Is white wine safe to drink for individuals with histamine intolerance?

White Wine and Histamine Intolerance

White wine is generally safer than red wine for individuals with histamine intolerance, but it still contains histamine and should be consumed with caution or avoided entirely by those with significant histamine sensitivity.

Histamine Content in Wine

• White wines typically contain lower histamine levels (3-120 μg/L) compared to red wines (60-3800 μg/L) 1
• Histamine is formed during fermentation processes, particularly during malolactic fermentation, which is more common in red wine production 2
• Ethanol concentration affects histamine production:
  • Levels above 13% inhibit histamine production
  • Levels below 9% have minimal effect
  • Concentrations around 11% allow continuous histamine accumulation 2

Why White Wine May Still Cause Problems

• Alcohol itself inhibits diamine oxidase (DAO), the primary enzyme responsible for histamine metabolism 3, 4
• This inhibition occurs regardless of the histamine content of the beverage
• Even with lower histamine content, white wine can still trigger symptoms in sensitive individuals due to:
  1. The competitive inhibition of DAO by alcohol
  2. The presence of other biogenic amines
  3. Individual sensitivity variations

Symptoms of Histamine Reactions from Wine

Individuals with histamine intolerance may experience:

• Headaches
• Flushing
• Skin itching
• Digestive issues (diarrhea)
• Sneezing
• Shortness of breath 3, 1

Diagnosis of Histamine Intolerance

• Symptoms occur after consuming histamine-containing foods or beverages
• Multiple organ systems are affected
• DAO activity is reduced 2
• Skin-prick testing and specific IgE to food allergens are typically negative 5
• Preliminary investigations show decreased DAO activity (0.03 nKat/L) in patients with histamine intolerance compared to healthy controls (0.07 nKat/L) 3

Management Recommendations

For individuals with confirmed or suspected histamine intolerance:

1. A histamine-free diet is the treatment of choice 3, 5

   • Avoid all alcoholic beverages, including white wine
   • Avoid other histamine-rich foods (fish, cheese, hard cured sausages, pickled cabbage)

2. For those who occasionally consume white wine:

   • Choose fresher wines (histamine levels increase during storage) 2
   • Select wines with higher alcohol content (>13%) which inhibit histamine production 2
   • Consider taking an antihistamine before consumption 1

3. Medical management:

   • H1 antihistamines (preferably second-generation with less sedation) can help control symptoms 2
   • A 14-day course of antihistamines along with a 4-week histamine-free diet is recommended for initial treatment 2
   • Vitamin B6 (pyridoxal phosphate) supplementation may support DAO activity 3

Important Caveats

• Individual tolerance varies significantly among those with histamine intolerance 2
• Wine-induced symptoms are reproducible and can be eliminated by antihistamines in most patients 5
• In a study of patients with wine intolerance, terfenadine premedication significantly eliminated symptoms in 10/12 patients during a subsequent wine test 1
• Storage conditions matter - even wines with initially low histamine content can develop higher levels during aging 2

For those with severe histamine intolerance, complete avoidance of all alcoholic beverages, including white wine, is the safest approach.