alteration of the microbiome by resulting in good bacteria to be killed off and dysbiotic bacteria to thrive, malabsorption of nutrients, including folate; directly causing intestinal inflammation through dysbiosis, mucosal erosion, and intestinal permeability; and by compromising gut immunity, which may very well cause increased susceptibility to food allergies and sensitivities. Now, many of these effects are highly dependent on the amount of alcohol consumed. We give them here for two reasons. First, they illustrate the connection between alcohol and the gut and demonstrate in some ways how histamine, immunity, the microbiome, DAO, inflammation, and intestinal permeability are tied together. Second, as we age, we likely become more susceptible to all of these effects. Our guts can become weaker, we are less able to break down acetaldehyde, and the totality of these effects becomes more likely.

So what is to be done? Lest you think this piece is merely a polemic against alcohol, let’s be more judicious in our approach. We know that the holidays are supposed to be fun, bring families, friends, and coworkers together socially, to honor traditions, and celebrate what we hold dear. In that context, two guiding philosophies should be kept in mind. Remember that every time you consume food or drink, you have a chance to either heal or hurt, and secondly, everything in moderation, including moderation. Sometimes people have to let go. That being said, there are obvious choices you could make. Eat histamine-laden foods sparingly. Drink moderately, and largely avoid histamine-containing alcohols. Most importantly, we believe strongly in surveillance. Going into the holidays (and beyond),

Know your food allergen and sensitivity triggers with the P88 Dietary Antigen Test

Know your current levels of DAO, Histamines, DAO/Histamine ratio, and markers of intestinal permeability with the Advanced Intestinal Barrier Assessment Test