Alcohol & Health
Treatment
Helping Alcoholics
Medically Reviewed by Dr P. E. Pancoast, MD
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Alcohol flush reaction, or alcohol flush syndrome, is a bodily response to drinking alcohol characterized by the red flushing of the face and skin. It is a primary indicator of alcohol intolerance.
When you drink alcohol, your body breaks down the ethanol in the liver with an enzyme called alcohol dehydrogenase (ADH). It transforms the ethanol into a toxic compound called Acetaldehyde (CH3CHO), a known carcinogen.
Then, another enzyme called Aldehyde Dehydrogenase 2 (ALDH2) quickly breaks down the Acetaldehyde into a less-toxic compound known as Acetate (CH3COO-).
Acetate is further broken down into carbon dioxide and water.
This is a natural process that your body does — or should do — on its own. Unfortunately, not everyone’s bodies can do this efficiently.
Alcohol flush syndrome is an inherited metabolic disorder. It causes the body difficulty when metabolizing the Acetaldehyde compound. Acetaldehyde accumulates in the blood, resulting in red flushing, or spots, on the skin.
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Alcohol intolerance is caused by a genetic variant or mutation in the ALDH2 enzyme. This makes it unable to break down the toxic byproduct acetaldehyde efficiently. ALDH2 deficiency can also affect your alcohol metabolism.
When the body’s ALDH2 gene doesn’t operate as well as it should, it can cause an alcohol flush response.
If the ALDH2 enzyme does not break down Acetaldehyde, the level of acetaldehyde builds up in the blood. This can cause flushed skin, a rapid heartbeat, high blood pressure, and other symptoms of alcohol flush.
One study estimates that approximately 8% of the population, or 540 million people, have alcohol flushing syndrome.6
Some demographics of people are at a higher risk, such as East Asian populations and people of Asian descent.
Approximately 36%of East Asians (Japanese, Chinese, and Koreans) show a physiological response to drinking alcohol.6 As a result, alcohol flush is sometimes referred to as “Asian flush” and “Asian glow.”
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The most common symptom of alcohol is facial flushing. The face turns red, making it look like you just exercised or stood outside in the cold. Other parts of the body that may be affected include your chest and back.
Alcohol flush can look and feel uncomfortable. Unfortunately, other symptoms can occur with alcohol flush that can be much worse.
Other side effects of alcohol flushing include:
Alcohol flush can have a serious impact on someone’s life. Facial flushing is associated with an increased risk of cancer in men in East Asia. This is especially true for esophageal cancer.
Anyone who deals with alcohol flushing should seek advice from a health care professional.
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Many confuse alcohol intolerance, or an alcohol flush reaction, with an alcohol allergy. Both alcohol intolerance and alcohol flush may cause nausea. However, there are some subtle differences between the two.
Alcohol intolerance is a genetic metabolic disorder of the digestive system. The most common symptom of alcohol intolerance is flushing of the face, neck, chest, or back.
Alcohol allergy is a rare immune system response to alcohol.
Alcohol allergy is when your body treats alcohol as an allergen or pollutant. Symptoms range from mild to severe. People with a true alcohol allergy should avoid drinking altogether.
Anaphylaxis (a life-threatening allergic reaction) is the worst potential effect of an alcohol allergy.
Other side effects of alcohol allergy include:
You can also be allergic to other ingredients in alcoholic drinks. Common ingredients that may cause an allergic reaction include:
Yes. A doctor can use an ethanol patch test to diagnose you for alcohol flush syndrome. This is a simple test and an effective indicator of the ALDH gene variation/mutation that causes alcohol intolerance.
A doctor will place a small amount of ethanol on gauze and press it against your arm. After approximately 7 minutes, the doctor will remove the gauze and check to see if your skin is red, itchy, or swollen.
Unfortunately, not all doctors have access to this testing procedure. Check with your doctor before asking for this test. You might need to visit a specialist for allergy testing.
To date, there is no cure for alcohol flush reactions. However, some medicines can help reduce symptoms.
Histamine-2 (H2) blockers can be used to control alcohol flush reactions. These medicines work by slowing the breakdown of alcohol to acetaldehyde.
The most common H2 blockers are:
A topical solution, Brimonidine, is also a popular treatment for flushing. This substance is applied to the affected areas to reduce the size of blood vessels temporarily.
Although these medicines are FDA approved, they only work to mask the symptoms of alcohol flushing. They also do not help cure ALDH2 deficiency. In turn, they may simply cover up important symptoms that may be important to take note of.
The best way to prevent alcohol flush reaction it is to avoid alcohol completely.
By not drinking alcohol, your body isn’t tasked with breaking down the toxic compounds that cause alcohol flush reaction.
However, if you do choose to drink, here are some tips to help manage or minimize alcohol flush reactions:
Alcohol flush reactions can be alarming, especially if you’ve never had one before. Here are answers to some of the most commonly asked questions about alcohol flush reaction.
Alcohol flush reactions can be alarming, especially if you’ve never had one before. Here are some of the most commonly asked questions about alcohol flush reaction.
Flushed skin, such as a red face, can indicate alcoholism.
While a red face is not always a sign of alcoholism, it is a possible symptom. If you or someone you know is struggling with alcoholism, seek help from a professional. There are plenty of treatment options available.
Alcohol intolerance is not the same thing as being intoxicated.
Not everyone who is intoxicated has an intolerance to alcohol. Getting intoxicated happens when you ingest enough alcohol into the body, but how the body breaks down the alcohol determines whether or not you have alcohol intolerance.
Usually, the effects last a few hours, but sometimes they can last as long as 5 days. This depends on many factors, such as how much alcohol you drank, whether or not you drank on an empty stomach, and your genetics.
The length and severity of alcohol flush reaction varies. Unfortunately, there is no clear answer as the duration and intensity are unique to each person.
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