17659 Alcohol Intolerance

Overview

Alcohol intolerance happens when your body cannot break down alcohol properly. It causes unpleasant symptoms like facial flushing, a stuffy nose, or headache shortly after drinking. It is not a true allergy, but it can feel like one.

Yes. It is very common, especially in people of East Asian heritage. Many people have it without ever knowing exactly what it is.

It can affect anyone of any age, but it is most often seen in people of East Asian descent, and it tends to run in families.

Symptoms

Common symptoms

• Facial flushing (red face and feeling of warmth)
• Stuffy or runny nose
• Nausea or headache
• Rapid heartbeat or palpitations
• Skin redness or hives

Symptoms in children

• Children who accidentally consume alcohol may become flushed, sleepy, or nauseous. Since alcohol is dangerous for children, this is a medical emergency — call your local emergency number right away.

Symptoms in older adults

• Older adults may feel more dizzy or unsteady after even small amounts of alcohol, and symptoms can be confused with side effects of medicines. If you notice a reaction after drinking, stop drinking and speak to your doctor.

Causes

Main causes

• A lack of a working aldehyde dehydrogenase 2 (ALDH2) enzyme, which normally breaks down a harmful by-product of alcohol called acetaldehyde. When this by-product builds up, it causes flushing and other symptoms.
• A reaction to other ingredients in alcoholic drinks, such as histamines, sulphites, or grains.

Risk factors

• East Asian ancestry
• A family history of alcohol intolerance
• Having asthma, hay fever, or another allergy condition
• Taking certain medicines that interfere with alcohol breakdown (ask your pharmacist)

When to see a doctor

See a doctor urgently if:

• If you have a severe reaction after drinking — especially trouble breathing, swelling, or fainting — call your local emergency number immediately.

Book a routine appointment if:

• If you regularly have unpleasant symptoms after drinking and want to find out why.
• If you think you might have an alcohol allergy or a more serious health condition.

Diagnosis

A doctor will ask about your symptoms, when they happen, and how much alcohol triggers them. They may also do a physical exam to rule out other causes.

Tests that may be done

• A detailed symptom diary reviewed with your doctor
• Allergy testing (skin prick tests) to rule out a true alcohol allergy
• In some cases, a blood test to look for immune reactions or genetic markers (not always needed)

What to expect at your appointment

Your doctor may ask you to stop drinking for a while to see if symptoms disappear. They may also suggest keeping a note of any products you used, so they can rule out a reaction to mixers or medications.

Treatment

There is no cure for alcohol intolerance. The main treatment is to reduce or avoid alcohol altogether. If you do drink, you will need to learn your limits and watch for early symptoms.

Self-care at home

• Drink low- or no-alcohol alternatives when you are out with friends.
• Read labels on foods, mouthwashes, and cold remedies — many contain alcohol.
• Stay well hydrated and never drink on an empty stomach.
• Stop drinking at the first sign of symptoms.

Medical treatments

In some cases, a doctor may recommend a medicine to help relieve symptoms like flushing or hives. However, medicines cannot make it safe to drink alcohol if your body cannot process it. You should never use medication as a way to 'get around' the intolerance.

When is surgery considered?

Surgery is not a treatment for alcohol intolerance.

Living with this condition

Plan ahead for social events. Decide what you will say when someone offers you a drink, and practice a polite 'no thanks.' Over time, this gets easier and more comfortable.

Lifestyle tips

• Always have a non-alcoholic drink in your hand so you do not feel left out.
• Let close friends and family know the reason you avoid alcohol — it helps them support you.
• Watch out for alcohol hidden in sauces, desserts, or medicines.

Diet and exercise

Eating a balanced diet and exercising regularly are good for your overall health. If you avoid alcohol, your body will thank you — and you may notice better sleep and more energy.

Mental health and emotional wellbeing

Avoiding alcohol can feel socially awkward or even isolating, especially if your social groups drink often. It is normal to feel this way. Talk to someone you trust, and remember that being comfortable in your own skin is worth more than any drink.

Prevention

You cannot change your body's enzyme makeup, but you can prevent symptoms by not drinking alcohol, or by limiting how much you drink and watching for early signs.

Vaccines

There is no vaccine for alcohol intolerance.

Screening programmes

There is no routine screening test for alcohol intolerance. If you have symptoms that worry you, your doctor can help you figure out the cause.

Complications

If left untreated

• If you continue to drink despite symptoms, you have a higher risk of certain cancers (especially of the throat and esophagus) because acetaldehyde builds up in the body.
• Severe reactions could cause falls, dehydration, or an injury from an accident.

Long-term outlook

The outlook is very good. Most people with alcohol intolerance can lead a healthy, social life by making a few simple adjustments. Knowing your body and making careful choices will keep you safe and comfortable.

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