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Alcohol Flush Reaction

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What is Alcohol Flush Reaction?

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.

Alcohol Flush Reaction

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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What Causes Alcohol Flush Reaction?

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.

How Common is Alcohol Intolerance?

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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Symptoms of Alcohol Flushing 

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.

Alcohol Flush Reaction Back

Other side effects of alcohol flushing include:

  • Reddening skin in other areas of the body
  • Increased heart rate
  • Overheating sensation
  • Headache
  • Dizziness
  • Nausea with or without vomiting
  • Horrible hangovers
  • Weight gain

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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Alcohol Intolerance vs Alcohol Allergy

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

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

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:

  • Hives, eczema, or itchy skin
  • Swollen face, throat, or other areas of the body
  • Itching mouth, nose, or eyes
  • Difficulty breathing or congestion
  • Nausea, vomiting, abdominal pain, or diarrhea
  • Lightheadedness, dizziness, or loss of consciousness

You can also be allergic to other ingredients in alcoholic drinks. Common ingredients that may cause an allergic reaction include:

  • Grapes
  • Wheat
  • Rye
  • Barley
  • Yeast

Can You Diagnose Alcohol Flush Syndrome?

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.

Treatment and Prevention for Alcohol Flush Reaction

To date, there is no cure for alcohol flush reactions. However, some medicines can help reduce symptoms. 

Treatments

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:

  • Zantac 360
  • Tagamet
  • Pepcid

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. 

Prevention

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:

  • Limit the amount of alcohol you consume in a given time
  • Limit how often you consume alcohol (only drink alcohol during special occasions)
  • Choose alcoholic beverages with lower alcohol contents
  • Practice breathing and relaxation techniques to help calm your heart rate and other symptoms of alcohol flush
  • Stay hydrated to help minimize the intensity of certain alcohol flush symptoms like overheating, nausea, and hangovers

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.

Frequently Asked Questions (FAQs)

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.

Is a red face a sign of alcoholism?

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.

Is alcohol intolerance the same as being intoxicated?

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.

How long do symptoms of alcohol flush reaction usually last?

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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Updated on September 29, 2022
9 sources cited
  1. Genetic and Rare Diseases Information Center. “Acute Alcohol Sensitivity.” U.S. Department of Health and Human Services. 
  2. Vertava Health.“Alcohol Intolerance - Causes, Symptoms, And Addiction Treatment Options.” 2019.
  3. NCH Healthcare System. “Alcohol Intolerance.”
  4. Mayo Clinic, Mayo Foundation for Medical Education and Research. “Alcohol Intolerance.” 2020. 
  5. National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services.“Alcohol Metabolism: An Update.” 2007.
  6. Brooks, Philip J, et al. “The Alcohol Flushing Response: an Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption.” PLoS Medicine, Public Library of Science, 2009. 
  7. Steps to Recovery. “Drinking Alcohol In Excess Can Cause Skin Problems.” 2020. 
  8. Nunez, Angela. “Alcohol Flush: A Healthy Glow or Health Concern.” Pathway Genomics, 2018. 
  9. A Healthier Michigan. “What Exactly Is 'Alcohol Flush Syndrome'?” 2018.

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