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Understanding Alcohol Intolerance Symptoms

Medically reviewed by Dr. Po-Chang HsuOctober 8, 2024
Written by
On October 8, 2024

Table of Contents

Key Points

  • Alcohol intolerance is a genetic metabolic disorder that impacts the digestive system.
  • People with alcohol intolerance have a deficiency in the enzyme aldehyde dehydrogenase 2 (ALDH2), which impairs the ability to metabolize alcohol properly.
  • The classic symptom of alcohol intolerance is skin flushing in the face, neck, and chest.
  • An alcohol allergy is an immune system response to an allergen in alcohol, which can be a chemical, grain, or preservative.

Alcohol intolerance is an inherited metabolic disorder. People with alcohol intolerance have a mutated gene that causes a problem with a specific enzyme that helps your body metabolize alcohol. People with this disorder have difficulty breaking down alcohol, which leads to them feeling flushed, warm, and generally uncomfortable.

What is Alcohol Intolerance?

Alcohol intolerance is a genetic metabolic disorder.[1] When a person consumes alcohol, the enzyme alcohol dehydrogenase (ADH) works to metabolize the ethanol. Next, the liver converts the ethanol to acetaldehyde (toxic), followed by another enzyme, aldehyde dehydrogenase 2 (ALDH2), that converts the acetaldehyde to acetic acid (nontoxic). 

Among people with genetic mutations, their ALDH2 is inactive or less active, resulting in the body’s inability to convert the acetaldehyde to acetic acid. Acetaldehyde builds up in their body, causing alcohol intolerance symptoms.

Common Symptoms of Alcohol Intolerance

Alcohol intolerance usually causes an immediate, uncomfortable reaction after consuming alcohol. Common symptoms of alcohol intolerance include:[2] 

  • Alcohol flushing syndrome: face, neck, and chest become warm and pink or red right drinking alcohol
  • Nausea, vomiting, diarrhea
  • Rapid heartbeat or heart palpitations
  • Low blood pressure
  • Throbbing headache
  • Fatigue
  • Stuffy nose
  • Hives
  • Worsening asthma
  • Other hangover-like symptoms

 

If you have an alcohol intolerance, it doesn’t matter if you drink beer, wine, liquor, or any other type of alcoholic beverage; you will experience a reaction. Complications of continuing to drink alcohol despite an intolerance include cancers of the mouth, throat, esophagus, stomach, and liver.[3] They may also have an increased risk for heart disease and stroke. 

Risk Factors of Alcohol Intolerance

Risk factors of having an alcohol intolerance include:[4] 

  • Being of Asian descent (30%-50% of people of East Asian descent have alcohol intolerance)
  • Having asthma or hay fever 
  • Having an allergy to grains or other food additives found in alcohol
  • Having Hodgkin’s lymphoma (drinking alcohol with Hodgkin’s lymphoma can result in severe pain for some people)
  • Being older as people age, many become more sensitive to alcohol

How to Diagnose Alcohol Intolerance

To diagnose alcohol intolerance, a healthcare provider will ask about symptoms and any reactions you have after drinking alcohol. Based on the symptoms you share with them, they may have enough information to provide you with a diagnosis of alcohol intolerance. 

Your healthcare provider may also have you complete an ethanol patch test to test for an alcohol intolerance.[5] An ethanol patch test involves your healthcare provider placing a few drops of ethanol on a gauze pad and then taping it to your arm. You will sit there for approximately seven minutes, and then they will remove the gauze pad and check for signs of redness, swelling, and itching. If you have a reaction to the ethanol patch test, your healthcare provider will diagnose you with alcohol intolerance.

Exploring with your healthcare provider the symptoms you experience after drinking alcohol and completing an ethanol patch test can help determine if you have alcohol intolerance or an alcohol allergy. Having a sudden onset of alcohol intolerance can be due to certain serious health conditions such as Hodgkin’s lymphoma or liver disease. If your alcohol intolerance is a new reaction you have not experienced in the past when consuming alcohol, you should contact your medical provider to discuss this.

Managing Alcohol Intolerance

There is no cure for the genetic mutation that causes alcohol intolerance. There are also no medication or lifestyle changes that can prevent a reaction to alcohol. The only way to prevent reacting is to avoid consuming alcohol.  

