Sulfites, Or Why Do I Have A Headache?

This is the second installment of "Boring Crap You Never Wanted To Know In This Much Detail", inspired by Jeff Morgan's "Pride And Prejudice" column in the August issue of Wine Enthusiast Magazine. (March 2009 update appended to the end of the piece.)

In my first missive in this series, "High Alcohol & A Hot Finish" I hypothesized that a hot finish in a wine is not due to a high ethanol content, but due to the presence of small quantities of higher alcohols and ketones (congeners) produced by stressed yeast and bacteria. Turns out that this previous discussion is germane to the current topic.

Are You Allergic To Sulfites?
I hear this all the time in the Tasting Salon -- "I can't drink much wine; it gives me a headache. I think I'm allergic to the sulfites." I don't know how this myth got started, but I sure would like to dispel it once and for all. You are not allergic to sulfites.

At least, the chances are 100,000 to 1 that you are not. And if you are in that 99.9999th percentile you KNOW it. You knew it when you woke up in the hospital after nearly dying of suffocation from your first trip to a salad bar or your first bite of dried fruit (potentially loaded with metabisulfite, to prevent browning).

People who are allergic to sulfites go into anaphylactic shock when they are exposed to them -- they choke to death. So far as I know there is no research to support the existence of a range of reaction to sulfite allergy. "Allergic to sulfites" equals anaphylaxis; no choking -- no allergy.

I will allow the possibility that there could be a lesser physiological reaction, but I have not seen any sort of intermediate in myself or any of the hundreds of people I have worked with in all my years in the winery cellar. And in the cellar we not only ingest sulfites, but frequently breathe in clouds of sulfur dioxide -- a much harsher test of sensitivity. Reactions may be choking and burning throat and eyes, but never headache.

You can do your own test at home (but only if you know you are not susceptible to anaphylaxis!). Light a kitchen match in a closed space and breathe in the fumes. If you develop a headache similar to the one you get when you drink wine, post a comment and let us know.

And by the way, everything fermented has a small amount of sulfites in it, because yeast produce sulfite as a metabolic by-product. Some wine yeast produce more than others. But every wine -- even "organic" wines labeled with "no sulfites" -- have some sulfites in them. So other fermented foods (bread, yogurt, kimchee, etc.) should give you a headache as well.

As an aside: "organic" wine -- I don't get the attraction. I know I can grow a better wine grape organically, and be more responsible to my neighbors and our descendents as a consequence. But nobody can make a better wine, nor lessen the impact of winemaking on the environment, by doing it "organically". In fact, since organic producers can't add sulfur dioxide to their musts or juices to inhibit spoilage, their wines are always at risk for having a higher congener content, as well as higher contents of biogenic amines (more on these below).

Do You Feel Flushed?
Some people do get flushed shortly after drinking some wine. This is a histamine response. If you are one of these people, the chances are good that this flush is more pronounced with red wines than with whites. If you are one of these folks there is a pretty good chance you have an allergy to tannins, which are more concentrated in reds than whites.

This kind of allergy is likely to lead to plugged sinuses and perhaps sinus headache. You definitely don't want to drink alcohol on top of most antihistamines, but maybe Claritin or one of the similar anti-allergy medications might help prevent this kind of headache.

Aaaaargh! Migraine!
Wine -- like all fermented foodstuffs -- also contains small amounts of compounds called biogenic amines. These are related to histamine and have similar effects on the body, including causing inflammation and vasoconstriction. In some people, sensitivity to these compounds triggers full-blown migraines (you know who you are).

Even if you don't get migraines, these biogenic amines create a physiological effect that may increase the unpleasantness of your headache. And stressed yeast (see my earlier post) pump out more biogenic amines. Your high-alcohol, native-fermented, "organic" wine is probably loaded with them.

But My Head Hurts!
In his column Jeff Morgan put it bluntly: "Most headaches are due to over-consumption -- otherwise known as a hangover." Wine is so easy to drink that it is easy to overdo it. Among the toxic effects of ethanol: it is a diuretic, and it also enhances the production of prostaglandins -- the body's pain messengers.

