Understanding The Differences Between Alcohol Intolerance vs. Alcohol Allergy

Most people are well aware of the numerous negative health consequences and side effects of alcohol consumption. However, some people have legitimate medical intolerances and allergies to alcohol. It’s crucial to understand the differences between an allergy and an intolerance so you know the risks you are taking and treatment options available. In short, alcohol intolerance is intolerance caused by a genetic inability to properly metabolize alcohol (missing ALDH2 enzyme), which leads to symptoms like flushing, headaches, and nausea shortly after drinking. An alcohol allergy on the other hand is an immune system reaction to ingredients in alcohol, (usually ethanol), which can cause more severe reactions, including hives, difficulty breathing, and even anaphylaxis. In this article I’ll review both of these conditions in-depth and explain treatment options and best practices to prioritize your health while still enjoying the occasional drink.

What is Alcohol Intolerance?

Alcohol intolerance is something I have dealt with since I started drinking in college. Similar to any type of intolerance (like dairy) there are unpleasant side effects that happen any time I drink alcohol (for me it’s primarily flushing on my face and chest). The root cause of most people’s alcohol intolerance is a deficiency in the ALDH2 often a deficiency in the enzyme which is responsible for metabolizing ethanol.When the ethanol is not properly metabolized the body has a build up of a toxic substance called acetaldehyde which can cause a host os issues I have listed below.

Symptoms of Alcohol Intolerance

  • Facial redness (flushing)
  • Red, itchy skin bumps (hives)
  • Gastrointestinal discomfort: Nausea and vomiting, diarrhea
  • Respiratory issues: Runny or stuffy nose, worsening of pre-existing asthma
  • Cardiovascular signs: Low blood pressure

The severity of these symptoms can vary from person to person and is largely dependent on genetics and the amount of alcohol consumed.

What is an Alcohol Allergy?

An alcohol allergy is a condition where the body’s immune system reacts to alcohol as if it were a harmful substance. It generally causes a much worse reaction than an intolerance and alcohol should be avoided entirely by people with this condition.

Signs of Alcohol Allergy

Generally speaking, an alcohol allergy is typically marked by an immediate immune system reaction after consuming alcohol. Below are the signs that may indicate the presence of an alcohol allergy:

  • Skin reactions: Rashes, itchiness, and hives
  • Respiratory issues: Difficulty breathing, nasal congestion, and a runny nose.
  • Gastrointestinal symptoms: Severe stomach cramps, vomiting, and diarrhea.
  • Swelling: Facial swelling, or angioedema, particularly around the eyes, lips, and throat.
  • Anaphylactic reactions: Although rare, alcohol can trigger anaphylaxis, a severe, potentially life-threatening allergic reaction.

Because of the severity of these symptoms it is highly advised to abstain from alcohol entirely if you are have an actual allergy. Anaphylaxis in particular, is the most extreme response and requires immediate medical attention, as it can include a dramatic drop in blood pressure, severe shortness of breath, and loss of consciousness.

Common Triggers and Ingredients

In exploring the difference between alcohol tolerance and alcohol allergy, I focus on the specific ingredients and substances in alcoholic beverages that can trigger intolerance and allergic reactions. These triggers vary widely and can affect individuals differently based on genetic factors and sensitivities.

Alcohol Types and Intolerance Triggers

Different types of alcoholic beverages contain various ingredients that can act as intolerance triggers. For instance:

  • Wine: Often contains sulfites, which are preservatives that can cause reactions in sensitive individuals. A study showed that about 7.2% of people report wine intolerance, with a higher incidence in women.
  • Beer: Composed of hops, barley, and yeast, ingredients that may prompt intolerance symptoms in some individuals, particularly those with sensitivity to gluten.
  • Spirits: The distillation process might not eliminate all triggers, but spirits generally have fewer of the proteins and chemicals that cause intolerance compared to beer or wine.

Individual reactions to these substances can range from mild to severe, and the severity doesn’t necessarily correlate with the amount of alcohol consumed (although it can). I personally find the worst reaction from alcoholic beverages with high sugar so I tend to stick to clear alcohols with mixed with soda water.

