Have you ever gone out for drinks with friends and suddenly experienced uncomfortable symptoms of alcohol intolerance? Perhaps you've wondered what the cause of this is, if it is an allergy and whether it poses any serious health risks.
The purpose of this article is to take an in depth look at the symptoms, causes and risks associated with sudden alcohol intolerance. It also aims to dispel the common confusion between a mere intolerance to alcohol and the much more serious symptoms of alcohol allergy.
Table of Contents
- Alcohol intolerance impacts your life
- Alcohol intolerance is not an allergy to alcohol
- Am I allergic to alcohol?
- Should I see a doctor about my alcohol allergy?
- How do alcohol allergies start?
- Alcohol intolerance symptoms
- Alcohol intolerance causes
- Alcohol intolerance health risks
- Pharmacological research into alcohol intolerance
- A note about other causes
Jump to: Alcohol intolerance treatments
Alcohol intolerance impacts your life
Living with 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 make the decision to drink less, or even nothing at all, in fear of suffering embarrassing symptoms in public like a red flushed face, hives and 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 blotchy and swollen red face is hardly the image you'd choose for a date or to close an important business deal.
The good news is, a basic understanding of alcohol intolerance and its various symptoms, causes and risks, is the first step towards enjoying a richer social and professional life.
Before going into depth about the various causes, symptoms and risks associated with alcohol intolerance, it is first necessary to distinguish it from the much more serious symptoms of alcohol allergy.
Alcohol intolerance is not an allergy to alcohol
Can you be allergic to alcohol? Yes, but alcohol intolerance and an alcohol allergy are two very different things.
This is an important distinction and one that needs to be made before we talk about ways to help solve your intolerance to alcohol. This is because the consumption of alcohol can sometimes lead to fatal consequences for people with a real allergy to alcohol, 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 relevant testing discussed below.
Am I allergic to alcohol?
Luckily for most, a real allergy to alcohol is rare but comes with some very severe symptoms.
If you have a true 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 labored breathing
- abdominal pain, vomiting or diarrhea
- dizziness or loss of consciousness
Alcohol allergy test - How to get tested for alcohol allergies
If you do think that you could be allergic to alcohol, make sure to see your doctor as a matter of priority. Getting an allergy test done is the only way to know the allergy relates to alcohol itself, or certain ingredients in alcohol, 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 substances that you may be allergic to. 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. By recording what you consume and when, along with any accompanying symptoms, you and your doctor will be able to see what could be causing the reaction.
Should I see a doctor about my alcohol allergy?
It’s best to visit your doctor if you ever experience severe symptoms or pain when drinking alcohol. It’s far more beneficial to understand your allergies than hoping they go away.
If you experience immediate severe symptoms after minimal alcohol ingestion, like one sip of wine, then it's more likely to be an allergy than an alcohol intolerance. Some believe that having this type of allergy is specifically a wine allergy, beer allergy, or even a vodka allergy.
By visiting a doctor, you’ll be able to get tailored advice and details on your particular allergies and avoid potentially life-threatening reactions.
How do alcohol allergies start?
It begins with exposure to an allergen. In this case, alcohol. This 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 against it to be prepared for the next time it encounters the threat.
When you come across this allergen again, the antibodies recognise it and activate what are known as mast cells.
These mast cells then release histamines that bind to various histamine receptors around the body and in turn 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. A possible alcohol allergy should be discussed with your doctor before drinking alcohol since, in rare cases, severe allergic reactions can be fatal.
Luckily, according to the Australasian Society of Clinical Immunology and Allergy, most people who think they have an alcohol allergy actually have an intolerance instead. As mentioned earlier, a true 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 alcohol flush reaction. 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
The onset of symptoms is usually noticed by slightly more labored breathing after consuming alcohol. Most sufferers will first report minor breathing difficulties, usually 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. This is soon followed by a red flushing skin reaction that lasts anywhere between 30 minutes to a few hours depending on the amount of alcohol consumed and a person's individual 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 serious and can be incredibly uncomfortable.
Alcohol intolerance causes
Alcohol intolerance can be caused either by a genetic trait or a damaged liver, the former being the primary reason. This being said, the following are the most common causes:
In this case, a person suffering from alcohol intolerance has problems breaking down alcohol in their body. This happens due to a genetic deficiency in the way they metabolise alcohol in their liver and their body gets flooded by a toxic by-product of alcohol called acetaldehyde.