And then those congeners (that might be present in higher concentrations in high-alcohol wines) are even more toxic than ethanol. Congeners at very low levels are almost guaranteed to give you a headache.

So if you want to avoid this headache, first, drink less -- especially if the wine has a hot finish. Second, drink water to keep from getting dehydrated. And third, take a couple of aspirins (if it is OK with your doctor!) before you go to sleep -- aspirin inhibits prostaglandin synthesis.

For the last installment of "Boring Crap You Never Wanted To Know In This Much Detail" I'm going to delve into "Unfined & Unfiltered: Philosophy Meets Reality"

Update: March 2009
This piece has generated a flood of comments along the lines of: "I once ate this and this and this and this, and one of them contained sulfites, and I got a headache." Some of these comments include the assertion "I have been told I have sulfite allergy." I have rejected and will continue to reject publication of this line of commentary.

I am not a physician. If I was, I would not venture to make diagnoses online. I am a trained experimental scientist, and as such will say that coincidence is not the same as causation. The continued assertion that "I ate or drank something that contains sulfites and got a headache therefore I am allergic to sulfites" demsonstrates how deeply and unshakably this "sulfites in wine causes heacaches" meme has penetrated popular culture.

I am waiting for one of the "I have been told I am allergic to sulfites" comments to include "...by my physician who did his/her dissertation on sulfite sensitivities at [insert respected medical institution here]." I have not seen any such coda, and frankly don't expect to.

20 Comments:

At 7:49 PM, Anonymous Anonymous said...

Just a comment that there are people—like me—out there who suffer from a sulfite intolerance. I'm not allergic and for that matter have never had a headache from wine, but since my first glass in college I've had the almost immediate reaction of flushed skin and vomiting. I'm willing to consider that it may be the tannins instead of the sulfites, but the symptoms definitely exist!

This article:

http://foxnews.webmd.com/content/
article/61/67474?src=rss_foxnews

has a good overview of allergy vs. intolerance.

 
At 7:20 PM, Anonymous Anonymous said...

i don't understand how you can say that no one is allergic to sulfites. where's your scientific proof? also, allergy does not equal anaphylaxis only. allergies encompass so many different reactions, and everyone has a different severity of their response to an allergen. i don't know where you got your information but maybe you should reevaluate it.

 
At 5:54 AM, Anonymous Paul said...

An interesting article, but the fact remains that Aussie reds give me a head and Spanish and Italian reds do not. Preservative free wines affect me less also. Why?

 
At 11:42 AM, Blogger John M. Kelly said...

Thanks for the comments. Responding to anonymous #1: if you have an intolerance to sulfites, then there are a lot of foods other than wine which should cause you to flush and vomit -- especially dried fruits (my favortite test is bright orange dried apricots). Or try the match test -- does the smell of burning matches make you retch?
Responding to anonymous #2: I did state that there are people allergic to sulfites. My understanding as a biochemist is that the definition of "allergy" is immunoglobulin E-mediated release of histamine in response to a chemical stimulus. In all the papers I have reviewed, only anaphylactic reaction to exogenous sulfites has shown IgE mediation. I would welcome the opportunity to see some peer-reviewed science that challenges or refutes this. Please provide me references if you have them.
In response to Paul: which specific wines from these different countries do and don't give you a head? Since all wines contain sulfites - even those that don't have sulfites added in processing - and since many contain ascorbic acid and some contain sorbates, I suggest that no wines are preservative-free. In the broadest generalization, Aussie reds have higher alcohol levels than most of what comes out of Spain and Italy.
The bottom line is that a demonstrable sensitivity to sulfites is rare. If sulfites are the actual trigger, many foods other than wine should cause similar reactions. Sulfites are present in nearly all fermented foods, and also nearly all preserved and dried foods. Sulfite is also generated inside our bodies in the course of metabolizing sulfur-containing compounds -- I recall seeing a paper showing that sulfite-sensitive individuals have trouble with foods rich in cysteine and methionine.
I know that some folks have an unshakable belief that sulfites in wine give them a headache. Nothing I know or write about will change their minds. I just would like to think that other folks are more amenable to reason.

