Does a sip of wine make you blush, or a bottle of beer give you a rash? If so, you might want to put the glass down to check whether you have an alcohol allergy or alcohol intolerance—two completely different conditions that are usually confused.

According to the top hospital in the Philippines, Makati Medical Center (MakatiMed), knowing the distinction can help you better recognize symptoms and make informed decisions to avoid complications in the long run.

“Many people interchange alcohol allergy and alcohol intolerance, but these actually involve different processes in the body,” explains Maria Socorro L. Agcaoili-De Jesus, MD, FPCP, FPSAAI, FPSRI, an Internal Medicine Specialist with a Subspecialty on Child and Adult Allergy, Asthma and Immunology and Reproductive Immunology. “An alcohol allergy is related to the immune system, while alcohol intolerance is the body’s inability to properly metabolize alcohol.”

Spotting the difference between the two may be difficult, as a true alcohol allergy is rare. A person with the condition has an immune system that mistakenly identifies alcohol as a threat and triggers an allergic reaction. More commonly, bodies react to the presence of wheat, barley, rye, hops, yeast, grapes, preservatives, or sulfites in an alcoholic beverage.

Symptoms to look for include itchy skin rashes; itchy mouth, eyes, or nose; swelling of the face or throat; coughing; and difficulty breathing. Severe cases can trigger anaphylaxis, wherein the immune system overreacts to an allergen that causes one’s blood pressure to drop and airways to narrow—a life-threatening emergency that requires immediate attention.

“Even a small amount of alcohol can induce symptoms in a person with alcohol allergy,” says Dr. Agcaoili-De Jesus. “Allergic reactions have the tendency to escalate quickly; therefore, it is important to seek immediate professional assistance, especially when breathing is affected or swelling is present.”

In contrast, alcohol intolerance is an inherited metabolic disorder wherein the body lacks the enzyme aldehyde dehydrogenase 2 (ALDH2) that is needed to break down alcohol.

The most known symptom of alcohol intolerance is the “Asian flush.” Immediately after drinking, the person’s face, neck, and chest become red and warm. In addition, people experience nausea, headaches, vomiting, low blood pressure, heart palpitations, and difficulty breathing.

It is called Asian flush since alcohol intolerance is common among people of East Asian descent, including the Chinese, Japanese, and Koreans. Nevertheless, it can be present in people of any race or ethnicity. 

While alcohol intolerance is often misunderstood as merely turning red from drinking, MakatiMed warns that it may cause long-term effects.

“The flushing reaction indicates that acetaldehyde is building up in the body. Research suggests that continued alcohol consumption of those with alcohol intolerance increases the risk of cancer in the mouth, throat, esophagus, stomach, and liver,” Dr. Agcaoili-De Jesus points out. To add, studies also linked alcohol intolerance with higher risks of heart disease, stroke, liver problems, and even late-onset Alzheimer’s disease.

To properly determine the root cause of those alcohol-induced symptoms, MakatiMed suggests seeking consult for evaluation. 

“The most important thing is not to self-diagnose,” reminds Dr. Agcaoili-De Jesus. “If you notice symptoms consistently every time you drink alcohol, it is best to seek medical attention to identify the cause and receive proper care.”

Persons with diagnosed severe alcohol allergies may be advised to carry an epinephrine auto-injector for emergency use. However, for those with alcohol intolerance, “there is no treatment that corrects the underlying enzyme deficiency.”

“Antihistamines or antacids cannot eliminate the health risks of alcohol intolerance. The safest way to avoid symptoms and long-term effects is to avoid consuming alcohol as much as possible,” Dr. Agcaoili-De Jesus advises. “Avoiding alcohol won’t only prevent alcohol allergy or intolerance, but it’s also a healthy habit that can help prevent alcohol-related health issues like liver and heart disease.” 

For more info, please contact MakatiMed On-Call at +632.88888 999, email mmc@makatimed.net.ph, or visit www.makatimed.net.ph. Follow @IamMakatiMed on Facebook and Twitter