Alcohol is indeed one of the most used and abused beverages all over the world, but generally allergies to it are not commonly reported. On the contrary, alcohol intolerance (or sensitivity) is a condition in which consumption is associated with negative symptoms, in some users with very minimal intake.
Alcohol is metabolized or broken down into simple products that can be easily excreted in urine (and are responsible for the resolution of its effects in the body). The liver is the detoxification center so any discrepancy or deficiency of liver function may lead to sensitivity or intolerance phenomena.
Generally true alcohol allergy is often confused with its intolerance due to partial overlap of symptoms. Scientifically speaking, true allergy is when the body produces IgE antibodies in response to extremely small dosages and produce severe allergic reaction. IgE antibodies are the proteins that cause hives, swelling, rash and asthma-like conditions in hypersensitive individuals.
Alcohol allergy cases are rare but may lead to severs symptoms if not promptly treated.
What causes issues in term of alcohol metabolism?
Alcohol sensitivity or intolerance is mostly the result of genetic defects in the enzymes that are responsible for its metabolism in the body. Other common causes include:
- Drug interaction of alcohol with some medications/ herb or supplement. Intake of drugs like disulfiram (Antabuse) that are generally prescribed to treat alcohol addiction may affect the metabolism leading to symptoms of intolerance.
- Defects of the liver or other parts of gastric tract that takes part in the metabolism of alcohol within human body.
- Co-existing medical conditions that aggravate the release of chemicals in response to alcohol consumption like Hodgkins Lymphoma (releases histamine in response to alcohol intake). Generally all the allergy symptoms in the body are mediated by histamine that causes rash, swelling, wheezing in chest and breathing issues.
In alcohol intolerance, individuals react to the ingredients that are present in such beverages like grains, corn, preservatives or other flavoring chemicals. Such individuals develop reactions to some liquor but are able to tolerate others that do not contain the particular allergy-causing chemical. In these individuals, liquor produces similar symptoms to that of food allergies such as that to wheat.
Aldehyde dehydrogenase deficiency is a condition whereby levels of aldehyde raise during the breakdown of alcohol. This can lead to severe nausea and vomiting, and is a common cause of intolerance of liquor in certain demographics, eg some Asian populations.
But in true alcohol allergy, individuals develop antibodies in response to alcohol itself. Even minor doses may result in massive release of histamine that may be life-threatening in untreated cases.
What are the symptoms of alcohol allergy?
In alcohol intolerance, individuals develop strong reactions after moderate consumption. The symptoms may be transient and minor, like nasal congestion (vasomotor rhinitis) or a flush reaction in the skin. But they also can be moderate to severe, depending upon the amount of liquor intake and the degree of impairment of liver enzymes.
Some true alcohol allergy symptoms include:
- Development of a rash that may start off as little bumps and can progress to widespread hives.
- Headache and congestion of sinuses
- Asthma like shortness of breath (or worsening of pre-existing asthma).
- Upper gastric illness like nausea, vomiting and low blood pressure in untreated cases.
- In true allergies to liquor cases, individuals can develop severe shock (pulselessness, cardiac arrest, low blood pressure and even death) in response to even an ounce of alcohol.
Note the distinction with alcohol poisoning, which is due to an overwhelming amount of liquor intake, not a reaction to it per se.
What to do if you are concerned?
If you have a personal or family history of alcohol allergy, it is recommended:
- To identify the cause of allergy and in case you are allergic to ethanol itself, you should maintain absolute abstinence as a treatment.
- If you are allergic to some ingredients it is better to switch to other beverages that do not contain allergens.
- If you develop serious reaction after consumption, see your doctor immediately especially if you are developing breathing issues or severe hives. Immediate treatment is necessary.
As always, speak to your own health professional for expert advice on the matter.