To prevent having an alcohol intolerance reaction, avoid: [6]

  • Alcohol: Avoiding or limiting alcohol consumption is the best way to avoid symptoms. Replace alcoholic drinks with ones that do not contain alcohol.
  • Tobacco use: Smoking can raise levels of acetaldehyde, which can increase one’s cancer risk. This includes exposure to secondhand smoke.
  • Alcohol use with certain medications: Some medications can cause symptoms to be more severe.
  • Certain medications: Some medications contain alcohol, such as cold medicines. This can also cause an alcohol intolerance reaction. You should read all ingredient lists before taking a new medication.  
  • Antacid or antihistamine to reduce symptoms: These medications mask the symptoms of alcohol intolerance. This can result in consuming more alcohol as you are less likely to feel its negative effects. However, you are making the problem worse. 

 

Most alcohol intolerance reactions are mild and do not require medical attention. Should your symptoms be more extreme or you experience severe pain, you should seek emergency medical attention immediately. 

You may wish to discuss with your healthcare provider about steps you can take should you consume alcohol unknowingly. For example, taking a medication for the first time that you are unaware of contains alcohol or accidentally consuming a cocktail when you ordered a mocktail.

Support for Alcohol Intolerance

While there is no cure for alcohol intolerance, there are ways to support your health through this diagnosis. If you are diagnosed with alcohol intolerance, you may choose to share this information with your friends and family so they can understand and support your decision to reduce or stop drinking alcohol. 

Stopping drinking alcohol is the best way to avoid alcohol intolerance reactions. This will also reduce your risks of developing other health conditions as a result of continuing to drink with an alcohol intolerance. If your healthcare provider has recommended you stop using alcohol and you think this may be difficult, there are alcohol rehabs and treatment programs that can help you stop using alcohol as quickly and safely as possible so you no longer have to experience the uncomfortable symptoms of alcohol intolerance.

Medical Content Writer

Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.

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Frequently Asked Questions About Alcohol Intolerance

No, alcohol intolerance and an alcohol allergy are two separate conditions.
Alcohol intolerance is a genetic condition; it is a metabolic disorder of the digestive system where a person’s body does not metabolize alcohol as it should. 

Alcohol allergies are an immune response where a person’s immune system overreacts to an ingredient in alcohol.[7] The substances in alcohol that most often cause an allergic reaction are chemicals, grains, or preservatives.

The key symptom of alcohol intolerance is flushed skin on the face, neck, and chest. Allergic reactions to alcohol tend to be more painful and include rashes, swelling, itchiness, and severe stomach cramps. An alcohol intolerance will be uncomfortable but tolerable. An alcohol allergic reaction can be life-threatening, should you have an anaphylactic reaction, as with any extreme allergic reaction.

No, while people with the genetic mutation do not have the enzyme in their body to metabolize the toxins in alcohol, there are other reasons a person may react to drinking alcohol. 

Other alcohol ingredients that can trigger allergic reactions in some people include[8]

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

No, alcohol intolerance is not the same as alcohol intoxication (being drunk). People with alcohol intolerance do not become intoxicated faster or after consuming less alcohol or have higher blood alcohol levels. People with alcohol intolerance often choose not to drink or limit their alcohol consumption due to the uncomfortable symptoms they experience.

Feeling sick after having an alcoholic drink could be due to many reasons. You could have an alcohol intolerance or an alcohol allergy. Even without a medical condition, there are reasons alcohol may be making you feel sick. The most common cause is that alcohol irritates the lining of the stomach, which increases acid release and can result in feeling nauseous. 

If you regularly feel sick after drinking alcohol, you should discuss this with your healthcare provider to rule out any serious medical conditions. Your medical provider will most likely recommend that you reduce or eliminate your alcohol consumption.

There are many prescription medicines, over-the-counter medications, herbal supplements, and illegal drugs that can interact negatively with combined with alcohol. Some of these medications include antibiotics, antidepressants, antihistamines, barbiturates, benzodiazepines, histamine H2 receptor antagonists, muscle relaxants, non-narcotic pain medications, and anti-inflammatory agents, opioids, and warfarin. 

You should always read the warning insert with medications to see if there are adverse effects if taken with alcohol. Before starting a new medication or supplement, you can also discuss your concerns with your healthcare provider or pharmacist.

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[1,2,5,6,7] Cleveland Clinic. (2024, May 1). Alcohol intolerance: Symptoms, tests & alcohol allergy. Retrieved from https://my.clevelandclinic.org/health/diseases/17659-alcohol-intolerance on 2024, Sept 25.

[3] Cedars-Sinai. (2023, November 3). Alcohol intolerance: What you need to know. Retrieved from https://www.cedars-sinai.org/blog/alcohol-intolerance-what-you-need-to-know.html on 2024, Sept 25.

[4,8] Mayo Foundation for Medical Education and Research. (n.d.). Alcohol intolerance. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/alcohol-intolerance/symptoms-causes/syc-20369211 on 2024, Sept 25.

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