Have you ever gone out for drinks with friends and suddenly experienced uncomfortable symptoms of alcohol intolerance? Perhaps you've wondered whether it is an alcohol allergy.
The purpose of this article is to take an in-depth look at the symptoms, causes and risks associated with alcohol intolerance. It also aims to dispel the common confusion between a mere intolerance to alcohol and the much more severe symptoms of alcohol allergy.
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Alcohol intolerance is not an allergy to alcohol.
Can you be allergic to alcohol? Yes, but intolerance and an allergy are two very different things.
This distinction is essential and one that needs clarification before we talk about ways to help your intolerance to alcohol. The reason for this is that the consumption of alcohol can sometimes lead to fatal consequences for people with a real ethanol allergy, as opposed to a mere intolerance.
Furthermore, some people may have a specific alcohol allergy, like a vodka allergy or wine allergy. The only way to reliably know whether you have an intolerance or allergy is to see your doctor and undergo the proper testing discussed below.
What is an alcohol allergy?
Luckily for most, a real allergy to alcohol is rare but comes with some very severe symptoms.
If you have an alcohol allergy, even a sip of alcohol can cause symptoms. In some cases, it can result in anaphylactic shock and death. Other symptoms can vary from difficulty breathing to unconsciousness. The surest way to know if you are allergic to alcohol or are merely intolerant is to visit an allergy specialist and have yourself tested.
According to the Australasian Society of Clinical Immunology and Allergy's article, alcohol allergy symptoms can include:
- itchiness of the eyes, nose or inside the mouth
- eczema, hives or general itchiness of the skin
- swelling of the face, neck and other body parts
- blocked nose, congestion
- wheezy, restricted or laboured breathing
- abdominal pain, vomiting or diarrhoea
- dizziness or loss of consciousness
Alcohol allergy test - How to get tested for alcohol allergies
If you think that you are allergic to alcohol, a doctor can arrange a test for you. Getting an allergy test done is the only way to know the allergy relates to ethanol itself, or certain ingredients in beverages, like rye, grapes or gluten.
A skin-prick test is also highly effective in testing for allergies. Your doctor will prick your skin with various allergens. If that section of skin reacts to the substance, then you’ll know that you’re allergic to that particular ingredient.
Keeping a food diary for a few weeks can also be helpful. Recording what you consume and when, along with any accompanying symptoms, is vitally important. The doctor will be then able to see what could be causing the reaction.
How do alcohol allergies start?
It begins with exposure to an allergen. In this case, alcohol. This reaction can happen suddenly after a lifetime of drinking alcohol without any trouble.
If the body identifies the alcohol as a threat, the immune system makes a record of it and produces antibodies to prepare for the next time it encounters the danger.
When you come across this allergen again, the antibodies recognise it and activate what is known as mast cells.
These mast cells then release histamines that bind to receptors around the body and cause the symptoms of alcohol allergy listed above.
An allergy to alcohol should never be ignored and pushed aside. If left untreated, it can quickly become worse.
Luckily, according to the Australasian Society of Clinical Immunology and Allergy, most people who think they have an alcohol allergy have an intolerance instead. As mentioned earlier, a real alcohol allergy is very rare.
Alcohol intolerance symptoms
One of the most common alcohol intolerance symptoms is getting red facial flushing, often referred to as the alcohol flush reaction. It is sometimes incorrectly referred to as an Asian alcohol allergy. Unfortunately, this one is difficult to hide.
Other symptoms of alcohol intolerance include:
- swelling around the eyes
- rapid heartbeat
- red flushing on the neck, chest or arms
- wheezy or restricted, laboured breathing
- pulsing headache
- nasal congestion or a stuffy nose
The onset of symptoms is usually noticed by slightly more laboured breathing after consuming alcohol. Most sufferers will first report minor breathing difficulties, traditionally accompanied by a noticeable increase in heart rate.
Approximately 20 to 30 minutes after alcohol consumption, sufferers will feel a hot or tingling sensation around the eyes, cheeks, forehead and ears. Following these symptoms is commonly a red flushing skin reaction lasting anywhere between 30 minutes to a few hours. The duration depends on the amount of alcohol consumed and a person's tolerance to alcohol.
More severe cases of intolerance can also involve headaches that occur approximately one to two hours after alcohol consumption and last up to several hours.
Even though these symptoms are not as severe as an alcohol allergy, they are still unpleasant and uncomfortable.
Alcohol intolerance causes
Alcohol intolerance can be caused either by a genetic trait or a damaged liver, the former being the primary reason.
The following are the most common causes of alcohol intolerance:
In this case, a person suffering from alcohol intolerance has problems breaking down alcohol in their body. The cause of this is a genetic deficiency in the ALDH2 enzyme, which affects the way the liver metabolises alcohol. This deficiency results in an accumulation of a toxic metabolic byproduct called acetaldehyde.
