One too many glasses of rosé might not be the only thing to blame for those horrible hangovers — you could also be dealing with a medical aversion. Are you allergic to alcohol? Learn the signs and symptoms to keep an eye out for and why certain drinks might affect you more than others.
Blame It On the Alcohol
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After a night of one too many vodka sodas, you might wake up and realize that you and alcohol aren’t the greatest of friends, especially if you get some really bad hangovers. But what if the usual stuff (ibuprofen, electrolytes, sleep) isn’t doing the trick? Come to think of it, you didn’t drink that much, so why do you feel so awful? Well, you might want to sit down for this news: There’s a possibility you could be allergic to alcohol.
In cases where your body can’t metabolize alcohol properly, it can lead to a slew of unfortunate symptoms, making you really regret that round of tequila shots. You can treat symptoms with OTC oral antihistamines, such as Benadryl, Allegra, or Dimetane, but more severe allergic reactions, such as heart palpitations or wheezing, may require a steroid shot, according to the Mayo Clinic. The scary thing: This and any kind of severe allergic reaction can be life-threatening if not treated, so book it to the ER if your reaction is extreme.
Ahead, Robert Glatter, M.D., an assistant professor of emergency medicine at Northwell Health and attending emergency physician at Lenox Hill Hospital, shares common signs to look out for if you think you or someone else might be allergic to alcohol.
Know the Difference Between an Intolerance and an Allergy
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First, an allergy to alcohol means any alcohol — wine, beer, and hard liquor are all potential threats (so, no, you probably don’t exclusively have a tequila allergy even if a couple of margaritas make you sick). It’s not necessarily the ingredients used to make the drinks that are the problem, but the process that makes them alcoholic. (However, there are some exceptions — more on that below — that can explain why someone could be allergic to beer and not liquor.)
It helps to pinpoint whether you have an intolerance or a full-blown allergy. “Intolerance to a component or additive in the alcoholic beverage (like histamine or yeast) produces a much less severe reaction. This may include mild itching, nasal congestion, nausea, or diarrhea,” says Dr. Glatter.
But the sign of a true allergy? You’ll have those same symptoms and a more intense reaction, such as wheezing, difficulty swallowing, low blood pressure, and heart palpitations, he says. An allergic reaction is also usually sudden and abrupt.
The Triggers
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“Certain types of alcohol (whiskey, cognac, and tequila, for example) contain more congeners (a naturally occurring by-product) than others, and can thus lead to a more intense allergic reaction,” says Dr. Glatter.
The triggers don’t stop there. You may often associate sulfites — food preservatives — with wine, but they are also found in other foods, such as dried fruit. Typically, reactions to sulfites are milder than reactions from an alcohol allergy.
Histamine, a naturally occurring compound in the body, is also found in fermented products, such as beer and wine, and can also be a common culprit of allergic reactions, as the buildup of histamine can trigger an allergic response, explains Dr. Glatter. (See more: What Is a Low-Histamine Diet, Exactly?)
If beer seems to be the issue, it’s probably the yeast, says Dr. Glatter. Beer drinkers can experience “an inflammatory response to the yeast proteins, which can lead to itching, superficial rashes, nausea, vomiting, or even diarrhea,” he says. This is not an allergy to the beer itself, just one specific ingredient in the beer, he explains. (On a separate note, gluten is often found in beer, which means trouble for anyone with a digestive intolerance or celiac disease. In this case, luckily, there are a few gluten-free beers to choose from.)
Now, it’s time to talk signs and symptoms of an allergy to alcohol….
Red, Itchy Skin
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The red, blotchy skin from a food allergy is much different from the acne you experienced as a teenager (or that you have now because, let’s be honest, adult acne is real.) This kind of skin irritation can also come with itchy rashes or hives.
