Alcohol Allergy vs. Alcohol Intolerance

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

Alcohol Allergy

• An alcohol allergy is a condition where the immune system identifies alcohol, or more specifically ethanol, as a harmful intruder that triggers an allergic reaction.
• Alcohol allergies are relatively uncommon but can be fatally serious.
• Individuals with an alcohol allergy 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.
• Allergy tests to alcohol are usually negative but are sometimes positive for breakdown byproducts of ethanol, such as acetaldehyde or acetic acid (vinegar).

Severe alcohol allergy should be managed in the same way as other severe allergic reactions (anaphylaxis): identify and avoid the cause and carry adrenaline (epinephrine or an “EpiPen”) as part of an emergency action plan if you’re at risk of potentially life-threatening allergic reactions.

Alcohol Intolerance

• Alcohol intolerance occurs when your body lacks the right enzymes to properly metabolise the toxins in alcohol.
• Alcohol intolerance is caused by inherited (genetic) traits most often found in Asians.
• Ingredients commonly found in alcoholic beverages can cause intolerance reactions. Reactions can be triggered by a true allergy to a grain such as corn, wheat, or rye or to another ingredient.
• The symptoms of alcohol intolerance are usually less severe than those of an alcohol allergy and include flushing, headaches, heartburn, hives, and a red, flushed face.
• Red wine is more likely to trigger a negative reaction compared to other alcoholic beverages.[1] 
• While rare, severe pain after drinking alcohol is a sign of a more serious disorder, such as Hodgkin’s lymphoma
• The best-known condition to cause alcohol intolerance is Hodgkin’s lymphoma; however, other conditions may also cause it.

It is important to note that alcohol intolerance is not the same as an alcohol allergy. 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 sulfites or other preservatives, chemicals, grains, 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 many of their favourite alcoholic beverages.

What diseases cause alcohol intolerance?

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

• Hodgkin’s lymphoma: This type of cancer is most attributed to causing alcohol intolerance.
• 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 late-onset Alzheimer’s disease may be more sensitive to alcohol.
• Cancer of the mouth and throat (head and neck cancer): People with cancer in these areas are more prone to alcohol intolerance.

It is important to note that only a small percentage of 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.

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.

The most effective way to stop alcohol intolerance is by halting or restricting consumption of alcohol – non-alcoholic drinks 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. If you suffer from what you think might be an alcohol intolerance, it is important to understand which ingredient of the drink is causing you issues (is it the gluten? or the fruit?). With this knowledge, you can choose alternatives to help you avoid the symptoms of alcohol intolerance.

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 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 enzyme aldehyde dehydrogenase 2 (ALDH2), which is crucial for metabolising alcohol. Genetic testing can help identify mutations in the ALDH2 gene 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 substances. 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, fruits, or additives. Because genetic causes of alcohol intolerance are uncommon, this type of test is a great place to start for most individuals.

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