COVID19 & Alcohol Intolerance

Several people who have recovered from the coronavirus have reported a new intolerance for alcohol. Some find themselves unable to have a single beer or one glass of wine without new negative effects, even months after all of their COVID19 symptoms have subsided. These people report increased “hangover” symptoms that seem to come on just minutes after having one drink. Some have even concluded that alcohol gives them a COVID “relapse” due to the fact that they become sick for 1–3 days after having, again, as little as just ONE beer.

This phenomenon made me very curious, so I set out to understand what the connection between surviving COVID and experiencing a new alcohol intolerance might be. I found out, through my non-academic, unofficial study of the subject, that these little guys called histamines might actually be responsible for this new intolerance. If you’ve had the novel coronavirus and now you have a novel bad time with booze, you may be interested in the theory I’ve thrown together below.

Bear with me, this is probably not organized like a real science paper, I’m definitely not a doctor or a scientist, and not all of my sources are from peer-reviewed medical journals, though some, indeed, are. If you can handle all that, allow me to introduce you to what I affectionately call Post-Covid19 Alcohol Induced Histamine Intolerance!

Anecdotal Evidence of Post-COVID19 Alcohol Induced Histamine Intolerance

The following are twenty-five personal testimonies gathered anonymously on Reddit and Facebook from people who tested positive for COVID19, recovered, and later experienced increased negative effects associated with alcohol consumption.

1. I had about 1.5 drinks 10 days after COVID and felt noticeably bad. This may have been too soon to consume alcohol in hindsight. It felt like my body wanted to reject it.

2. I had Covid in November (2020) and now drinking is… different. I have way less tolerance and I don’t feel well as soon as I start.

3. I don’t drink very often, but now consuming alcohol feels like an allergic reaction. It just started after I was infected.

4. I tested positive on Dec 1st. I drank before I got sick (not an absurd amount) and have never really had problems with alcohol. I mainly just drink wine & beer. Since getting better, nearly every time I drink even just a few sips of wine, I start feeling absolutely awful. It’s mostly in my head, where the virus affected me most — my sinuses. It’s not necessarily a BAD thing that I can’t really drink, but I do enjoy a glass of wine every now and then & I’m a bit bummed that I can no longer do that.

5. I don’t know if there is a fix, but alcohol makes my COVID symptoms relapse, to the point I’m scared of drinking at all. My labs show significant levels of histamines, which would explain the alcohol intolerance I developed after COVID.

6. I was sick for almost 2 weeks with COVID. I had felt back to 100% for a week, so I went out drinking. Not too much, like 5 drinks in 5 hours (I’m 6ft 200lbs). I felt horrible all night and couldn’t sleep. It’s been a few days since and I felt fine again, so last night I had a few beers at home, and today I feel like I’m sick again. Needless to say I won’t be drinking for a while.

7. I had a drink last night and woke up feeling awful everywhere. It has happened every time I’ve had a drink since having COVID.

8. I had COVID in July (2020). I felt like I almost died on the first day symptoms showed. The next day was way better but I noticed my body felt weird. However, after a week I felt fine. Fast forward to August, I wanted to have a couple drinks on my birthday with my girlfriend at home. I didn’t drink too much, but when I woke up, I felt absolutely horrible. Puked my guts out. I tried again in September and the same thing happened. Then I didn’t try again until January (2021). I felt weird but no puking. I think the effect reduces over time.

9. Every time I have had a drink since COVID I feel awful. The next morning my sinuses are super stuffy and I feel sick.

10. After COVID, my tolerance has changed massively. I don’t really ‘feel’ the alcohol anymore. I just get really tired and have to sleep.

11. I had 1.5 glasses of wine the other night and felt completely hung over the next day, as if I had had 2 bottles.

12. I’ve had different ranges of reactions from only having shortness of breath to having mild fever and dry cough.I was positive for COVID in March (2020). I don’t consume alcohol on a daily basis, mostly just on weekends. I typically only have 1–2 cocktails or 2 glasses of wine. It has been a recurring theme for the past month that I start having symptoms again after drinking. I’m currently not drinking alcohol at all in fear of becoming bedridden again.

13. I am COVID positive. My symptoms get worse from even a half a glass of beer. I also can’t have any dairy or coffee. I’m on a low inflammation diet now, drinking alkaline water, and ginger boiled in water/tea of sorts. This seems to be helping a bit.

14. I have noticed that my hangovers seem to be worse, post-COVID. I caught it back in March (2020) and now nearly a year later I am noticing that my hangovers are horrible, often lasting 2 days after 4 or 5 drinks and not even staying up late. I have heard some of my friends mention having the same experience after COVID.

