What to know about alcohol intolerance vs alcohol allergy

IIf your body doesn’t absorb alcohol well, you might wonder why your BFF can finish a bottle of vino on its own — while you’re left with flushing, fatigue, hives, or other side effects. after barely drinking a glass. Is it possible that you are intolerant to alcohol, or possibly allergic to it? And what is the difference between alcohol intolerance and alcohol allergy?

Below, Gary C. Steven, MD, PhD, CPI, FAAAAI, FACAAI, FAPCR—founder of the Allergy, Asthma and Sinus Center in Milwaukee and medical director of the Allergy, Asthma & Allergy Registry American immunology—provides a serious explanation for adverse reactions to alcohol.

Alcohol intolerance vs alcohol allergy

To begin with, alcohol intolerance is an inherited condition characterized by the inability to process alcohol efficiently. Dr. Steven explains that there are two enzymes involved in the metabolism of ethanol, an intoxicant that exists in varying amounts in wine, beer and spirits.

“Alcohol dehydrogenase converts ethanol to acetaldehyde, a toxic substance; and aldehyde dehydrogenase 2 (ALDH2) is an enzyme that converts acetaldehyde into vinegar, which is non-toxic,” says Dr. Steven. “People with an inherited deficiency of ALDH2 are unable to remove acetaldehyde from the blood,” suggesting an intolerance or sensitivity to alcohol that can lead to aldehyde poisoning. According to Dr. Steven, symptoms include “blushing, rapid heart rate, low blood pressure, headache, fatigue, nausea, vomiting and diarrhea”. He added that people of East Asian descent were more likely to have ALDH2 deficiency.

Meanwhile, Dr. Steven mentions that alcohol allergy is not really a problem. Instead, another allergic reaction may occur, which alcohol consumption may aggravate rather than be the direct cause. “We can’t make antibodies to small molecules like ethanol,” he said. “However, we can make IgE into cereal-like proteins that can be found in fermented beverages. Distilled beverages are less likely to contain protein, but they can be added after distillation.” (For reference, the American Institute of Allergy, Asthma & Immunology notes that IgEs are antibodies that the immune system makes in response to an allergen. These antibodies travel to cells. release chemicals, causing allergic reactions.) Also, as certified by the board. Allergist Purvi Parikh, MD, previously told Well + Good, that alcohol contains histamine, which, in excess of this substance “could exacerbate all underlying allergies by increasing inflammation in the skin. body”.

In addition, Dr. Steven also mentions that ethanol is a vasodilator—meaning it widens blood vessels, increasing blood flow and lowering blood pressure. While these effects may be circulation-promoting, the ethanol in alcohol can cause people with rosacea or other skin sensitivities to “present more severe symptoms from ethanol—such as flushed and itchy—more than the others.”

How to deal with adverse reactions to alcohol

If you have a true alcohol intolerance, Dr. Steven says you don’t must must go cold turkey if you like imbibing here and there. “People with alcohol intolerance can find a threshold through trial and error as to how much ethanol they will tolerate before they have symptoms,” he said. Sometimes, symptoms like hot flashes can be minor or even avoidable with certain types of alcohol or levels of intake, which — on the plus side — isn’t so terrible compared to some of the potential side effects. more serious potential for alcohol consumption in the absence of ALDH2. (For example, being half-Filipino, I’ve found that I’m more prone to “Asian sight” and headaches when drinking a glass of wine…even though I can tolerate a few beers. All in the name of research, of course.)

On the other hand, if your allergies are made worse by drinking, Dr. Steven says the best way to get started is to address the root of the problem. For example, if you have sensitive skin caused by a chronic rash and your symptoms flare up when you drink alcohol, “treating the underlying condition that led to the overreaction will help you tolerate ethanol.” better,” he explained.

In the case of allergies (and for that matter overall health), limiting your exposure to alcohol is never a bad idea. “If someone has a genetic predisposition to develop allergic antibodies to certain proteins found in fermented beverages [like alcohol], they can develop an increasing reactivity to that beverage over time,” shared Dr. Steven. In other words, continued exposure can combine what was once a small response into something larger later. And although true alcohol allergies are rare, if your allergic reaction is severe to drinking, Dr. Steven recommends eliminating alcohol altogether for safety reasons. “People with a real allergy, and especially an anaphylactic reaction, to fermented beverages need to avoid it. There is no treatment that can prevent anaphylaxis.”


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