“Development of hives or red bumps is commonly due to a reaction to histamines that can’t be broken down,” says Dr. Glatter. It’s the inability to metabolize these histamines that can cause an allergic reaction or flare-up, he says. People who have smaller amounts of a particular enzyme called diamine oxidase, which is responsible for breaking down histamine, can have trouble digesting alcohol, which causes an inflammatory, allergic reaction. Levels of histamines vary based on alcohol, but they will be in higher concentrations in beer and wine (especially red), he says.
As with any other allergen, your body reacts to alcohol as a foreign invader and creates antibodies as a response, he explains. These antibodies trigger a release of histamines, causing red and itchy skin. Unfortunately, if the body can’t effectively process and break down these histamines, it creates a buildup, which can cause these uncomfortable skin conditions, he explains.
Heart Palpitations
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If you start to feel flushed or overheated, begin sweating on your forehead, or your heart starts racing, you might be having an adverse reaction to alcohol due to your body’s inability to metabolize it properly.
As with histamines, this issue comes down to a depletion of enzymes — in this case, enzymes that are required to metabolize alcohol in the liver.
What’s more, research shows that some people have a gene variant (ALDH2) that prevents the body from producing aldehyde dehydrogenase, an enzyme that helps break down alcohol. So if your heart races and your body temperature skyrockets after drinking, your liver may not be able to manage the concentration of alcohol in your body effectively.
Facial Swelling
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If you start to experience swelling while drinking, be warned. Due again to the reaction from histamines, it’s not uncommon to experience swelling (think Will Smith in Hitch) when you have an alcohol intolerance.
Often, it’s facial swelling of the lips and tongue, says Dr. Glatter. In some cases, it could require a trip to the ER. If you experience this kind of swelling, “along with difficulty swallowing and breathing, low blood pressure, and dizziness, it could indicate anaphylaxis and require immediate administration of intramuscular epinephrine,” he says. The medication is injected to quickly relax muscles to open up airways.
Wheezing
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Alcohol allergies can cause your throat to feel tight, as if it’s closing up a bit. You can experience wheezing, shortness of breath, and coughing fits because of this, says Dr. Glatter. What’s more, “people with sinus problems may also develop more pronounced upper respiratory symptoms, including nasal congestion, stuffiness, and facial pressure” when they drink, he adds.
So, if you have asthma, frequent colds, and any other respiratory complications, a bad reaction or any of these symptoms associated with alcohol allergies could be worse. It’s fair to get a second opinion from a doctor to see if your symptoms are due to an alcohol allergy or worsening chronic respiratory issues.
Stomach Cramps
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If you experience stomach cramps after drinking alcohol, it can be a sign of an alcohol allergy or intolerance. With an allergy, the pain tends to be more severe and debilitating and may come on suddenly. It may even happen within the first sips: As little as a 1/3 of an ounce of wine or a mouthful of beer may be enough to trigger stomach cramps and other symptoms in those with an alcohol allergy.
Diarrhea and Nausea
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If you’re making frequent trips to the bathroom accompanied by painful abdominal cramps, diarrhea, nausea, vomiting, or other forms of indigestion, an allergy to alcohol could be to blame, says Dr. Glatter.
Of course, digestive trouble is a leading symptom of many health conditions, so you’ll want to consult your doc before diagnosing yourself with, say, a tequila allergy. But, if it happens after drinking, without any other weird lifestyle or dietary changes, there’s a high probability that the symptoms are linked to those wine spritzers.
How to Test for an Alcohol Allergy
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If all or some of these symptoms sound familiar, it’s time to get to the bottom of it. Meeting with an allergist can clarify what’s going on. An allergist can perform a skin prick test to determine if you are truly allergic to alcohol, says Dr. Glatter. “If you develop a reaction to the alcohol, you may see a raised bump known as a wheal or urticaria,” he explains. “An oral alcohol challenge test in the presence of an allergist is another option, along with specific blood tests that may identify enzymatic deficiencies in alcohol metabolism.” (Read more: What You Need to Know About Allergy Testing)
