Allergy diet - alcohol free

Aim

To provide a diet that excludes all sources of alcohol (ethanol) added to or present in foods, to avoid reactions in individuals with personal or medical requirements to exclude alcohol.

Characteristics

Avoid all sources of alcohol.

This includes:

• alcoholic beverages, such as wine, fortified wine (brandy, port and sherry); beer (ale, lager); cider; distilled beverages (whisky, rum and vodka) and liqueur
• flavourings suspended in alcohol, such as extracts
• vinegar directly derived from alcohol or grapes, such as rice vinegar, wine vinegar and balsamic vinegar
• some soy sauces
• some mustards
• fermented beverages, such as kefir and kombucha, where alcohol remains after the fermentation process
• brewed soft drinks, such as ginger beer
• ‘grape must’ as there is no control over production and consumption times
• products with alcohol as an ingredient, even if the alcohol content is reduced during the cooking process.

This diet does not exclude foods that may utilise ethanol fermentation in manufacture, such as breads made with yeast or vinegars derived from non-alcohol sources, for example, white vinegar.

Indications

All patients who have a preference or medical requirement to avoid alcohol should be ordered this diet unless a medical officer or dietitian has advised otherwise.

Patients who are prescribed alcohol-aversive or alcohol-sensitising pharmacological agents, e.g., disulfiram.

If the patient observes Islamic practices, the halal diet may be more appropriate as it includes other dietary considerations.

Nutritional adequacy

This diet can be nutritionally adequate.

Precautions

If the patient has an allergy or intolerance to ingredients potentially found within alcoholic beverages, such as gluten, wheat, egg, preservatives, salicylates or amines, the appropriate diet must be ordered.

The Australia New Zealand Food Standards Code requires a statement of the alcohol content for beverages if they contain more than 0.5% alcohol by volume. Foods (and beverages) are required to carry a statement of the alcohol content if they contain more than 1.15% alcohol by volume. Some of the products identified as potentially unsuitable on this diet may have an alcohol content below these labelling thresholds. Therefore, it is recommended to confirm with manufacturers the presence or absence of alcohol in specific products. Clarification may also be required for foods containing compound ingredients to determine their suitability.

It is not possible to provide a full list of all permitted commercial products. The following suggestions are general guidelines only.

Alcohol flavourings are not made with alcohol but are excluded from this diet.

Paediatrics

Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	All others	Those containing any added alcohol or ingredients containing alcohol. For example, casseroles, bolognaise, mixed pasta or rice dishes, stews, lasagne etc. Meats with a soy or mustard-based marinades
Sauces, gravies	All others	Those containing any added alcohol or ingredients containing alcohol, e.g., red wine jus and those containing soy or mustard
Starchy vegetables / pasta / rice	All others	Those containing any added alcohol or ingredients containing alcohol. For example, alcohol may be present in risotto, mixed pasta dishes etc
Vegetables	All	-
Soups	All others	Those containing any added alcohol or ingredients containing alcohol, e.g., sherry
Sandwiches	All	-
Salads, dressings	All others	Those containing any added alcohol or ingredients containing alcohol. For example, dressings containing vinaigrette with grape must, balsamic vinegar etc, some mustards
Breads, cereals	All	-
Spreads	All others	Those containing any added alcohol or ingredients containing alcohol
Hot breakfast choices	All	-
Fruit	All	-
Yoghurt	All others	Those containing any added alcohol or ingredients containing alcohol
Desserts	All others	Those containing any added alcohol or ingredients containing alcohol. For example, desserts made with vanilla extract in alcohol, brandy custard, tiramisu, Christmas pudding etc
Milk and cheese	All others	Those containing any added alcohol or ingredients containing alcohol, e.g., egg nog
Beverages	All others	Those containing any added alcohol or ingredients containing alcohol, e.g., kombucha, ginger beer, keffir
Biscuits	All others	Those containing any added alcohol or ingredients containing alcohol. For example, brandy snaps, biscuits made with vanilla extract in alcohol
Miscellaneous	All others	Those containing any added alcohol or ingredients containing alcohol. For example, soy sauces, liqueur or alcohol-filled chocolate and cakes with alcohol-soaked fruit

References

1. Chen C-H, Ferreira J, Joshi A, Stevens M, Li S-J, Hsu J, Maclean R, Ferreira N, Cervantes P, Martinez D, Barrientos F, Quintanares G, Mochly-Rosen D, 2020, Novel and prevalent non-East Asian ALDH2 variants; Implications for global susceptibility to aldehydes’ toxicity, EBioMedicine, vol. 55.
2. MIMS Online Full Prescribing Information - Antabuse. [Cited 3 March 2021].
3. U.S. Department of Health and Human Services. Centre for Substance Abuse Treatment. Substance Abuse and Mental Health Service Administration; 2009. Incorporating Alcohol Pharmacotherapies into Medical Practice, A Treatment Improvement Protocol TIP 49.
4. Australia New Zealand Food Standards Code – Standard 2.7.1 – Labelling of alcoholic beverages and food containing alcohol (legislation.gov.au). [Cited April 2023].
5. Australia New Zealand Food Standards Code Standard 2.6.2 Non-alcoholic beverages and brewed soft drinks. Federal Register of Legislation. [Cited April 2023].