 
At 5:17 PM, Anonymous Anonymous said...

For twenty years I've tried on and off to drink California wines and am unhappy each time--unfortunately. I would love to support California wines and be able to drink them. But, not only do I get an aftertaste with each sip, but I also get headaches from one or two glasses. I have never had that issue with any other country's wine (Italian, Chilean, German, French, Australian) that I've tried. So far, it's only happened with California wines.

I also *know* that I'm one of those rare people who is allergic to Sulfa (coincidentally). If I take it I get a spiking fever. I understand that all wines have sulfites so I must be able to drink some amount of them. My query is, do California wines put *more* sulfa in their wines, or is there something else which is different about them?

 
At 6:38 PM, Blogger John M. Kelly said...

Sulfa drugs are a class of antibiotics that, in a few sensitive individuals, produce the allergic reaction (spiking fever, etc.) you refer to. Sulfites in wine are not the same class of compound at all. I have found no peer-reviewed research which suggest that allergy to sulfa drugs is related to wine discomfort.

We aren't doing anything different in making California wine from what is done everywhere else in the world. Australian wines tend to have higher alcohol levels. And German wines - especially spatleses or sweeter - have much higher sulfite levels than what is typically used in California winemaking.

You don't mention what California wines you are having trouble with. Cheap wines everywhere are liable to have poorer aftertastes and greater tendency to cause headaches.

If you tell me that MY wine gives you a headache, while Grange from Australia, Sassicaia from Italy, Montes Alpha from Chile, Jos. Prum Beerenauslese from Germany, Ch. Latour from Bordeaux or DRC from Burgundy do not, I will tell you that it is all in your head - you are suffering from a psychosomatic reaction to the word "California" on the label.

 
At 7:31 PM, Anonymous Anonymous said...

I'm having a reaction in my mouth to something I eat or drink. Red wine has been a constant each time this has happened. My symptoms are a burning on my tongue tip and upper gums. The symptoms appear 2 to 3 days after I consume several glasses of red wine. An allergist attributes it to the sulfites. The allergist tried to have my blood tested for a sulfite allergy but no test was available. I did have a skin reaction to the wine that I had drunk. Any thoughts?

 
At 2:49 PM, Blogger John M. Kelly said...

Yes, my firrst thought is that I'm not a doctor of medicine, and even if I was I would not attempt to make a diagnosis on the basis of an anonymous post on the internet.

That said, if I was experiencing your symptoms the first thing I would do is find a new allergist.

Any number of the phenolic compounds naturally present in wine -- especially RED wine -- are known to induce histamine release. Unless your "allergist" tested you for reaction to some of these compounds independent of the wine matrix, and demonstrated that you DID NOT react to then, IMO to suggest sulfites are causing the reaction betrays a serious lack of competence.

Heck, some people get dermatitis -- burning, itching and redness of the skin -- just from contact with alcohol alone.

 
At 6:55 AM, Anonymous Terri said...

I realize this article is from last year, but I found it extremely interesting and thought I'd ask a few questions of Mr. Kelly.

Because I love red wine, I'm willing to try just about anything to be able to enjoy it. I never overindulge (brings on a migraine and nausea if I have more than 2 glasses of any alcohol). But to just enjoy a normal glass of wine would be nice. After a glass, I usually wake up with a headache, and a mouth that feels like it has been left out to dry...cotton mouth i guess you could say. I do stay hydrated as much as possible. I realize now after reading your article that it is NOT a sulfite allergy (altho i am allergic to topical sulfa drugs and suffer from mild to moderate rosacea).

So if it is histamines and/or tannins, are there wines out there that have minimal or lesser amounts of these? and i would think it is dangerous to combine an anti-histamine or an aspirin with alcohol. Have you heard about drinking a cup of black tea prior to drinking? I do drink green tea, but this has had no impact.

 
At 2:09 PM, Blogger John M. Kelly said...

