June 7, 2021

ALDH2 Deficiency Test - How to Test for Alcohol Intolerance

If you’ve had negative reactions to drinking alcohol, you might have wondered if you’re experiencing an allergic reaction. However, it’s likely you may have a liver deficiency, or dealing with an intolerance to alcohol. Here you’ll learn how to test for alcohol intolerance and what to expect with an ALDH2 deficiency test.

There are a few terms that are used interchangeably when researching this condition:

Alcohol intolerance - Experiencing negative symptoms from drinking alcohol. Could be due to an allergy or sensitivity to an ingredient or could be due to an ALDH2 deficiency.

ALDH2 deficiency - A condition where the individual has an ineffective liver enzyme that is supposed to metabolise alcohol. Because it doesn’t work properly, a toxic byproduct of alcohol will accumulate in their body when they drink, causing negative symptoms.

Asian Flush or Asian Glow - When an individual has a ALDH2 deficiency, it may be referred to as Asian Flush or Asian Glow. This is because many people of Asian decent experience this condition (although other people can, too).

Alcohol Flush Reaction - The same condition as Asian Flush or an ALDH2 deficiency. This is commonly used in scientific journals since “Asian Flush” can sometimes be misleading.

How can I test for alcohol intolerance?

To get tested for an alcohol intolerance, you’ll need to visit your doctor. You really can't diagnose this condition yourself, but will need support from your doctor or allergy specialist. 

When meeting with your doctor or allergy specialist, here are a few things to expect during your appointment:

  • They will likely discuss your family history as alcohol intolerance or an ALDH2 deficiency can be passed down from generation to generation. If one of your parents has it, it’s likely that you’ll have it too. Your family history may help draw an easy conclusion on what you're dealing with.
    • You’ll explain your symptoms to your doctor in detail, including the severity. Do you experience these symptoms only when drinking red wine, or does this happen no matter what type of alcohol you consume? Your doctor will need to know.
  • You’ll may do a physical exam.
  • Your doctor might perform a skin prick test.
  • Using a tiny needle, your skin (likely on your arm) will be pricked and the potential allergen will be applied. If your skin negatively reacts to the substance, it’s likely that you’re allergic to that element or ingredient.
    • Many children experience a skin prick test to determine their allergies, including common allergies like peanuts, dust mites and animal dander.
  • Your doctor may complete a blood test.
  • Your doctor might suggest an elimination diet.
    • This is when you stop drinking all alcohol beverages for a few weeks. Then you try one of your typical alcoholic drinks and see if your reaction resurfaces. If your symptoms return, your doctor may conclude that alcoholic drinks are the problem.
    • You may also only see a reaction with certain drinks, which you should avoid in the future.
  • You could do Gene Testing or DNA Tests
    • While companies like 23andMe are known for genetic testing and learning about your heritage, they can also run health tests. Specifically with 23andMe, they can test if you’re likely to have an ALDH2 deficiency and are likely to experience alcohol flushing. However, these tests can be expensive.

What is alcohol intolerance?

Alcoholic drinks, from beer to cocktails and everything in-between, contain numerous ingredients, preservatives and additives. If your body rejects any of these, you may experience negative symptoms when drinking alcohol.

As you can imagine, it can be hard to pinpoint exactly what the issue is. So while you may not be allergic to the alcohol itself, you may be allergic to one of the ingredients in alcoholic beverages, or have a sensitivity to them.

Typical ingredients in drinks that can cause issues include:

  • Hops, barley, rye, wheat and grain (commonly found in beer)
  • Egg protein (usually found in wine)
  • Gluten
  • Grapes
  • Histamines
  • Sulphites
  • Yeast

So if you have a negative reaction to beer, it may be one of the many ingredients involved in beer and the brewing process, rather than being allergic to alcohol itself. You may notice less of a reaction when drinking certain types of drinks, and worse reactions with others.

If you want to learn more about alcohol intolerance, make sure to check out our in-depth guide on alcohol allergies and alcohol intolerance.

What is an ALDH2 deficiency?

If you’re not sensitive to any particular ingredient in alcoholic beverages, it may be that you have an ALDH2 deficiency, or Asian Flush. This condition is caused by an ineffective liver enzyme that is common in those of Asian decent (although Caucasians can get Asian Flush, too).

In short, those with an ALDH2 deficiency cannot metabolise alcohol properly.

In a regular body, alcohol is broken down into acetaldehyde. But what is acetaldehyde? This chemical is highly toxic and needs to be broken down further, as soon as possible, before it can cause increased health risks. The liver works hard and eventually, all the byproducts from alcohol are eliminated from the body. The individual drinking may feel hungover the next day, but they won’t experience alcohol flush reaction.

In those with an ALDH2 deficiency, this progress gets interrupted. The body will break down alcohol into toxic acetaldehyde, but it cannot break it down any further. The ineffective liver enzyme can’t fully break down acetaldehyde fast or efficient enough. This means that acetaldehyde will continue to accumulate in the body and cause some really nasty symptoms.

alcohol intolerance test

Common alcohol intolerance symptoms

People with an ALDH2 deficiency or have an alcohol intolerance may experience symptoms such as:

As you can see, some of these symptoms are common in typical allergic reactions, so it’s understandable why you might think you’re allergic to alcohol if you experience these after drinking. However, a true allergy to alcohol is extremely rare. If you deal with these symptoms after drinking alcohol, it’s like you have an alcohol intolerance or an ALDH2 deficiency.

However, a true allergy to alcohol isn’t impossible. If you experience these symptoms to an extreme degree after drinking alcohol, make sure to speak to your doctor before drinking again. Just because a real alcohol allergy is rare, doesn’t mean that it’s impossible. However, alcohol allergy symptoms will be an extreme version of those felt from alcohol intolerance.

It’s likely that if you have alcohol flush reaction, you may begin to experience these symptoms after just one drink of alcohol. In severe cases, you may experience symptoms after just a few sips. As alcohol consumption increases, so will the symptoms. It may even get to a point where you cannot comfortable continue to drink alcohol.

If you want to know for sure about your possible alcohol intolerance, ALDH2 deficiency, or Asian Flush, it's important to check with your doctor.

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