Can You Be Allergic to Alcohol?

Alcoholic drink causes Asian Flush

If you've ever eaten something and then had a negative reaction, such as hives or laboured breathing, it's pretty clear that you're having some kind of allergic reaction to the food.

So if something similar happens when you drink alcohol, does that mean you're allergic?

The simple answer is: probably, no. Although it's possible, being allergic to alcohol is extremely rare. It's more likely that you are intolerant or allergic to an ingredient in the alcoholic drink, rather than the alcohol itself. To make this more confusing - does this reaction mean you're allergic to alcohol, or do you have Asian Flush? Or are they the same thing?

Find out everything you need to know about alcohol allergies, Asian Flush and how they are different here.

How is an alcohol allergy different from Asian Flush?

This topic can be confusing because there are a few different terms at play.

Alcohol Allergy - A very rare allergic reaction to alcohol where your immune system overreacts to alcohol. Symptoms can be very severe

Alcohol Intolerance - If you experience negative symptoms when drinking alcohol, it's more likely that you have an alcohol intolerance which means your digestive system doesn’t process alcohol properly

Asian Flush - Asian Flush is the same as an alcohol intolerance, or is also called alcohol flush reaction. Just like an alcohol intolerance, this condition happens because your body cannot metabolise alcohol properly

Alcohol Allergy Symptoms

We know that a true alcohol allergy is very rare. However, if you're one of the few who experience this, it comes with some very severe symptoms, including:

  • itchiness of the eyes, nose or inside the mouth
  • hives on the body
  • swelling of the face, neck and/or other body parts
  • stuffy nose
  • laboured breathing
  • abdominal pain and/or vomiting
  • dizziness or loss of consciousness

If you experience any of the above symptoms when consuming alcohol, it's vital to talk to your doctor before drinking again. Serious symptoms such as these should not be ignored and can result in even worse scenarios, such as worsening symptoms or even death.

As mentioned before, a true alcohol allergy is very rare, thankfully. The Australasian Society of Clinical Immunology and Allergy, states that most people who think they have an alcohol allergy actually have an intolerance instead.

Allergy medicine and pills

Alcohol Intolerance Symptoms

Alcohol intolerance, or Asian Flush, has similar symptoms to an alcohol allergy, which is why they are often mistaken for one another. However, alcohol intolerance symptoms are far less extreme than alcohol allergy symptoms, such as:

  • swelling of the skin around the eyes
  • rapid and increased heartbeat
  • red flushing on the face and cheeks
  • red flushing on the neck, chest and/or arms
  • wheezy or restricted, laboured breathing
  • headaches
  • dizziness

So while the two sets of symptoms sound similar, even with numerous overlapping symptoms, those that accompany a true alcohol allergy are extremely serious and life-threatening. It could be similar to someone who has an intolerance to gluten and experiences uncomfortable symptoms, versus someone who experiences anaphylactic shock from peanuts. A true allergy can be far more serious than an intolerance, even to alcohol.

It's also important to note that while some of these symptoms, both for allergies and intolerances, seem like hangover symptoms, they are felt far quicker. Most of us have experienced those unpleasant symptoms of a hangover the day after drinking, like headache, dizziness and nausea. Allergy and intolerance symptoms (including Asian Flush) are often felt immediately after drinking. In some cases, the individual may experience symptoms after only a few sips of alcohol.

What is the cause of alcohol intolerance?

Alcohol intolerance, or Asian Flush (or even alcohol flush reaction) comes down to the way the body deals with alcohol.

In a typical body, the consumed alcohol goes from the stomach and small intestine straight into the blood stream. Your body sees alcohol as a poison and wants to eliminate it through the liver as soon as possible.

To do this, your liver will use two different enzymes to break down alcohol, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH2). For those who suffer from Asian Flush, they have an ALDH2 deficiency and cannot finish this process fully.

ADH works by breaking the consumed alcohol into toxic acetaldehyde, then the ALDH2 enzme would normally break acetaldehyde down further into a harmless chemical called acetate or acetic acid. This is basically the acidic component of vinegar. For those with an ALDH2 deficiency, their system gets flooded with acetaldehyde that they can't break down, causing all of those horrible symptoms mentioned earlier.