Terri:

Again let me say I'm not qualified to make medical recommendations. Personally I don't take OTC anti-histamines (they knock me out) and I minimize my intake of aspirin (family history of gastric bleeding). I certainly would not take either directly on top of alcohol of any sort due to potential negative interactions. However, if I were to take these meds I would be comfortable taking both together a couple of hours after drinking, when the alcohol was no longer in my stomach. But what's right for me may not be at all OK for you, or for anyone else.

Where I am on solid ground is in discussing wine contents. Reds have more tannins and other potential allergens and vaso-active compounds than whites and pinks. Big reds, like spendy Cabernets , have more than lighter reds - Pinot Noirs for example.

Teas and coffees also have varying levels of phenolic compounds in them, though there are differences in the chemical structures compared to wine phenolics. I have not heard that drinking tea helps avoid wine headache one way or another, but I perhaps the stimulants in tea and coffee help prevent the release of pain-causing prostaglandins.

 
At 3:01 PM, Anonymous Anonymous said...

Hi, In my 40s I developed an adverse reaction to all types of alcohol - wines, champagnes, vodka, beer, you name it - I've tried everything. I feel fine while I'm drinking and for about 8-12 hours afterwards, but then have what feels like a cross between a hangover and a sinus infection - just from one or two glasses of wine etc., and it lasts for days. I used to be able to drink and I miss it. Any ideas? Many thanks - DB

 
At 11:52 AM, Blogger John M. Kelly said...

Ideas, as in possible explanations? None. The only shared composition of all these beverages is alcohol. Personally, if I had a hangover that lasted for days after just a couple of drinks, it would scare me enough to send me to the doctor for a liver function test.

 
At 5:36 AM, Anonymous Anonymous said...

I do not have an actual allergy to sulfite but I definitely have a severe sensitivity to it. For thirteen years I have been going to doctor after doctor complaining of strange symptoms. My biggest complaint is that every single time I ate I experienced an upset stomach and internal trembling thirty minutes later. Not only that but I was weak and lightheaded. I have had many, many medical tests over the years and, most recently, was being tested for MS because of my many neurological symptoms. I changed my doctor two weeks ago and, during the very first visit with my new doctor, he suggested that I try a sulfite free diet for two weeks as he was certain that was my problem. He even mentioned that a prolonged exposure to sulfite WILL cause neurological fatique, which was probably why my first doctor thought I had MS.

Well, I'm here to say that I've been sulfite free for exactly seven days (boy, was it hard to do!) and the difference in how I feel is absolutely amazing! I am no longer lightheaded nor do I experience tummy upset or shaking when I eat. I do admit that I am still a little tiny bit on the weak side but, after poisoning my body on a daily basis for thirteen years, I imagine it will take a few more weeks before I begin to feel normal.

One of the reasons I think my diagnosis was missed for so long is that I do not drink alcohol at all - no wines, beers, or spirits - so my problem wasn't so obvious.

 
At 7:37 PM, Anonymous Anonymous said...

I'm rather certain I'm allergic to sulfites. I didn't drink alcohol often until I was about 24 years old during the holiday season. I had been suffering chronic hives for years, and was taking antihistamines to control it. During Christmas week after several dinners with wine, my lips were swelling, my body was itching, I felt like I was coming down with a cold, and my stomach was also very upset and volatile. I didn't put it all together until the next month when my lips swelled after eating chicken francaise (which has white wine in it). Then, my lips swelled after drinking a smirnoff ice that said "contains sulfites" on the label. The last straw was when my lips swelled after eating cupcakes (icing often contains sulfites). I pieced it together after all my food allergy tests(except peanuts) came back negative, and I looked for the common denominator in the foods I was eating. I don't totally avoid sulfites at this point, but I keep control of how much I take in and I'm now on a more effective antihistamine daily. When eating higher risk foods, I double the dosage.

-AC

 
At 12:26 PM, Anonymous Anonymous said...

