Alcohol intolerance

Overview

Alcohol intolerance is a genetic condition in which the body can't break down alcohol efficiently. Alcohol intolerance can cause immediate reactions after you drink alcohol. The most common reactions are stuffy nose and flushed skin. The only way to prevent these reactions is to avoid alcohol.

Many people have reactions with various alcoholic drinks. These people may think they have alcohol intolerance. But these reactions are different from alcohol intolerance.

Alcohol intolerance and alcohol allergy are different. True allergies to alcohol are rare. More commonly, symptoms related to alcoholic beverages might be an allergic reaction to something in the alcoholic beverage, such as sulfites, grains or preservatives.

Combining alcohol with some medicines also can cause reactions.

Symptoms

Symptoms of alcohol can include:

• Facial blushing or flushing.
• Red, itchy skin bumps, known as hives.
• Worsening of preexisting asthma.
• Runny or stuffy nose.
• Low blood pressure.
• Nausea and vomiting.

When to see a doctor

For a mild intolerance to alcohol, you don't need to see a healthcare professional. Simply avoid alcohol, limit how much you drink, or avoid certain types of alcoholic beverages.

But if you have a serious reaction or severe pain, see a healthcare professional. Also see a healthcare professional if your symptoms seem to be linked to an allergy or a medicine you're taking.

Causes

Alcohol intolerance happens when your body doesn't have the proper enzymes to break down the toxins in alcohol molecules. This is a caused by a genetic trait that is most often found in people of Asian ancestry. But anyone can have it.

Other ingredients that are in alcoholic beverages, especially in beer or wine, can cause reactions. These components include:

• Sulfites or other preservatives.
• Chemicals, grains or other ingredients.
• Histamine, which is a byproduct of fermentation or brewing.

In some people, a grain or another substance in alcoholic beverages can trigger a true allergic reaction. Common triggers can be grapes, wheat or rye.

Very rarely, people who develop reactions later in life may have a more serious condition, such as Hodgkin lymphoma.

Risk factors

Risk factors for alcohol intolerance or other reactions to alcoholic beverages include:

• Being of Asian descent.
• Having asthma or hay fever, also called allergic rhinitis.
• Having an allergy to grains or to another food.

Complications

Depending on the cause, complications of alcohol intolerance or other reactions to alcoholic beverages can include:

• Migraines. Drinking alcohol can trigger migraines in some people, possibly as a result of histamines contained in some alcoholic beverages. The immune system also releases histamines during an allergic reaction.
• A severe allergic reaction. In rare instances, an allergic reaction can be life-threatening. This is known as an anaphylactic reaction. Symptoms may include a severe skin reaction, weak pulse, vomiting or trouble breathing. An anaphylactic reaction requires emergency treatment.

Prevention

Nothing can prevent reactions to alcohol or ingredients in alcoholic beverages. To avoid a reaction, don't drink alcohol or the particular type of alcoholic beverage that causes your reaction.

Read beverage labels for the ingredients or additives you know cause a reaction, such as sulfites or certain grains. But be aware that labels might not list all ingredients.

Diagnosis

Besides doing a physical exam, a healthcare professional may request these tests:

• Skin test. A skin test can show whether you might have an allergy to something in alcoholic beverages, for example, the grains in beer. Your skin is pricked with a tiny amount of a substance that could be causing your reaction. If you're allergic to the substance being tested, you'll develop a raised bump or other skin reaction.
• Blood test. A blood test can measure your immune system's response to a particular substance. It looks for allergy-type antibodies in your bloodstream called immunoglobulin E antibodies. A blood sample is sent to a laboratory to check reactions to certain foods. These tests aren't always accurate.

Treatment

The only way to avoid alcohol intolerance symptoms or an allergic reaction is to avoid alcohol or the beverage or ingredients that cause the problem.

For a minor reaction, antihistamines might help reduce symptoms, such as itching or hives. You can get them without a prescription. If you need a stronger antihistamine, see a healthcare provider for a prescription.

Preparing for your appointment

Although alcohol intolerance usually isn't a serious issue if you don't drink alcohol, you might want to discuss it with your healthcare team at your next appointment. Here's some information to help you get ready.

What you can do

Make a list of:

• Your symptoms, including any that seem unrelated to the reason for which you scheduled the appointment, and when they happen.
• Key personal information, including major stresses or recent life changes. Stress can sometimes worsen allergic reactions or sensitivities.
• All medicines, vitamins or supplements you take and the dosage.
• Questions to ask during the appointment.

For alcohol intolerance, some questions to ask include:

• What do you think is causing my reaction to alcoholic beverages?
• Are any of my medicines likely causing or worsening my reaction to alcohol?
• Other than the most likely cause, what are other possible causes of my symptoms?
• What tests do I need?
• What treatments are available?
• Do I need to give up alcohol?

Don't hesitate to ask other questions.

What to expect from your doctor

You may be asked:

• When did you notice a reaction to alcoholic beverages?
• What alcoholic beverages trigger your symptoms? Are you bothered by beer, wine, mixed drinks or a particular type of liquor?
• How severe are your symptoms?
• How long does it take for symptoms to appear after drinking the beverage?
• How much of the beverage do you drink before you notice a reaction?
• Have you tried nonprescription allergy medicines, such as antihistamines, for your reaction, and if so, did they help?
• Do you have allergies, such as to particular foods or to pollens, dust or other airborne substances?

What you can do in the meantime

Avoid the beverage or beverages that seem to cause your reaction until your doctor's appointment.

If you drink a beverage that causes a mild reaction, antihistamines you can get without a prescription might help relieve symptoms. However, for a severe skin reaction, weak pulse, vomiting or trouble breathing, seek emergency help, as you could be having an anaphylactic reaction.