Researcher Robert Swift says: "Acetaldehyde is nasty stuff". "It's like formaldehyde, which is embalming fluid. It destroys proteins. It destroys DNA." Moreover, studies show that acetaldehyde is responsible for other negative symptoms when drinking alcohol in general, including vomiting, nausea, blackouts and hangovers.

For those with Asian Flush, or alcohol intolerance, the red flush face and other negative symptoms is the body telling them there are high levels of acetaldehyde in their system. Extended exposure to acetaldehyde has shown links to cancer and DNA damage, so it's a very serious chemical to have in your system for any extended period of time.

You may also find that different drinks can worsen your symptoms. Various additives and preservatives in alcoholic drinks can make your Asian Flush symptoms more prominent. By understanding what affects you the most, you can work towards avoiding drinks that are high in that ingredient or preservative.

Aged spirits can cause worse symptoms because they are usually stored in wooden barrels and tend to accumulate tannins, which has been shown to cause a minor histamine re-action in some people. This can exaggerate symptoms in people with Asian Flush who are already trying to deal with the histamines from acetaldehyde. Red wine also contains high amounts of tannins and can make the overall reaction worse.

Sulphites have also been known to exaggerate symptoms in those with alcohol intolerance. Beer and cider both contain sulphites, a common preservative, but this in itself can cause various symptoms such as headaches and red facial flushing. Combine this reaction with the toxic effects of acetaldehyde and you're in for an unpleasant night.

Asian Flush from beer in barrels

Do only Asians get Asian Flush?

Alcohol intolerance is commonly referred to as Asian Flush, so does that mean only Asians can get this condition? The answer is: no!

About 36% of East Asians (Japanese, Chinese and Koreans) experience this condition, hence being called Asian Flush. However, it can impact anyone, even caucasians. Asian Flush just refers to the previous ALDH2 deficiency detailed earlier and can occur in anyone. Primarily this condition is passed down from generation to generation. Therefore, if your mother or father has it, it's likely that you will have it as well.

Can I get tested for an alcohol allergy?

If you're still unsure about your personal symptoms when drinking alcohol, you can get more information from your doctor and allergy specialist. Your doctor can offer treatment for mild allergies with an obvious cause. However, if your symptoms are more severe, or the cause is unclear, you may be referred to an allergy specialist. By using your family history and likely completing an allergy test, they will be able to advise you on your allergies and intolerances.

What type of allergy tests can I expect?

A skin prick test is very common when trying to determine allergies. This test involves putting a drop of liquid onto your arm that contains a substance you may be allergic to. The skin under the drop is then gently pricked. If you're allergic to the substance, an itchy, red bump will appear within 15 minutes. This gives a clear indication that your body reacts negatively to that particular substance.

It's also important to note that this type of testing is painless, but it can be a little uncomfortable. It's also very safe but it's vital not to take any antihistamines before this type of allergy test, as they can interfere with the results.

Because you're reacting negatively to alcohol, your allergy specialist may try an elimination diet test. This test involves avoiding eating or drinking a particular item to see if your symptoms improve. After a few weeks without that item, you may then be asked to try eating or drinking it again to see if you have another negative reaction.

Because this type of test requires you to give yourself a reaction (which may be potentially serious), it's important not to attempt this test yourself without discussing it with a qualified healthcare professional.

Somewhat similar to an elimintation diet test, your allergy specialist may try a challenge test. During this test, you will be given the food or drink you think you're allergic to in gradually increasing amounts to see how you react under close supervision. Obviously, this type of allergy test is riskier than other forms as it could cause a severe reaction, but is the most accurate way to diagnose food allergies. Again, this type of test should not be carried out by yourself, but completed in a clinic where a severe reaction can be treated if it does develop.

Thankfully a true alcohol allergy is very rare, so it's likely that your reaction is due to an alcohol ingredient (such as barely or grapes), a preservative in alcohol (like sulphites), or you have an ALDH2 deficiency (Asian Flush) and are unable to process alcohol properly.

Have any comments? Want to share your experience dealing with Asian Flush? As always, you can drop us a line!