15. I go COVID a month and a half ago. After feeling better, every time I drink, I wake up the next day with nasal congestion, anxiety and fogginess, no matter how little I drink.

16. I can no longer drink more than two beers or it feels like I went out clubbing. I was hungover for like 2 days with my heart racing after just a few beers.

17. I had my first alcoholic beverage since having COVID about 3 to 4 weeks after testing positive. It felt weird. Next beer was about 5 weeks later.That felt fine, so the next day, I had around 6 beverages over the course of 6 hours. The day after that, I had an awful hangover. By mid afternoon I was in a total relapse of COVID symptoms. I eventually went to the urgent care due to my high heart rate. About a week ago, I had two beverages, spaced out an hour apart. I still felt weird. I’m done with alcohol for now.

18. Since having COVID, I have had a rash on my face that improves with Zyrtec. Alcohol exacerbates it and makes it swell.

19. Since COVID, alcohol makes my joints hurt, my heart rate goes up, and after one glass I feel sick to my stomach, almost like an instant hangover.

20. I was beginning to feel a little better so I thought I’d treat myself to a lager, which I have never had any issues with in the last. But this time my whole face, legs and arms turned bright red and were burning! Not having even thought about the beer, I had another the next night and the exact same thing happened. Haven’t touched beer since.

21. I can’t handle drinking now. I always enjoyed wine and beer seltzers prior to Covid, but now they make me sick.

22. I recently had a sangria after recovering from COVID and felt fine at first. Two hours later I felt awful and had to lie down

23. I had one glass last night. and it was almost like an instant hangover after 20–30 minutes.

24. After COVID, I immediately have a splitting headache and nausea after drinking.

25. I got COVID in November (2020). Now if I drink even a little, my face gets red and hot to the touch and I feel very tired and mildly depressed. I then get a headache and some congestion the next day. It all starts within an hour of having a drink.

Incidence of Self-Reported Symptoms

The table below records the incidence of symptoms reported in the testimonies above. It should be noted that the participants were not asked about any specific symptoms.

Histamine Intolerance (HIT) Symptoms

I found that the symptoms described in the testimonies above happen to be consistent with the symptoms of histamine intolerance, which is why I titled this experience the way I did. Here are some of the symptoms associated with HIT according to some sources I found online. The first one features fancy words for “congestion,” “hives,” and “itching.”

“The ingestion of histamine-rich food or of alcohol or drugs that release histamine or block DAO may provoke diarrhea, headache, rhinoconjunctival symptoms, asthma, hypotension, arrhythmia, urticaria, pruritus, flushing, and other conditions in patients with histamine intolerance” (Maintz L, Novak N. 2007)

“Impaired histamine degradation due to enzyme deficiency or inhibition can result in histamine toxicity and numerous symptoms that mimic an allergic reaction:

• Skin: itchiness, redness, rash/ eczema, hives
• Gastro-intestinal tract: stomach acid reflux, diarrhoea, nausea, vomiting
• Respiratory: runny nose, broncho-constriction, asthma, chronic cough, nasal congestion
• Vascular: (vasodilation) low blood pressure, dizziness, fainting, rapid heart beat, oedema, migraine/ headaches
• Neurological: insomnia, anxiety, memory” (LifecodeGx website)

“Within minutes a person exposed to histamine may experience flushing of face, nausea, headache, runny nose or congestion, dizziness, racing heart, anxiety” (Power2Practice website)

Immunological Role of Histamine

Histamine is a compound utilized by mast cells in the natural immune response of the body. Mast cells are immunity cells that release “mediators” when activated. Mediators are compounds that facilitate inflammation, and histamine is the primary mediator released by mast cells. Mediators like histamine increase the permeability of blood vessels and tissues to allow white blood cells and plasma to enter tissues more easily to address a threat.

When you have a cut or a splinter and the skin surrounding the wound swells, turns red and gets warm, that is a direct result of the inflammatory response. Mast cells in the surrounding area release histamine which makes it possible for lots of white blood cells and plasma to enter the affected area, causing the swelling symptoms.

COVID19 and Mast Cell Activation

COVID19 is an “emerging” condition, as any online medical journals will remind you in bold banners, meaning that we still have much to learn about the virus and, in less scientific terms, we should take any research developments on it with a grain of salt, because our understanding is evolving rapidly. That said, we do seem to be fairly sure that inflammation plays a big role in the severity of symptoms a COVID patient might experience.

