What should you know about hives after drinking alcohol?

Hives are itchy, raised welts that can appear soon after drinking and then change or fade. The trigger may be the alcohol itself, an ingredient such as a flavouring or preservative, or a food eaten alongside the drink. Heat, exercise and infection can also overlap with the timing.

Flushing alone is different from hives, but a reaction can include skin rash, itchy skin or swelling. Keep track of the drink, ingredients, amount, food and symptoms rather than assuming one cause.

Stop drinking and avoid the suspected drink until you have medical advice. Write down the brand or ingredients, timing, foods, medicines and symptoms; photographs can help if the welts disappear before review. Do not test the drink again to see whether the reaction returns.

A clinician or pharmacist can discuss whether oral antihistamine treatment is suitable. Do not mix medicines with alcohol, and do not use someone else’s emergency medication.

Get emergency help for difficulty breathing, wheezing, faintness, repeated vomiting, or swelling of the lips, tongue or throat. These symptoms can signal a severe allergic reaction. Seek medical review for recurrent episodes, extensive skin swelling, or a rash after a new medicine.

Could the reaction be caused by an ingredient rather than alcohol? Should I avoid all alcoholic drinks or a particular product? Is an antihistamine appropriate? Do I need an emergency action plan or allergy assessment?