Allergic Reactions to Ingredients

Allergic reactions to alcoholic beverages are less common, but certain ingredients can cause true allergic responses:

  • Grains: Beverages containing wheatbarley, or rye may trigger reactions in individuals with a gluten allergy.
  • Yeast: Common in beer and wine fermentation, yeast can be an allergen for some.
  • Grapes: Specifically in wine, certain proteins in grapes can be allergenic to rare cases.

Allergic reactions might include symptoms such as hives, swelling, or a drop in blood pressure. Unlike intolerance, which relates to the digestive system’s response, allergies involve the immune system reacting to specific ingredients as if they were harmful pathogens.

Diagnostic Testing Advice For Alcohol Intolerances & Allergies

Although the severity of alcohol intolerance and alcohol allergies can seem indistinguishable to many people it is important to know which condition you are dealing with, as a true allergy can be fatal.

Because of this, proper diagnosis is essential to give you the necessary piece of mine to manage your condition effectively. Personally, I went to go see an allergist when I began having adverse reactions from alcohol. Their testing showed I simply had an intolerance which then allowed me to begin experimenting on different supplements tactics that allowed me to still enjoy the occasional drink or two.

Typically this encompasses a blood test that identifies potential allergic reactions to substances found in alcoholic beverages and a skin prick test where small amounts of allergens are introduced to my skin, allowing the allergist to observe a reaction immediately.

Following diagnosis, medical advice often includes avoiding alcohol or specific ingredients found in alcoholic beverages that trigger reactions based on your test results. For milder intolerance symptoms, antihistamines may be prescribed, although they do not resolve the underlying intolerance.

My healthcare provider ensures that I’m equipped with the knowledge to manage my condition, emphasizing the importance of adhering to recommended lifestyle adjustments namely lots of hydration, whole foods, and limited alcohol consumption

Management and Treatment Options

When managing and treating alcohol intolerance, I consider several key approaches. Alcohol intolerance often requires simple abstinence to avoid symptoms. If I accidentally ingest alcohol and experience discomfort, over-the-counter antihistamines can help mitigate mild reactions. For alcohol allergy, a more cautious approach is necessary, since such reactions can be severe.

For Alcohol Intolerance:

  • Hydration: Before drinking alcohol you should make sure you are properly hydrated with water before, during, and after you drink.
  • Food: Drinking on full stomach slows the release of alcohol into the blood stream and allows your body more time to process it.
  • Supplementation: I discuss with my healthcare provider to determine if any supplements may aid in digestion or metabolism when I consume alcohol-based products accidentally. Specifically for alcohol intolerance there are patches which can mitigate flushing and hangovers.
  • Types of Alcohol: Stick to beverages with Low ABV, low histamines, and low sugar.

For Alcohol Allergy:

  • Avoidance: I strictly avoid alcoholic beverages to prevent symptoms.
  • Emergency Medication: I always carry if diagnosed with a severe alcohol allergy carrying an epinephrine pen is crucial in case you unknowingly ingest alcohol.
  • Allergist Consultation: Regular consultations with an allergist help me keep track of my allergies and their reactions.
  • Ingredient Awareness: I’m diligent about reading labels and inquiring about the content in drinks to avoid preservatives or other substances I’m allergic to.
  • Medication Review: I ensure that any medications I take do not contain alcohol or ingredients that might cause an allergic reaction.

Additionally, I recommend discussing all symptoms you have while drinking alcohol with your medical provider, as they can offer personalized advice based on my health history. This ensures that the management plan for you alcohol intolerance or allergy is both safe and effective.

Originally Published: January 17, 2024

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Analyzed by Ashley Wilson

Hi, I’m Ashley Wilson, a part-time personal trainer, yoga instructor, and mother of three. My journey with hormonal acne started during pregnancy, which led me to natural remedies discussed on GoodGlow like utilizing a low-inflammation diet, dramatically improving my health and skin. After successfully clearing my acne during my first pregnancy I to share my insights on managing acne naturally and maintaining overall wellness on GoodGlow. I’ve adopted a lifestyle focused on nutrition, yoga, resistance training, and meditation, helping me juggle my busy life with kids and work. I’m always eager to connect and share skincare tips, so feel free to reach out!

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