I definitely have some kind of a reaction to sulphites. After eating some dried fruit, sausages, drinking wine, some soft drinks,some vitamins (anything with a certain level of sulphites), I get a very itchy rash on head and neck within minutes. If I get a large dose my throat itches and my stomach is upset and I feel very unwell. I do not have anaphylaxis but been to the emergency room a few times and they have given me antihistamines etc. I have been caught out a few times, thinking some thing is free from sulphites, then finding out that they were sprayed with sulphites e.g organic fruit on supermarket shelves.
I have a degree in nutrition and am actually wondering what you are basing your information to say it is not an allergy unless you have anaphylaxis?

 
At 11:06 AM, Blogger John M. Kelly said...

Responding to the last three comments, I am reminded of one of my favorite lines from Hamlet: "There are more things in heaven and earth... than are dreamt of in your philosophy." Stomach upset, trembling, lip swelling, itches and rashes - all apparently but arguably linked to intake of sulfite by three individuals. The human organism is truly a strange and wonderous complexity.

None of this contradicts my original thesis, that the vast majority of folks who think wine gives them a headache because of the presence of sulfites are just plain wrong. Where is "headache" in the litany of symptoms above?

I urge readers to consider why the Federal TTB requires that we put "Contais Sulfites" on the wine label. It is NOT because some people claim to get headaches or other annoying but minor symptoms. It IS because one in 100,000 people (or so) goes into anaphylactic shock when they ingest sulfites. This anaphylactic reaction has been documented in epidemiological and medical studies and biologically characterized as a pure IgE-mediated reaction (the definition of "allergy"). These studies have been reported in respected peer-reviewed journals - the gold standard by which the quality of scientific studies should be judged before making public policy.

My days of doing pure research are behind me - I am busy running a business - but I still try to keep up with developments in this area via PubMed and other online resources when I can. I have not come across any references to sulfite allergy symptomatology other than anaphylaxis in the respectable literature. Perhaps I just have not seen some recent work, but I believe there is no literature in this area because 1) non-anaphylactic reactions are not life-threatening and therefore not a matter for policy making, and 2) so few people are affected by non-anaphylactic sensitivity, their symptoms avoidable by dietary monitoring and treatable with OTC remedies, that there is no money to be made from studying these conditions with an eye to developing new treatment options. If anyone has a reference for a published study PLEASE share it! (Note: Fox News, "explain my symptoms" websites and similar references are not acceptable sources.)

 
At 1:30 PM, Blogger ponca said...

I have been told that I do have an slight allergic reaction to sulfites. And yes, my reaction typically takes two forms, either a headache or a stomach ailment, depending on the food consumed. First, anytime I drink
any fermented drinks (including any type of wine, beer, meade, wine coolers, etc) I get a headache tht is so bad that no medicine will touch it. In fact, that last time I went to a reastuarnt where the cooking style including white wine, I ended up with a headache for 2 days that left me helpless on the couch. Since I don't overindulge in alcohol (one glass is my limit), and since when the wine is cooked in any case, the alcohol is removed, it's tough to argue the case that the headache is a hangover. In addition, I also get headaches from drinking too much apple cider and grape juice. 9the smell of most of the fermented alcohols is also enough to make my stomach upset, so I don't typically drink them, but hard alcohols don't affect me.) I also get stomach ailments and headaches from grape jellies, dried fruit, and the kinds of pickles that are not kept cold constantly (which require more preservatives). I have read an article which says that people will asthma will get headaches if they have have a sulfite allergy, and since
I have a mild asthma, that might well explain it. However, this allergy, with all of the same symptoms, runs in my family, and the other sufferers are not asthmatic. Your column looks like an interesting one, so I figured I'd give you a bit more information from the point of view of someone who DOES get headaches, along with stomach ailments when presented with sulfites.

 
At 2:35 PM, Blogger John M. Kelly said...

ponca's comment is the last along this line that I will publish. Please see the March 2009 update I appended to the original post.

First please let me make clear that I am not belittling anyone as a hypochondriac. Suffering is suffering, and I personally feel compassion whenever anyone suffers -- whatever the cause.

My original purpose in publishing this piece was to point out that the claim that sulfites cause headaches is by and large an urban myth, inconsistent with the peer-reviewed science and medicine on the question.

