Alcohol Allergy: A Rare Condition Explained

Alcohol allergies are rare, but they can be severe and even life-threatening if untreated. An allergic reaction to alcohol occurs when the immune system overreacts to alcohol, treating it as a harmful substance. This can cause symptoms such as difficulty breathing, hives, swelling, or even anaphylaxis. Most people who have a reaction to alcohol don't have a true allergy but rather an intolerance, which is caused by a deficiency in an enzyme called aldehyde dehydrogenase (ALDH2) that breaks down alcohol in the body. Alcohol intolerance can cause symptoms such as flushing, rapid heart rate, headaches, and nausea. Whether it's an allergy or intolerance, it's important to speak to a doctor to understand the root cause and make informed decisions about your health and safety.

Alcohol intolerance vs. allergy

Alcohol intolerance and alcohol allergy are two different conditions that may share certain symptoms. However, they differ in terms of causes, severity, and treatment.

Alcohol Intolerance

Alcohol intolerance is a genetic condition in which the body cannot break down alcohol efficiently due to a deficiency in the enzyme aldehyde dehydrogenase (ALDH2). This enzyme is responsible for metabolizing acetaldehyde, the primary metabolite of alcohol, into a non-toxic substance called acetate. When this process is impaired, acetaldehyde builds up in the blood and tissues, causing uncomfortable symptoms. Alcohol intolerance is more common among people of East Asian descent, affecting between 30%-50% of this population.

Symptoms of alcohol intolerance typically appear shortly after alcohol consumption and can include flushing of the skin on the chest, neck, and face, nausea, vomiting, rapid heartbeat, low blood pressure, headaches, fatigue, and other hangover-like symptoms. While there is no cure for alcohol intolerance, the condition can be managed by avoiding or restricting alcohol consumption, choosing drinks low in sulfites and other preservatives, staying hydrated, and eating before consuming alcohol.

Alcohol Allergy

An alcohol allergy is an immune system response to an ingredient in alcohol, such as chemicals, grains, preservatives, or proteins in filling agents. True alcohol allergies, where an individual is allergic to the ethanol in alcohol, are rare. Alcohol allergies can cause more severe and painful symptoms than alcohol intolerance, including rashes, itchiness, swelling, severe stomach cramps, and in rare cases, anaphylaxis, a life-threatening allergic reaction.

If you suspect you have an alcohol allergy or intolerance, it is important to consult a healthcare professional for proper diagnosis and guidance. They may recommend avoiding alcohol or switching to different alcoholic drinks if you are allergic to specific ingredients.

Allergy symptoms

Alcohol allergies are uncommon, but they can pose a serious threat to one's health. An allergic reaction to alcohol does not necessarily indicate an allergy to alcohol itself. Instead, it is usually a response to an ingredient in the alcoholic beverage, such as grains, chemicals, or preservatives.

The symptoms of an alcohol allergy can vary and are often more painful and uncomfortable than alcohol intolerance symptoms. Here are some common allergy symptoms:

• Skin Reactions: Alcohol flushing syndrome, characterised by redness and warmth on the face, neck, and chest, is a common symptom of alcohol intolerance, but it can also occur in allergic reactions. Other skin-related allergy symptoms include itchiness, rashes, and hives.
• Respiratory Issues: Allergic reactions can lead to respiratory problems, such as a stuffy nose, asthma attacks, and difficulty breathing.
• Gastrointestinal Distress: Nausea, vomiting, abdominal pain, and severe stomach cramps are common gastrointestinal symptoms associated with alcohol allergies. Diarrhoea may also occur due to allergies to certain preservatives, such as sulfites.
• Cardiovascular Symptoms: Alcohol allergies can cause rapid or weak pulse, hypotension (low blood pressure), and tachycardia (rapid heartbeat) or heart palpitations.
• Anaphylaxis: In rare cases, an alcohol allergy can lead to anaphylaxis, a severe and life-threatening reaction. Symptoms of anaphylaxis include a rapid pulse, nausea, vomiting, swelling, difficulty breathing, dizziness, a drop in blood pressure, shock, and loss of consciousness. Anaphylaxis is a medical emergency that requires immediate treatment.

It is important to note that the symptoms of an alcohol allergy may vary from person to person, and some individuals may experience additional or different symptoms. If you suspect an alcohol allergy, it is crucial to consult a healthcare professional for proper diagnosis and guidance.

Allergy testing

Alcohol allergies are rare, but they can be severe and even life-threatening if untreated. An allergy occurs when the immune system overreacts to alcohol, identifying it as harmful. This causes the body to produce antibodies that trigger an allergic reaction. Symptoms of an alcohol allergy include rashes, itchiness, hives, swelling, severe stomach cramps, nausea, vomiting, coughing, a runny nose, and in extreme cases, anaphylaxis.

