What is alcohol intolerance?
You may notice that even after drinking a small amount of alcohol, you don’t feel great. Your skin feels warm, and you may be nauseous. These might be signs of alcohol intolerance, an inherited disorder. While there is no cure for this condition, avoiding alcohol helps you stay symptom-free.
Alcohol intolerance is an inherited metabolic disorder. Metabolic disorders affect your metabolism, the way your body converts and uses energy. An inherited metabolic disorder means you got this condition from your parents — they each passed down a mutated (changed) gene that resulted in this disorder. Even if your parents don’t have the condition, they can pass it to you.
Our bodies are full of enzymes, proteins that help break down food. Alcohol intolerance is a problem with the specific enzyme that helps your body metabolize alcohol. Even drinking a small amount of alcohol (ethanol) causes unpleasant symptoms. Your face may turn pink or red (alcohol flush) and feel warm.
How common is alcohol intolerance?
One study of 948 individuals found that 7.2% self-reported wine intolerance. It happened to women more than men (8.9% versus 5.2%). It is unclear if that number reflects the general population.
Is this condition the same as an alcohol allergy?
People often confuse alcohol intolerance with alcohol allergy, but they aren’t the same condition.
- Alcohol allergy: is an immune system response — your immune system overreacts to an ingredient in alcohol. You may be allergic to one of the substances in alcohol (a chemical, grain or preservative, such as sulfite).
- Alcohol intolerance: is a genetic, metabolic disorder of the digestive system. Your body doesn’t process alcohol the way it should.
The symptoms differ slightly. Both alcohol intolerance and an allergy can cause nausea. But the hallmark symptom of alcohol intolerance is flushing of the skin of the chest, neck, and face.
Symptoms of an alcohol allergy include rashes, itchiness, swelling, and severe stomach cramps. Allergy symptoms are often more painful and uncomfortable than alcohol intolerance symptoms. In rare cases, if untreated, an alcohol allergy can be life-threatening. If you have any unpleasant symptoms after drinking alcohol, see your healthcare provider. Your provider can help get to the bottom of your symptoms and recommend the best next steps.
Is this condition the same as being intoxicated?
No, alcohol intolerance is not the same as being alcohol-intoxicated or drunk. This condition doesn’t mean you become drunk faster or after drinking less alcohol. And the condition does not increase your blood alcohol level, either. Often, people with alcohol intolerance drink less, because the symptoms they experience are so unpleasant.
Who might have alcohol intolerance?
People of East Asian descent are more likely to have the inherited genetic mutation that causes alcohol intolerance, so they develop the condition at higher rates. Anyone can have an enzyme problem that causes this condition.
Causes for this condition
A genetic metabolic disorder causes alcohol intolerance. When most people ingest alcohol, which contains ethanol:
- An enzyme called alcohol dehydrogenase (ADH) helps metabolize (process) the ethanol.
- Your liver converts the ethanol to acetaldehyde, a substance that can cause cell damage.
- Another enzyme called aldehyde dehydrogenase 2 (ALDH2) helps convert acetaldehyde to acetic acid (vinegar), which is nontoxic.
In people with this condition, a genetic mutation (change) makes ALDH2 less active or inactive. As a result, your body can’t convert acetaldehyde to acetic acid. Acetaldehyde starts to build up in your blood and tissues, causing symptoms.
What are symptoms of alcohol intolerance?
Alcohol flushing syndrome is a major sign of alcohol intolerance. Your face, neck, and chest become warm and pink or red right after you drink alcohol.
Other symptoms include:
- Throbbing headache, fatigue and other hangover-like symptoms
- Stuffy nose
- Worsening asthma
- Nausea and vomiting
- Rapid heartbeat (tachycardia) or heart palpitations
- Hypotension (low blood pressure)
How is alcohol intolerance diagnosed?
Your healthcare provider will ask you about the symptoms and reactions that occur after you drink alcohol. You may also have a test for alcohol intolerance called an ethanol patch test. During this test, your provider:
- Places a drop of ethanol on a gauze pad and tapes it to your arm.
- Waits about seven minutes.
- Removes the gauze and checks for signs of redness, itching or swelling.
Is there a cure for alcohol intolerance?
Because the condition is inherited, there is no way to cure or treat it. Your healthcare provider can recommend ways to limit unpleasant symptoms.
How is alcohol intolerance treated?
While there is no way to treat this condition, your healthcare provider can talk with you about ways to reduce the negative effects of alcohol intolerance.
You may need to avoid:
- Alcohol: Avoiding or restricting alcohol consumption is the most straightforward way to avoid the symptoms. Consider nonalcoholic substitutions instead.
- Tobacco use or exposure to secondhand smoke: Smoking may increase levels of acetaldehyde, which may raise cancer risk.
- Alcohol use when taking certain medications: Some drugs may make your symptoms more severe.
- Antacid or antihistamine use to reduce symptoms: These medications mask the symptoms of alcohol intolerance. You may end up drinking even more alcohol, since you don’t feel the negative effects. If you do so, the problem will worsen.
How can I prevent alcohol intolerance?
You cannot prevent alcohol intolerance from developing. It is an inherited disorder, so it was passed down to you from your parents. However, you can take steps to avoid the symptoms.
Can I continue to drink alcohol if I have alcohol intolerance?
Drinking if you have this condition causes uncomfortable symptoms. It also may put you at higher risk for other diseases. People with alcohol intolerance who drink alcohol regularly are at higher risk for:
- Cancer of the mouth and throat (head and neck cancer)
- Liver disease (cirrhosis)
- Late-onset Alzheimer’s disease
How long will I have alcohol intolerance?
Alcohol intolerance is a lifelong condition. It won’t go away, but by taking some precautions, you can avoid the symptoms and enjoy a healthy, active life.
How can I learn to live with alcohol intolerance?
The best way to live with this condition is to avoid alcohol as much as possible. Try nonalcoholic beverages as substitutions for your favorite alcoholic drinks. Avoiding alcohol will allow you to live an active, enjoyable life without unpleasant symptoms.
Treatment for alcoholism
When it comes to Alcoholism treatment, it is normal to think of 12-step programs or 28-day inpatient rehab, but it becomes difficult to think of more options of treatment for this condition. There are a variety of treatment methods currently available. According to the National Institute on Alcohol Abuse and Alcoholism, there are three types of treatment:
- Behavioral Treatments for alcoholism: are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.
- Medications for alcoholism: Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent relapse. They are prescribed by a primary care physician or other health professional and may be used alone or in combination with counseling.
- Peer-Support Groups for alcoholism: Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support. Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.
Prevent Alcohol Intolerance Symptoms by Stop Drinking
The best way to live with this condition is to avoid alcohol as much as possible, but if a person suffers from alcohol use disorder this may be difficult to do. Alcoholism is a serious disease that should not be taken lightly. We Level Up California can provide you, or someone you love, the tools to recover from alcoholism with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
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 Ballard HS. (1997). The hematological complications of alcoholism.
 Centers for Disease Control and Prevention. (2018). Fact sheets – alcohol use and your health [Fact sheet].