Overview

Alcohol intolerance can cause immediate, unpleasant reactions after you drink alcohol. The most common signs and symptoms of alcohol intolerance are stuffy nose and skin flushing. Alcohol intolerance is caused by a genetic condition in which the body is unable to break down alcohol efficiently. The only way to prevent alcohol intolerance reactions is to avoid alcohol.

Alcohol intolerance isn't an allergy. However, in some cases, what seems to be alcohol intolerance may be your reaction to something in an alcoholic beverage — such as chemicals, grains or preservatives. Combining alcohol with certain medications also can cause reactions.

In rare instances, an unpleasant reaction to alcohol can be a sign of a serious underlying health problem that requires diagnosis and treatment.

Symptoms

Signs and symptoms of alcohol intolerance — or of a reaction to ingredients in an alcoholic beverage — can include:

  • Facial redness (flushing)
  • Warm, red, itchy bumps on the skin (hives)
  • Worsening of preexisting asthma
  • Runny or stuffy nose
  • Low blood pressure
  • Nausea and vomiting
  • Diarrhea

When to see a doctor

You may not need to see a doctor if you have a mild intolerance to alcohol or something else in alcoholic beverages. You may simply need to avoid alcohol, limit how much you drink or avoid certain types of alcoholic beverages. However, if you have a serious reaction or severe pain, see your doctor. Also, if your symptoms seem to be linked to an allergy or a medication you're taking, see your doctor.

Causes

Alcohol intolerance occurs when your body doesn't have the proper enzymes to break down (metabolize) the toxins in alcohol. This is caused by inherited (genetic) traits usually found in Asians.

Other ingredients commonly found in alcoholic beverages, especially in beer or wine, can cause intolerance reactions. These include:

  • Sulfites or other preservatives
  • Chemicals, grains or other ingredients
  • Histamine, a byproduct of fermentation or brewing

In some cases, reactions can be triggered by an allergy to a grain such as corn, wheat or rye or to another substance contained in alcoholic beverages.

Rarely, severe pain after drinking alcohol is a sign of a more serious disorder, such as Hodgkin lymphoma.

Risk factors

Risk factors for alcohol intolerance or other reactions to alcoholic beverages include:

  • Being of Asian descent
  • Having asthma or hay fever (allergic rhinitis)
  • Having an allergy to grains or to another food
  • Having Hodgkins lymphoma

Complications

Depending on the cause, complications of alcohol intolerance or other reactions to alcoholic beverages can include:

  • Migraines. Drinking alcohol can trigger migraines in some people, possibly as a result of histamines contained in some alcoholic beverages. Your immune system also releases histamines during an allergic reaction.
  • A severe allergic reaction. In rare instances, an allergic reaction can be life-threatening (anaphylactic reaction) and require emergency treatment.

Prevention

Unfortunately, nothing can prevent reactions to alcohol or ingredients in alcoholic beverages. To avoid a reaction, avoid alcohol or the particular substance that causes your reaction.

Read beverage labels to see whether they contain ingredients or additives you know cause a reaction, such as sulfites or certain grains. Be aware, however, that labels may not list all ingredients.

March 26, 2015
References
  1. Wigand P, et al. Prevalence of wine intolerance. Deutsches Ärzteblatt International. 2012;109:437.
  2. Fazio SB. Approach to flushing in adults. http://www.uptodate.com/home. Accessed Jan. 16, 2015.
  3. Bryant AJ, et al. Alcohol intolerance as associated with Hodgkin lymphoma. Canadian Medical Association Journal. 2013;185:E353.
  4. Linneberg A, et al. Prevalence of self-reported hypersensitivity symptoms following intake of alcoholic drinks. Clinical and Experimental Allergy. 2007;38:1.
  5. Uticaria, facial swelling after beer/alcohol. American Academy of Allergy, Asthma & Immunology. http://www.aaaai.org/ask-the-expert/Urticaria,-facial-swelling-after-beer-alcohol.aspx. Accessed Jan. 16, 2015.
  6. Alcohol angioedema and uticaria. American Academy of Allergy, Asthma & Immunology. http://www.aaaai.org/ask-the-expert/alcohol-angioedema-urticaria.aspx. Accessed Jan. 16, 2015.
  7. Alcohol and migraine. American Headache Society. http://www.achenet.org/resources/alcohol_and_migraine/. Accessed Jan. 18, 2015.
  8. Food allergy testing. American Academy of Allergy, Asthma & Immunology. http://acaai.org/allergies/types/food-allergies/testing. Accessed Jan. 18, 2015.