Alcohol and Asthma

Reviewed by: HU Medical Review Board | Last Reviewed: May 2016. | Last updated: March 2023

Alcohol can cause an allergy-like reaction in people with and without asthma.1 These reactions include a wide range of symptoms such as breathing problems, hay fever, cough, swelling in the face, itching, eczema, and headache.2

People with asthma are more likely than others to report a reaction to alcohol.1 As many as 40% of people with asthma report that drinking alcohol can trigger a reaction.2 About 30% report that it makes their asthma worse. People with aspirin-induced asthma are especially at risk. One study showed that 51% of people with this type of asthma had wheezing or breathlessness after drinking alcohol, compared with 20% of people with other types of asthma and 0% of people with hay fever or no asthma/allergies.3

However, some people actually breathe easier after drinking alcohol. Ethanol—the type of alcohol found in beverages—is a bronchodilator.2 This means that it relaxes the smooth muscles around the airways, opening them up. It also lowers the immune system.

What type of alcohol is most likely to cause a reaction?

People may react to all types of alcohol.3 Wine is the most common culprit.2 Among people with asthma, 30.1% of wine drinkers report having an alcohol sensitivity, compared with 22.6% of beer drinkers.2 It is much less common to react to distilled alcohol.2

Why does alcohol cause a reaction for asthmatics?

The reaction to wine is usually blamed on sulfites. Sulfites are used in wine production to sterilize the barrels and control the growth of yeast and bacteria.2 They are also preservatives that are added to maintain the taste, smell, and look of beer and wine. Sulfites are also used to prevent potatoes, shrimp, and dried fruit from browning.4 Sulfite sensitivity is not a true “allergy,” because sulfites do not fire up the immune system.2

Other compounds in alcohol may also cause reactions. Some people cannot break down ethanol. This means that when they drink, alcohol causes symptoms such as redness in the face, increased skin temperature, faster heart rate, nausea, and airway tightening. This type of reaction is particularly common among people of Asian ethnicity.2

Red wines can be high in histamine, the chemical that causes typical allergy symptoms. One study has shown that taking antihistamine medications before drinking red wine eliminated symptoms in most people.2 However, other studies have shown no link between the amount of histamine in wine and wine intolerance.2

Reactions to beer have not been well studied. They seem to be related to the barley or malt used to make beer.

Can I drink alcohol while taking asthma medications?

If you drink alcohol, it is a good idea to talk with your health care provider or pharmacist about the medications you are taking.

Zafirlukast (Accolate) and zileuton (Zyflo) are leukotriene modifiers that are sometimes used together with other asthma medications. These medications can affect the liver. The medication label for zileuton specifically recommends being cautious about using this medication if you drink heavily.5

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