In a healthy liver, acetaldehyde is broken down into a harmless, non-toxic substance called acetate and won't cause any severe symptoms. Unfortunately, this doesn't happen to someone dealing with alcohol intolerance. The toxic acetaldehyde continues to build-up in their system while they drink alcohol and brings about the uncomfortable and sometimes painful symptoms mentioned above.
According to Dr Benjamin Voight, PhD and associate professor in the Perelman School of Medicine at the University of Pennsylvania:
"Acetaldehyde itself is toxic, and when accumulated causes flushing and is associated with the feelings we associate with hangovers."
"Carriers of the inactive enzyme are extremely slow to metabolise acetaldehyde, as a result, they experience higher internal levels of acetaldehyde and have much higher risks of oesophageal cancer and cancers of the head and neck compared with individuals with the active enzyme."
Therefore, uncomfortable symptoms like red facial flushing, congestion and increased heartbeat are not the only concern. It can also cause serious long-term harm like an increased risk of cancer.
Our bodies naturally created histamines which are chemicals also found in certain foods and alcoholic drinks like beer, champagne and wine. When histamine is not adequately broken down, it accumulates. This build-up causes symptoms with an accent on nasal congestion and skin flushing.
According to researchers in the Department of Dermatology at the University of Bonn, the build-up develops because of a dysfunction in one or two of the following enzymes: Diamine Oxidase (DAO) and histamine-N-methyltransferase (HNMT). By not processing the histamine correctly, one may experience symptoms similar to those of an allergic reaction.
Sulfites have been very useful to us from Roman times as additives for preserving foods and beverages while preventing bacterial growth. However, sulfates can be found naturally in many alcoholic drinks like wines (mainly white), beer, vermouth, sake and some others.
If you have a sensitivity or intolerance to sulfites, the reaction may increase when consuming sulfites-rich alcohol. The symptoms are similar to those caused by histamine intolerance and can easily be confused with allergy-like symptoms. Doing a test can confirm or deny the actual cause of the alcohol intolerance.
Some people may experience uncomfortable symptoms when drinking alcohol because they are intolerant to an ingredient in the drink. Grapes, wheat, hops and gluten may be present in the alcoholic beverage, which is causing the problems, instead of the reasons mentioned above. By knowing what ingredients cause you issues, you can avoid those drinks and make an informed decision about what to drink.
Non-alcohol related allergies
Sometimes the consumption of alcohol itself can increase sensitivity to pre-existing allergies. In a 2005 Swedish Study of several thousand individuals, researchers found that people with asthma and hay-fever had a higher chance of experiencing breathing difficulties after consuming alcohol. The study founds that grape-based wine was the most frequent trigger, with women being approximately twice as likely to be affected as men.
Regular alcohol consumption has also been shown to aggravate other allergy symptoms. In a 2008 study of thousands of women, researchers found that exceeding more than two glasses of wine a day nearly doubled the risk of participants experiencing non-alcohol allergy symptoms. These finding also included women who did not have seasonal and perennial allergies when they started the study.
Alcohol intolerance health risks
The body is smart. When it reacts negatively to external stimuli, it could be a sign to stop consuming whatever it was that caused it (at the very least in the short term).
In the case of alcohol and the various negative symptoms discussed above, the body is very much giving us a warning sign that something is not right.
This logic is consistent with warnings from governmental bodies such as the United States Department of Health Services and the International Agency For Research On Cancer. Both agencies have issued media releases specifically warning people with alcohol intolerance of their heightened cancer risks from alcohol consumption.
If you want to find out more about these risks, please have a read of our article titled: Debunking the Asian Flush Cancer Myth.
How alcohol intolerance impacts your life.
Living with the symptoms of alcohol intolerance is difficult. In many cultures, alcohol is the unequivocal drink of choice when it comes to celebration, dating and even doing business. It underpins our general enjoyment of life, relationships and even professional networking.
That's not to say you can't have a great social or professional life if you have alcohol intolerance. However, it's sometimes easy to feel left out. You may decide to drink less, or even nothing at all, in fear of suffering embarrassing symptoms in public like Asian flush, hives and alcohol-related headaches.
It's natural to care about how we look. Most of us take pride in the clothes we wear, our hairstyle, skin complexion and general appearance, especially before going out to socialise or preparing for a special occasion.
Understandably, it is frustrating for people who are intolerant to alcohol when their symptoms come in the way of looking their best. Because let's face it, a red face from alcohol is not the ideal 'look' you'd choose for a hot date or business meeting.
The good news is, a basic understanding of alcohol intolerance is the first step towards enjoying a more vibrant social and professional life.