In a normal liver, acetaldehyde is broken down into a harmless non-toxic substance called acetate and won't cause any serious symptoms. Problem solved. But 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.
It has also been reported that acetaldehyde can cause long-term issues for those who deal with alcohol intolerance. In 2009, the International Agency for Research on Cancer (IARC) stated in a press release:
"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."
Not only does this process cause uncomfortable symptoms like red facial flushing, congestion and increased heartbeat, it can also cause serious long-term harm like an increased risk for cancer.
Our bodies naturally created histamines which are chemicals that are also found in certain foods and alcoholic drinks like beer, champagne and wine. When the ingested histamine is not properly broken down it accumulates, just as the previously-mentioned acetaldehyde, in this manner causing the aforesaid symptoms with an accent on nasal congestion and skin flushing.
This histamine build up develops due to improper metabolization of the ingested histamine by one or two of the following enzymes: Diamine Oxidase (DAO) and histamine-N-methyltransferase (HNMT). So, by not processing the histamine correctly, which is usually the main job of the DAO enzyme, one can experience symptoms similar to those of an allergic reaction, which is why these two conditions are often not so distinguishable.
Sulfites have been very useful to us from Roman times onward, since these compounds are used as additives for preserving foods and beverages while preventing bacterial growth. However, sulfates can be found naturally in many alcoholic drinks like wines (especially white), beer, vermouth, sake and some others.
If you have a sensitivity or intolerance to sulfites, the reaction may be increased when consuming sulfites-rich alcohol. The symptoms are similar to those caused by histamine intolerance, meaning that they can easily be confused with allergy-like reactions, so by doing an intolerance test you can confirm or deny this cause for your alcohol intolerance.
Some people may experience uncomfortable symptoms when drinking alcohol because they are actually intolerant to an ingredient in the drink. Grapes, wheat, hops and gluten may be present in the alcoholic drink which is actually causing the problems, instead of the reasons mentioned above. By knowing what ingredients cause your body issues, you can avoid those drinks and make an informed decision about what you'll drink.
Non-alcohol related allergies
Sometimes the consumption of alcohol itself can increase sensitivity to pre-existing allergies. For example, a 2005 Swedish Study of several thousand individuals found that, compared with the general population, people with asthma and hay-fever had a greater chance of experiencing breathing difficulties after consuming alcohol.
Wine showed up as being 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 allergy symptoms. This also included women who did not have seasonal and perennial allergies when they started the study.
Alcohol intolerance health risks
The body is smart. Whenever it reacts negatively to external stimuli it is usually a good idea 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 warning has been publicly reiterated by governmental bodies such as the United States Department of Health Services and the International Agency For Research On Cancer. Both agencies have issued media released specifically warning people with genetic alcohol intolerance (i.e. Asian flush) of their heightened cancer risks from alcohol consumption.
If you want to find out more about these cancer risks, please have a read of our article titled: Debunking the Asian Flush Cancer Myth. In short, those of us who exhibit negative symptoms when consuming alcohol may have a greater risk of developing certain types of cancers.
Pharmacological research into alcohol intolerance
Back in 2007, a company called Raptor Pharmaceuticals developed a drug that claimed to tackle the symptoms of ALDH2 deficiency - i.e. the genetic alcohol intolerance.
On the road to commercialising their drug, Raptor Pharmaceutical initiated a phase 2a clinical trial for Convivia that was aimed at establishing a scientific basis for the efficacy of the treatment. The results demonstrated that the active ingredient in Convivia significantly reduced heart palpitations and also reduced peak acetaldehyde levels and total acetaldehyde exposure.
It is worth noting that they make no mention of its efficacy in addressing the red flushing commonly experienced on the face, neck and upper body.
From what we can tell about the Convivia release date, development of the drug has been stagnant for the most part of that last decade and doesn't appear to be getting ready for commercialization anytime soon.
A note about other causes
Beware that alcohol intolerance can also occur due to antibiotics or anti-fungal medication use as they can sometimes prevent the ALDH enzyme from working properly, so talk to your doctor if you think this or liver damage is the cause.