It is important to distinguish between an alcohol allergy and alcohol intolerance, as the latter is more common and is caused by a deficiency in an enzyme called aldehyde dehydrogenase (ALDH2) rather than an immune response. This enzyme is responsible for breaking down alcohol in the body, and a deficiency can result in symptoms such as flushing (a red face), rapid heart rate, headache, low blood pressure, hives, runny nose, and stomach pain. Alcohol intolerance can be inherited and is often treated by avoiding alcohol or limiting consumption.

If you suspect you have an alcohol allergy, it is important to consult a doctor or allergist, who can perform allergy tests and evaluate your symptoms. One such test is the ethanol patch test, where a drop of ethanol is placed on a gauze pad and taped to your arm for about seven minutes. If you are allergic, you may experience redness, itching, or swelling at the site. Another test is the skin prick test, where a small amount of the substance you may be allergic to is pricked into your skin, causing a raised bump if you are allergic.

If you are diagnosed with an alcohol allergy, the recommended treatment is to avoid alcohol entirely, as even small amounts can trigger a reaction. It is also important to check labels for hidden alcohol and be mindful of medications, mouthwashes, and foods that may contain alcohol. For severe allergies, always carry an epinephrine auto-injector and wear a medical alert bracelet.

Treatment options

It is important to differentiate between alcohol intolerance and alcohol allergy, as the former is a genetic metabolic disorder of the digestive system, while the latter is an immune system response to an ingredient in alcohol. Alcohol intolerance is primarily caused by an enzyme, aldehyde dehydrogenase (ALDH2) deficiency, which is more common in individuals of East Asian descent. This results in acetaldehyde buildup, causing symptoms such as flushing, rapid heart rate, headaches, and nausea. On the other hand, an alcohol allergy can trigger severe reactions, including anaphylaxis, requiring immediate medical attention.

• Avoidance: The primary treatment for both alcohol intolerance and allergy is avoidance of alcohol or the specific ingredients causing the problem. This may involve refraining from drinking altogether or being cautious to avoid exposure to the allergen in various forms.
• Antihistamines: For minor reactions, over-the-counter or prescription antihistamines may help reduce symptoms such as itching, hives, or rashes. Antihistamines like Benadryl can be used to alleviate mild to moderate allergic reactions. However, it's important to note that antihistamines do not address the underlying cause of the allergy.
• Skin and blood tests: Skin tests involve pricking the skin with a small amount of the suspected allergen to observe any reactions. Blood tests, on the other hand, measure the immune system's response to a particular substance by checking for immunoglobulin E antibodies. While these tests can help identify allergies to specific components in alcoholic beverages, they may not always be accurate.
• Medical consultation: It is recommended to consult a healthcare provider for an accurate diagnosis and personalized treatment plan. A medical professional can provide appropriate testing, considering an individual's detailed medical history, symptoms, and other factors.
• Allergy testing and prevention: Allergy testing can help identify specific allergens in alcoholic beverages, such as grains, preservatives, or proteins. This knowledge can aid in prevention by allowing individuals to make informed choices and avoid exposure to allergens.
• Support and helplines: Seeking support from organizations such as SAMHSA's National Helpline can provide valuable resources and referrals for individuals dealing with alcohol-related issues, including allergies. These services offer confidential treatment referrals, support groups, and community-based organizations to help manage and treat alcohol-related concerns.

Alcohol allergy causes

Alcohol allergy is an immune system response to an ingredient in alcohol. The allergy is rare, but if you have one, even a small amount of alcohol can trigger a reaction. Alcohol intolerance is distinct from an alcohol allergy, although the two conditions share some symptoms and are often confused.

Alcohol intolerance is a genetic condition in which the body cannot break down alcohol efficiently due to an enzyme, aldehyde dehydrogenase (ALDH2), deficiency. This causes acetaldehyde to build up in the blood and tissues, leading to symptoms such as nausea, vomiting, rapid heartbeat, low blood pressure, headaches, fatigue, and skin flushing. Alcohol intolerance can be inherited, and there is currently no cure or treatment for it. However, symptoms can be managed by limiting alcohol consumption, staying hydrated, and eating before drinking.

An alcohol allergy, on the other hand, is caused by an immune system response to an ingredient in alcohol, such as grains, chemicals, or preservatives. Common allergens include sulfites, which are used as preservatives in wine and beer, and grains like wheat, barley, rye, corn, or rye, which are found in beer and whiskey. Symptoms of an alcohol allergy include rashes, itchiness, swelling, and severe stomach cramps. In rare cases, an alcohol allergy can be life-threatening, requiring emergency treatment.

If you suspect you have an alcohol allergy or intolerance, it is important to consult a healthcare professional. They may recommend lifestyle changes, such as avoiding alcohol or choosing drinks with lower levels of sulfites and other preservatives. They may also suggest medication, such as antihistamines, to help manage symptoms. To determine the specific cause of your allergy or intolerance, your doctor may recommend allergy testing, including skin prick tests or blood tests.

Frequently asked questions