Can You Become Intolerant to Alcohol? Separating Fact from Fiction

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What you will learn

• Though people often use the terms alcohol allergy and alcohol intolerance interchangeably, they are two distinct conditions.
• Intolerance comes from a genetic difference in how your body breaks down alcohol, and is most commonly linked to low levels of an enzyme known as aldehyde dehydrogenase.
• A true alcohol allergy is a genuine immune system response to an additive in the drink, such as sulfites, histamine, or proteins found in grapes or grain; alcohol allergies are much more rare than intolerance.
• Symptoms may develop at any time, regardless of if you’ve never had problems with alcohol, since both enzyme efficiency and immune sensitivity can vary over time.
• While many symptoms associated with intolerance are merely uncomfortable, true allergic responses can on occasion result in serious problems requiring immediate medical treatment.

If a glass of wine or a can of beer suddenly leaves you flushed, feeling congested, or much worse than you are used to feeling after a drink, you’re not crazy, you’re not alone, and you’re certainly not the first person to question it.

Alcohol intolerance can seem to appear out of nowhere, and there is much confusion surrounding the term. The truth is that alcohol intolerance actually encompasses a couple of different issues involving how your body processes alcohol and reacts to additives in your drinks, and knowing more about what you are experiencing can help you know if any effects should cause concern and the right action to take if it does.

Intolerance vs. Allergy: Two Different Problems With the Same Trigger

If having an alcoholic drink is leaving you feeling off, one of two things could be happening: alcohol intolerance or an alcohol allergy.

The term “alcohol intolerance” is used somewhat loosely, but it specifically refers to difficulties related to how your body metabolizes alcohol itself, instead of a reaction to an ingredient in the alcoholic beverage.[1]

When you drink alcohol, your liver breaks down ethanol into a harmful byproduct called acetaldehyde and then uses another enzyme (referred to as aldehyde dehydrogenase or ALDH) to convert that acetaldehyde into acetate.[2]  In a true alcohol intolerance, a genetic mutation results in significantly reduced effectiveness of this second enzyme, resulting in acetaldehyde accumulating in the body instead of clearing quickly. This buildup typically results in symptoms like facial flushing, nausea, vomiting, headache, rapid heartbeat, dizziness, and low blood pressure, which can start within minutes of drinking and even after a relatively small amount.[3]

A true allergic reaction is a completely separate process. Rather than having  an enzyme problem, it is your immune system responding to a specific allergen in the beverage instead of the ethanol itself. Common culprits include:

• Sulfites (a preservative used in wine)
• Histamines (found naturally in fermented beverages such as red wine and beer)
• Proteins from grapes, wheat, barley, or hops used to make the beverage

Since this is a legitimate immune response, your body responds to the allergen exactly like it would respond to pollen or a food item, by creating antibodies that trigger a similar reaction to hay fever or food allergies.[4]

The distinction matters because intolerance is primarily an inconvenience, while an actual allergy involves a slight but real danger of developing into an acute situation that requires medical attention.

What the Symptoms Actually Look Like

Due to their differing mechanisms for development and action in the body, intolerance and allergy tend to exhibit slightly different symptoms, although there’s considerable overlap.

Alcohol intolerance usually presents as follows:

• Skin flushing, particularly in the face and neck
• Rapid heartbeat or heart palpitations
• Nausea and vomiting
• Headache
• Nasal congestion or a runny nose
• Low blood pressure, in certain instances

Actual allergic reactions to alcohol frequently look like standard allergic reactions and can include:

• Hives or rashes
• Hay fever-like symptoms, such as nasal congestion and a runny nose
• Swelling, particularly around the face, lips, or throat
• In severe reactions, respiratory distress or anaphylaxis, a life-threatening allergic reaction

It’s also common for symptoms of intolerance, especially headache and nasal congestion, to linger into the next day rather than resolving as soon as the alcohol wears off. Some people find this particularly true with red wine, possibly because it is higher in both histamines and sulfites than other alcoholic beverages, though sensitivity to it varies from person to person.[5]

Why Reactions Can Seem to Show Up Out of Nowhere

A genetic enzyme deficiency exists from birth, so it’s a fair question why someone could consume alcoholic beverages for many years without problems and then suddenly develop negative reactions.

Some things may influence the development of this type of scenario over time:

• Aging may cause a decline in enzyme effectiveness, possibly creating more pronounced signs of intolerance that were previously too subtle to notice.
• Liver health directly influences the processing of alcohol, since that is where the enzyme does its work; any liver dysfunction will impair the body’s ability to process alcohol effectively.
• Certain medications can inhibit aldehyde dehydrogenase directly.
• Changes in overall health or immune function can allow an existing, potentially latent allergy to emerge, since immune sensitivities aren’t always present at birth the way enzyme deficiencies are.
• Increased alcohol consumption over time may result in more pronounced signs of intolerance to a substance that was previously tolerated since the amount of acetaldehyde being produced and needing to be cleared by the body increases with greater amounts of alcohol.

Is Alcohol Intolerance Dangerous?

Alcohol intolerance is usually unpleasant for people who experience these symptoms, but not typically harmful. Symptoms such as flushing, fast heart rate, and headaches usually resolve on their own once the body has completed processing the alcohol.

A true alcohol allergy is where there is a greater risk. Although most allergic reactions caused by alcohol are minor in nature, in rare cases, they can lead to anaphylaxis, a medical emergency involving swelling of the throat, difficulty breathing, and a sharp drop in blood pressure.[6] Anyone who experiences facial or neck swelling, or shortness of breath, after drinking alcoholic beverages should immediately seek medical attention.

There is another very legitimate reason to investigate a new or unusual reaction to alcohol: pain at the site of lymph nodes after drinking alcohol has been reported as an infrequent but recognized symptom of Hodgkin’s lymphoma.[7] This is extremely rare, and alcohol intolerance is much more likely the explanation of this symptom for most people, but it’s one additional reason why consulting a healthcare professional is wise before dismissing a new or unidentified reaction to alcohol.

What You Can Do About Alcohol Intolerance

If symptoms are mild and clearly related to intolerance, eliminating problematic beverages (usually red wine or those containing high levels of sulfites) is usually sufficient to prevent the reaction. Over-the-counter antihistamines can also help alleviate mild allergy-like symptoms, though they won’t treat the underlying enzyme problem in true intolerance.

If you believe you have a true allergy and not an intolerance to alcoholic beverages, an allergist may use allergy tests to determine which component of the beverage is producing the adverse reaction. This is helpful information if you wish to continue enjoying certain types of beverages while limiting or excluding others. Finally, if you’re experiencing new, recurring, or severe reactions that aren’t typical of what you normally experience, a consultation with a healthcare provider would be warranted to rule out possible causes for concern and clarify what’s happening in your body.

When the Issue Runs Deeper Than Intolerance

Alcohol intolerance refers to how one’s body reacts to alcohol and is unrelated to alcohol use disorders.

That said, some people will continue to push their limits and endure uncomfortable symptoms because reducing their alcohol consumption feels harder than tolerating the symptoms.

If this is the case and controlling alcohol intake is difficult, this could be indicative of an alcohol use disorder and not just the body chemistry behind how it makes you feel. For those looking for help with their alcohol consumption, Ascendant New York offers medical detoxification and treatment for alcohol dependency in a serene environment for those in Manhattan and the surrounding boroughs, with an emphasis on genuine comfort and discretion.

If alcohol is playing a bigger role in your life than you want it to, then we are here to help. Reach out to our admissions team to see what treatment could look like for you.