Why your Asian Flush Syndrome may not be indication of an allergy
Have you gone drinking with your group of friends, and there’s always that one guy who goes,
“I can’t drink! I have an alcohol allergy”
Sounds like a familiar excuse to wuss out? Except he’s probably not lying. People CAN be allergic to alcohol. It is not a particularly common allergy compared to other irritant reactions, but it should not be ignored.
If you have an alcohol allergy, a relatively small amount of alcohol can cause pretty severe reactions. When I say small, I mean as little as a glass of wine.
How do I know if I’m allergic to alcohol?
If you are having an allergic reaction to alcohol, you may experience these unpleasant symptoms:
- Severe rashes
- Difficulty breathing
- Stomach cramps
Another little known fact is that alcohol increases your risk of anaphylaxis. Who knew right?
Are there any tests for alcohol allergies?
What is truly unfortunate about alcohol allergy tests is that they often come back negative. You see, your body actually produces alcohol - albeit small amounts (0.01- 0.03 alcohol). As such, the tests are often off.
For example, they can come back positive when there is vinegar in your body.
Now, you must be thinking: if your body produces alcohol, how can a person have an alcohol allergy? I’ll address this shortly.
If I experience flushing, does this mean I have an alcohol allergy?
Flushing is the sudden reddening of your face and sometimes other parts of your body. You may become flushed after consuming alcohol - we call this the Asian Flush Syndrome. However, this is not an allergic reaction.
Anyone can experience flushing, but it's especially prevalent among Asians. Flushing can also come with uncomfortable symptoms, like:
- Heart palpitations,
- Feeling terribly hot
- A sudden dip in your blood pressure
These symptoms are most likely linked to elevated levels of acetaldehyde in the blood.
Interestingly enough, you may experience flushing if you have a skin condition like rosacea, are reacting to medication, or have low blood sugar.
What is Asian Flush Syndrome?
So, your body breaks down alcohol using 2 enzymes. Alcohol dehydrogenase turns alcohol into acetaldehyde. Acetaldehyde dehydrogenase (ALDH2) then breaks down the acetaldehyde into safe substances for the body.
Are you one of those who hardly feel any kind of buzz when you drink? It’s not uncommon; approximately 80%1 of Asians have extremely reactive alcohol dehydrogenase. This means that we break down alcohol into acetaldehyde quicker than non-Asians.
This is coupled with an inactive variant of the ALDH2 liver enzyme which means the acetaldehyde remains for longer in the bloodstream. Your facial blood vessels dilate resulting in a red face, i.e. Asian flush syndrome.
On top of facial flushing, you may also experience headaches, nausea, and rapid heartbeat.
While there are supplements on the market that claim to lessen the effects, the only way you can be completely free from the symptoms is to not consume alcohol.
Why you may not exactly be allergic to alcohol
When you consume alcohol, your liver breaks down the ethanol in the alcohol into acetaldehyde, which is then turned into vinegar.
The trouble begins when your body can't break down the alcohol. In addition to ethanol, alcohol contains grape, yeast, barley, hop, wheat, wood-derived substances, and other food substances as well.
You may not be allergic to ethanol, but you may be reacting to the proteins in the grapes, wheat, yeast, hops, and/or barley.
Additionally, there are often fining agents in alcohol, like egg or seafood which are used to stabilize alcohol. You may be allergic to one of these substances, although it's hard to know for sure.
Will alcohol make my asthma worse?
While it does not happen to everyone, about 33%2 of asthma patients report a worsening of symptoms after consuming alcohol. Champagne, wine, and beer all contain a preservative called sodium metabisulfite which often makes asthmatics with uncontrolled symptoms wheeze.
Of course, the amount of sodium metabisulfite in wines varies from brand to brand. There is also more in white wines than reds.
Levels may vary because sometimes grape farmers spray sulfur powder over the grapes before harvest time.
Full disclosure - while wine can trigger asthma symptoms, sodium metabisulfite is not the only cause.
Is enzyme deficiency linked to asthma symptoms?
Yes, there seems to be! People who have low levels of an enzyme called aldehyde dehydrogenase are unable to break down alcohol properly. As such, there is often a high level of acetaldehyde in their blood after drinks at happy hour.
Allergic responses like sneezing, runny nose, stomach aches, and wheezing are often triggered by Histamine. Their amounts usually vary depending on the wine brand. Also, red wines have more histamines than white wines. You might want to opt for Cabernet over Shiraz since it has lower histamine levels ?
Other than alcoholic drinks, what other sources of alcohol could be in my diet?
Here is a useful list of consumables that may contain alcohol:
- Tomato purees
- Food marinades
- Overripe fruit (fermentation)
- Cough syrups
All of these may have alcohol in sufficient amounts to provoke an allergic response.
What can I do to manage my alcohol reaction?
- Know your triggers - If you know which alcohols make you react make sure to stay away from them.
- If you are prone to severe, life-threatening reactions, always keep an epipen in your possession
Not all alcohol reactions are severe. Sometimes, people develop hives if they already have a history. Needless to say, these symptoms can be uncomfortable. Also, alcohol contact rashes rarely occur.
In what other ways can alcohol affect my body?
Heavy consumption of alcohol can adversely affect you in many ways. Alcohol may have the following effects on these parts of your body:
- Stomach - nausea, damage to your stomach lining.
- Liver damage
- Brain - You may notice that thinking clearly becomes more difficult the more you drink! Alcohol may also cause agitation and anxiety in some individuals.
To sum up…
An alcohol allergy is rare but can be severe. So if you think that you may be experiencing symptoms, dial back your alcohol consumption and make an appointment to talk to your doctor.
- Kim HK, Lim Si En R, Wong Kang Min D. Int J Environ Res Public Health. 2019 May 29;16(11):1897. doi: 10.3390/ijerph16111897. PMID: 31146355
- Matsuse H. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2016 Jun;51(3):214-220. PMID: 30480906
This article was written and medically reviewed by Dr Ben, M.D on 23/11/21