Allergic to Alcohol? 10 Common Symptoms of Alcohol Intolerance

Key takeaways:

True alcohol allergies are very rare, but many people have an alcohol intolerance. This is when the body doesn’t break down alcohol well.
Symptoms of alcohol intolerance include hives, skin flushing, stuffy nose, nausea, and vomiting.
Alcoholic drinks that are high in histamine — like red wine — are more likely to trigger symptoms of alcohol intolerance.

If you’ve ever had an alcoholic drink only to find your nose running and your stomach roiling, you may have an alcohol intolerance. Or you may have an alcohol allergy, a stronger reaction that involves the immune system. But this is much less common.

People with an alcohol intolerance or sensitivity can start feeling sick after just a few sips of alcohol. If you’re one of the many people who feel hungover after just 1 drink, here’s what you need to know about alcohol intolerance.

Is it possible to be allergic to alcohol?

Yes. It’s possible to be allergic to alcohol, but it’s not very common. Most people who think they have an alcohol allergy actually have an alcohol intolerance (also called acute alcohol sensitivity).

The difference between the two has to do with how the body reacts to alcohol.

A true allergic reaction happens when your immune system goes into overdrive to attack something it sees as a threat. Allergic reactions can cause hives, facial swelling, nausea, and vomiting. They can also lead to life-threatening reactions like anaphylaxis.

While just about anything can trigger an allergic reaction, some things (like a bee sting, peanuts, and certain foods) are more likely to trigger allergic reactions than others. Alcohol doesn’t commonly trigger allergic reactions. In fact, many people who have true allergic reactions while drinking alcohol are actually allergic to something else in the drink (like wheat, barley, grapes and yeast), but not the alcohol itself.

Alcohol intolerance happens when your body reacts in an unpleasant way to alcohol, but the process doesn’t involve your immune system. You may develop many symptoms, but you won’t have an anaphylactic reaction.

What are the symptoms of alcohol intolerance?

The 10 most common symptoms of alcohol intolerance are:

Face redness (flushing)
Skin redness
Runny nose
Stuffy nose
Nausea
Dry mouth
Feeling warm
Headaches
Indigestion
Rapid heart rate (palpitations)

Why do people develop an alcohol intolerance?

People can develop an alcohol intolerance for a couple of reasons.

Low aldehyde dehydrogenase

Some people don’t have enough of an enzyme called aldehyde dehydrogenase (ALDH). Or they have ALDH, but it doesn’t work very well.

Alcohol breaks down into aldehyde. Aldehyde is toxic, and buildup is one of the key reasons people develop symptoms of a hangover. ALDH turns aldehyde into acetic acid, a nontoxic substance that doesn’t cause any harm.

If ALDH doesn’t work, the body starts to build up aldehyde pretty quickly after any exposure to alcohol and people can feel sick.

Your genes determine how well your enzymes work. So, people are typically born with a tendency for alcohol intolerance, which also runs in groups of people who are more closely genetically related. For example, people of Asian descent tend to have lower levels of ALDH.

Sulfite and histamine sensitivity

Sulfites, tyramines, and histamines are substances that are naturally found in many forms of alcohol. They’re present in higher amounts in certain types of alcohol, like red wine, than others.

These substances can make your blood vessels dilate, which causes symptoms of alcohol intolerance. A 2014 study showed that people who have a history of hay fever (allergic rhinitis) or asthma are more likely to develop symptoms of alcohol intolerance when they’re exposed to these substances. People with aspirin-exacerbated respiratory disease (AERD) are also more likely to have alcohol intolerance.

Can you suddenly develop alcohol intolerance?

Yes.

Some medications can stop your ALDH enzymes from working as well as they normally do. If you drink alcohol while taking these medications, you can experience alcohol intolerance.

Medications that can trigger alcohol intolerance include:

If you’re starting a new medication, it’s always a good idea to talk with your healthcare provider or pharmacist about how your medication can interact with alcohol.

Can you get tested for alcohol intolerance?

Maybe.

There are genetic tests that can tell you if you have an ALDH deficiency. Your healthcare provider can order this test or you can purchase one through private vendors.

You can also get allergy testing to check whether you have a true allergy to alcohol. Allergy testing can also tell you if you have an allergy to another component of alcoholic beverages like wheat, grapes, or barley.

But there aren’t any tests for sulfite or histamine sensitivity.

The bottom line

Some people experience flushing, headaches, and nausea shortly after drinking alcohol. These are symptoms of an alcohol intolerance.

Alcohol intolerance is most often due to genetic conditions and sensitivity to histamine and sulfites in alcoholic beverages. True allergic reactions to alcohol are very rare.

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who believes in achieving optimal health through healthy lifestyles. She’s a diplomate of the American Board of Obesity Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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