Alcohol Intolerance

Overview

What is alcohol intolerance?

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 the women more than men (8.9% verses 5.2%). It is unclear if that number reflects the general population.

Is alcohol intolerance the same as an alcohol allergy?

People often confuse alcohol intolerance and alcohol allergy, but they aren’t the same condition.

Alcohol intolerance is a genetic, metabolic disorder of the digestive system. Your body doesn’t process alcohol the way it should.

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).

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 alcohol intolerance the same as being intoxicated?

No, alcohol intolerance is not the same as being intoxicated or drunk. Alcohol intolerance 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 the enzyme problem that causes alcohol intolerance.

Symptoms and Causes

What causes alcohol intolerance?

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 alcohol intolerance, 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:

Diagnosis and Tests

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:

  1. Places a drop of ethanol on a gauze pad and tapes it to your arm.
  2. Waits about seven minutes.
  3. Removes the gauze and checks for signs of redness, itching or swelling.

Management and Treatment

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.

Prevention

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:

Outlook / Prognosis

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.

Living With

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.

A note from Cleveland Clinic

It may seem unfair that an inherited condition keeps you from enjoying the occasional glass of wine or beer. But staying away from alcohol can free you from the uncomfortable hot flushes and digestive issues that come with alcohol intolerance. Plus, avoiding alcohol lowers your risk for cancer and other serious diseases. If you have alcohol intolerance but still find yourself drinking excessively, despite the pain and discomfort, talk to your healthcare provider. Services are available to help treat alcohol use disorder.

Last reviewed by a Cleveland Clinic medical professional on 08/24/2020.

References

  • National Institute for Advancing Translational Sciences/Genetic and Rare Diseases Information Center. . Accessed 8/24/2020.Acute Alcohol Sensitivity (https://rarediseases.info.nih.gov/diseases/12634/acute-alcohol-sensitivity)
  • National Institute on Alcohol Abuse and Alcoholism. Accessed 8/24/2020.Alcohol "Flush" Signals Increased Cancer Risk Among East Asians. (https://www.niaaa.nih.gov/news-events/news-releases/alcohol-flush-signals-increased-cancer-risk-among-east-asians)
  • National Institute on Alcohol Abuse and Alcoholism. Accessed 8/24/2020.Alcohol Metabolism: An Update. (https://pubs.niaaa.nih.gov/publications/AA72/AA72.htm.)
  • Wigand P, Blettner M, Saloga J, Decker H. Prevalence of Wine Intolerance. Dtsch Arztebl Int. 2012;109(25):437-444. Accessed 8/24/2020.

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