Cytokines are particularly nasty players in the lung damage seen in severe cases. You may have heard the term “cytokine storm” more than once over the last year of this pandemic. My uneducated understanding is that cytokines are mediators released by white blood cells. I think it’s safe to say that they share some similarities with histamines in their mediating function, but I will leave the specifics to the professionals. I know for sure that accumulation of cytokines has been implicated in some of the worst COVID symptoms.

But leukocytes aren’t the only immune cells throwing a mediator party in response to COVID, it turns out. There is evidence that mastocytes, those mast cells, are also activated in the inflammatory response to the coronavirus. A study done last summer found that “the development of clinical COVID-19 involves dysfunctional mast cell activation and histamine release.” (Malone R. et al. 2020)

That’s significant to my scientific-sounding, unscientific proposal of Post-COVID19 Alcohol Induced Histamine Intolerance (PCAIHIT — a 7 letter acronym for easy reference), because it means that tissue histamine levels may already be elevated in COVID survivors. In fact, the more I learn about the symptoms shared by so-called COVID “long haulers’’ and those presented by non-COVID positive patients with Mast Cell Activation Syndrome, the more I believe this to be plausibe.

The Role of Alcohol

Knowing now that histamine intolerance produces symptoms that are similar to the novel alcohol intolerance experienced by some COVID survivors, that histamine is an inflammatory mediator released by mast cells during natural immune response, and that there is some evidence that COVID19 in particular can cause dysfunctional mast cell activation and release of histamine, we need only to look back at the role of alcohol to tie up this whole thing in a gorgeous bow of little academic value.

As it just so happens to shockingly turn out, beer and wine are positively teeming with histamines! In fact, all aged foods are high in histamine content, and people with Histamine Intolerance (HIT) and Mast Cell Activation Syndrome (MCAS) are often put on low-histamine diets to avoid flare ups of their conditions. Alcohol almost always makes it to the top of the list of foods they need to avoid. Those folks already have abnormally high amounts of histamine in their tissues, so consuming foods that are high in histamine content can cause a sort of global immunological reaction by overdosing the body, more or less, with histamine. That is, in essence, the same mechanism of allergic reaction.

I will add, as a side note that I am not able to get into out of pure ignorance, that alcohol *might have a double whammy effect here in that it could also impair histamine degradation, along with caffeine, because of its blocking interaction with diamine oxidase (DAO), the enzyme that regulates histamine release. But that’s between you and Google.

The Gorgeous Bow

Here’s the pretty bow. If you have recovered from COVID and now find that you cannot enjoy even one beer, even one glass of wine without feeling terrible, breaking out in a rash, having a hot flash, a headache, nausea, or some sort of unexpected “hangover” symptom or “covid relapse,” you probably aren’t crazy. It may actually be that you are experiencing a histamine intolerance caused by leftover inflammatory responses to the virus. It may be that you are already teeming with histamines because COVID has caused a temporary dysfunction in mast cell activation for you and even one beer may be the straw that breaks the camel’s back, to use a medical expression.

You may want to avoid alcohol for a while. You may want to look up other high histamine foods and avoid those too. You can find plenty of diets designed for people with MCAS online, and it may be helpful to adopt one of those low-histamine diets for the time being. To alleviate the immediate effects of PCAIHIT (lol), you may try an antihistamine like Zyrtec. Do not reach for the Benadryl if you’ve had any amount of alcohol!

Final Thoughts

The most jarring conclusion I have reached in this very informal bit of pseudo-research is that diet MAY play a role in the severity of symptoms experienced by COVID19 patients. If COVID can cause mast cell activation irregularities, essentially giving you temporary MCAS, then couldn’t consuming high-histamine foods lead to worsened symptoms for those with active infection???

The 25 anecdotes reviewed above were from people who had already apparently recovered from COVID, and their dietary choices are definitely giving them symptoms AFTER apparently recovering. I can only guess that the MCAS symptoms may be even worse for those in the throes of the virus. Who knows? Certainly not I. But the lack of attention given to the role of diet in this disease is at least somewhat worrisome. It makes me wonder what other dietary choices could contribute to other COVID symptoms? Are there lifestyle choices that contribute to negative experience with cytokines, for example, or the many other medical doodads involved in the inflammatory response? Are some people suffering unnecessarily as a result?

My own wonderings are naturally teeming with ignorance, given how little I understand about medicine. But it’s notable to me that these possibilities are left unexplored in most of the reporting I have seen about this pandemic. My unofficial findings about the interactions between COVID, mast cells, histamines and alcohol have left me with doubts about our approach to the virus thus far and concerns for those suffering the worst cases of it. That said, I didn’t earn my MD at any point in the last couple paragraphs. All I can say for sure is I’m not having a beer anytime soon.