I went on to point out the things in wines and other alcoholic beverages that demonstrably DO cause headache in the clinical setting: ethanol and higher alcohols and derivatives (congeners) in all subjects, and certain tannins and biogenic amines in certain individuals.

I acknowledge that there are outliers in all populations, and that it is unlikely the full range of sensitivites to sulfur-containing compounds has ever been studied in the clinical setting. I accept that perhaps someday it will be demonstrated in a series of double-blind trials that every person who tells me sulfites give them a headache -- and this is about 1 in 7 of the people who visit my tasting Salon -- actually IS sensitive to sulfites, and I will have to rethink my position.

But I ask (rhetorically), which is more likely? 1) That for the last 500 years -- as long as sulfites have been used as preservatives -- science and medicine have just missed this high rate of sensitivity in the population? Or 2) that as never before in history, the internet has made it possible for quacks and frauds to profit from sham pseudo-scientific explanations for symptoms that sufferers have not found diagnosable by real medical practice (traditional or not)?

Call me a cynic if you will, but I'm going with the second explanation.

 
At 1:02 AM, Blogger Calvyn said...

I do love wine. I do get headaches from consuming too much wine and it is not because of the sulfites in the wine! Wine is in general, when consumed with moderation, very good for you ie. it helps with cholesterol etc..

My wife on the other hand is highly allergic to Sulfas in medications and she has an intolerance to sulfites - not just sulfites found in wine but in most processed foods and some fresh foods like onions, garlic, mustard etc.

I think the trick is to be careful and not to consume too many food stuff at any time that contains sulfites, take a good multi vitamin supplement and have antihistamines handy. a light dose (500mg) of Paracetamol seems to help her as well when she had a few glases of wine (or foodstuff with sulfites) - not to prevent the headaches but it seems to suppress the nausea and other symptoms of her intolerance to sulfites.

I am so lucky that I can drink enough wine without any reaction to the sulfites! But too much wine does give headache and a good aspirin fixes that up quickly! ;-)

Thank you for all the information it did help my wife a lot.

 
At 1:24 PM, Anonymous Anonymous said...

Sulfites and asthma

I agree that the tannins often cause headaches but as an Adult with asthma I find that a glass of wine tends to tighten my chest and I often find myself coughing, itchy and uncomfortable. And that coughing along with diminished oxogen absorbtion often leads to headaches.

On a side note I was advised by an allergist that German wines have far less sulfite content than most wines and I have found my response to them much less severe. And I found this original post quite informative

"Generally, sulfite sensitivity is found in patients with asthma who are steroid dependent. In steroid-dependent children, the prevalence has been found to be 20%. Reactions to sulfites can vary from mild to severe and even fatal bronchospasm in about 5% to 10% of patients with asthma. Sensitivity to sulfites is found more often in women than in men.

It should be noted that sodium and potassium bisulfites can cause bronchoconstriction in persons with asthma, and sensitivity to bisulfites in children increases with age. Sulfite sensitivity has also been linked to atopy. It is generally not found in persons who are both non-atopic and non-asthmatic. Even in patients who are sensitive to inhaled sulfites, the ingestion of foods containing sulfite may not cause a reaction, since the reaction depends on a number of factors.

There is no clear understanding of the mechanism by which inhaled sulfites trigger bronchospasm. It may be due to the formation of sulphur dioxide within the airways that affects the airway mucosa, and to some extent activates both the IgE mechanism and the cholinergic reflex resulting in bronchoconstriction.

Some asthma medications contain sulfites. Sulfite can trigger bronchspasm in a dose-related manner. For instance, both isoproterenol and isoetharine contain sulfite in sufficient dosage to trigger bronchospasm in most patients with asthma. They can also give rise to bronchospasm in those with asthma who are not sulfite sensitive.

Sulfite sensitivity should not be confused with sulphates or with sulfur drugs. Patients with sulfite sensitivity should avoid all forms of sulfite."

http://www.aaaai.org/members/allied_health/articlesofinterest/sulfite.stm

 

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