Alcohol Allergy vs. Alcohol Intolerance

Alcohol allergy and alcohol intolerance are often considered as two different conditions that can cause similar symptoms. Here are the fundamental differences between the two conditions:

Alcohol Allergy

• An alcohol allergy is not a traditional allergic reaction (immune response) but more a condition where alcohol heightens the immune system to harmful intruders that can trigger an allergic reaction.
• The allergic reaction is not readily directly caused by the alcohol (ethanol) itself but it is as a result of drinking the alcohol or the ingredients in the alcoholic drink .
• Allergies relating to alcohol are relatively uncommon but can be fatally serious.
• Individuals with an alcohol related allergies can experience an adverse reaction after as little as a mouthful of wine or beer (or about 10 millilitres).
• Alcohol allergy symptoms can involve serious reactions like hives, facial swelling, nausea, and vomiting.

With severe alcohol allergy an emergency action plan should be put into place by your healthcare provider if you’re at risk of such potentially life-threatening allergic reactions.

Alcohol Intolerance

• Alcohol intolerance occurs when your body lacks sufficient enzymes to properly metabolise the alcohol.
• Alcohol intolerance is usually caused by inherited (genetic) traits most often found in Asians.
• Ingredients commonly found in alcoholic beverages can also cause intolerance reactions. Reactions can be triggered by an alcoholic drink intolerance reaction to a grain such as corn, wheat, or rye or to another ingredient.
• The symptoms of alcohol intolerance include flushing, headaches, heartburn, hives, and a red, flushed face.
• Some research has shown that red wine is more likely to trigger a negative reaction compared to other alcoholic beverages but this still isn’t clear and many different factors are involved.[1] 

If you suspect that you have an alcohol allergy or intolerance, it is important to talk to get tested to understand the nature of your condition and consult with your healthcare provider to determine the best course of action moving forward.

How is alcohol intolerance caused?

The most common cause of alcohol intolerance is a genetic condition in which the body cannot break down alcohol efficiently, which is a condition most frequently found in Asians.[2] However, the ingredients commonly found in alcoholic beverages, especially in beer or wine, can cause intolerance reactions, including sulphites, histamine or other preservatives, chemicals, grains, yeasts and fruits.

Of the common ingredients found in alcohol, gluten, grapes, wheat, and hops are all frequent triggers of inflammation and an underlying cause of alcohol intolerance symptoms. Certain people may find that they are in fact not able to comfortably consume such things as seafood proteins, egg protein, or barley found in their favourite alcoholic beverages. These ingredients are often hidden and it’s not always easy to understand what might be causing a reaction.

What diseases cause alcohol intolerance?

Certain diseases and health conditions can contribute to developing or exacerbating alcohol intolerance. Some of the most notable include:

• Hodgkin’s lymphoma: Alcohol intolerance can show up in those that have the disease.
• Liver disease (cirrhosis): People with liver disease who drink regularly are at a higher risk of developing alcohol intolerance.
• Late-onset Alzheimer’s disease: Individuals who experience Alzheimer’s disease may be more sensitive to alcohol.

It is important to note that only some  people with these diseases actually develop alcohol intolerance.

Do I have an alcohol intolerance?

If you’re intolerant to alcohol, you might experience certain signs and symptoms that occur after drinking. Alcohol intolerance does not mean you will become intoxicated faster than others, simply that you will have a negative reaction to alcohol.

How long does it take for alcohol intolerance to show?

Some sufferers may experience alcohol intolerance symptoms shortly after consuming alcohol – roughly 20 or 30 minutes – with some finding the runny nose and flushed face occurring first.
Respiratory reactions also tend to happen quickly, including shortness of breath and quickening of your heart rate. The signs and symptoms depend on how much alcohol has been drank and individual tolerances.

If you have an IgG type of intolerance reaction to alcoholic drink ingredients these reactions may take hours or even days to show up.

How long do alcohol intolerance symptoms last?

If the intolerance is severe, symptoms like major headaches can occur that can carry on for one or two hours. Every person, situation, and severity are different, and not everyone will experience intolerances the same way.

If your exposure to an alcoholic drink ingredient is on a regular basis then chronic conditions such as IBS, headaches and migraines might be ongoing.

The most effective way to stop alcohol intolerance is by halting or restricting consumption of alcohol – non-alcoholic drinks (that don’t contain the specific ingredients that you are reacting to) can be useful in social situations.

Intolerance tests can help you to understand what it is that you’re intolerant to, as it may be that it is ingredients within certain drinks that are causing you discomfort and other beverages may be okay for you to consume.

Advice for alternatives

It is widely known and understood that over consumption of alcohol is generally bad for your health. However, many of us enjoy a drink in moderation.

If you suffer from alcohol intolerance, it is important to understand which ingredient of the drink causes a problem for you (such as the alcohol itself or is it the wheat, the gluten in the wheat, fruit or yeast?). With this knowledge, you can choose alternatives to help you avoid the symptoms of alcohol intolerance.

How to Test for Alcohol Intolerance

To determine if you have alcohol intolerance, you may want to consider the following testing options:

Genetic Testing

Alcohol intolerance is often associated with a deficiency in the enzymes alcohol dehydrogenase (ADH) and/or aldehyde dehydrogenase (ALDH)which are crucial for metabolising alcohol. Genetic testing can help identify mutations in the genes that are linked to this condition.[3] This type of alcohol intolerance test is typically performed in a medical setting where a healthcare professional collects a DNA sample (usually through a blood sample or cheek swab), and the sample is then sent to a lab for analysis.

At-Home Blood Test Kits

There are various home-to-laboratory test kits that can help identify sensitivities to common ingredients found in alcoholic beverages. These tests typically measure the immune system’s IgG response to different food and drink ingredients. For example, YorkTest’s Premium Food Intolerance Test is a reliable and easy-to-use option that tests common ingredients found in alcoholic beverages, such as certain grains, yeast or fruits. Because genetic causes of alcohol intolerance are uncommon, this type of test is a great place to start for most individuals who want to know more about how they can change their diet and feel better.

Any abnormal or concerning results from an alcohol intolerance test or similar test kit should be followed up with a healthcare professional for further evaluation and confirmation through more comprehensive testing if necessary.

Scientific References

1. Wüthrich B. Allergic and intolerance reactions to wine. Allergol Select. 2018 Sep 1;2(1):80-88. doi: 10.5414/ALX01420E. PMID: 31826033; PMCID: PMC6883207.
2. Morozova TV, Mackay TF, Anholt RR. Genetics and genomics of alcohol sensitivity. Mol Genet Genomics. 2014 Jun;289(3):253-69. doi: 10.1007/s00438-013-0808-y. Epub 2014 Jan 7. PMID: 24395673; PMCID: PMC4037586. 
3. Shin MJ, Cho Y, Davey Smith G. Alcohol Consumption, Aldehyde Dehydrogenase 2 Gene Polymorphisms, and Cardiovascular Health in Korea. Yonsei Med J. 2017 Jul;58(4):689-696. doi: 10.3349/ymj.2017.58.4.689. PMID: 28540979; PMCI