Am I Allergic to Alcohol? 9 Signs You Might Be

Blame it on the alcohol

After a night of one too many vodka sodas, you might wake up and realize that you and alcohol aren’t the best of friends, especially if you get really bad hangovers. But what if the usual things (ibuprofen, electrolytes, sleep) aren’t doing the trick? Come to think of it, you didn’t drink That Too much, so why do you feel so terrible? Well, you might want to sit down for this news: There’s a chance you might be allergic to alcohol.

In cases where your body can’t metabolize alcohol properly, it can cause unfortunate symptoms, causing you to Really Sadly in this age of tequila shots. According to the Mayo Clinic, you can treat symptoms with OTC oral antihistamines, such as Benadryl, Allegra, or Demetene, but more severe allergic reactions, such as heartburn or wheezing, may require a steroid shot. The scary thing: This and any other severe allergic reaction can be life-threatening if left untreated, so book an ER appointment if your reaction is severe.

Next, Robert Glatter, MD, assistant professor of emergency medicine at Northwell Health and an emergency physician in training at Lenox Hill Hospital, shares common symptoms so you know if you or someone else may be allergic to alcohol.

Know the difference between an intolerance and an allergy

First, an allergy to alcohol means any alcohol—wine, beer, and hard liquor are all potential hazards (so, no, you’re not exclusively allergic to alcohol even if a couple of margaritas make you sick). It’s not necessarily the ingredients that make the drinks problematic, but the process by which they become alcoholic. (However, there are some exceptions – more on that later – that may explain why someone might be allergic to beer and not wine.)

This helps identify whether you have an intolerance or a full-blown allergy. “Intolerance to an ingredient or additive in alcoholic beverages (such as histamine or yeast) rarely causes a severe reaction. It may include mild itching, nasal congestion, nausea, or diarrhea,” Dr. Glatter says.

But a true allergy symptom? They say you’ll have the same symptoms and a more severe reaction, such as wheezing, trouble swallowing, low blood pressure and heart palpitations. Allergic reactions are also usually sudden and abrupt.

Motivations

“Some types of alcohol (for example, whiskey, cognac, and tequila) contain more congeners (naturally occurring products) than others, and thus may cause more severe allergic reactions,” says Dr. Glatter.

The motivations don’t stop there. You might often associate sulfites — food preservatives — with alcohol, but they’re also found in other foods, like dried fruit. In general, reactions to sulfites are milder than allergic reactions to alcohol.

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 in allergic reactions, as a build-up of histamine can trigger an allergic reaction. (See also: What is a low-histamine diet, exactly?)

Dr. Glitter says that if beer appears to have a problem, it’s probably yeast. Beer drinkers “may experience an inflammatory response to yeast proteins, which can lead to itching, rash, nausea, vomiting, or diarrhea,” he says. He said it’s not an allergy to beer itself, just a specific ingredient in beer. (On a separate note, gluten is often found in beer, which means trouble for anyone with a digestive intolerance or celiac disease. Fortunately, in this case, there are some gluten-free beers to choose from.)

Now, it’s time to talk about the signs and symptoms of alcohol allergy….

Red, itchy skin

Red, blotchy skin from a food allergy is very different from the acne you experienced as a teenager (or that you have now because, let’s be honest, adult acne is real.) This type of skin irritation can also come with an itchy rash or hives.

“The development of hives or red bumps is usually caused by a reaction to histamines that can’t break down,” says Dr. Glitter. They say that the inability to metabolize these histamines can cause allergic reactions or flare-ups. People who have low levels of a certain enzyme called diamine oxidase, which is responsible for breaking down histamine, may have trouble digesting alcohol, causing an inflammatory, allergic reaction.. Histamine levels vary based on the alcohol, he says, but will be higher in beer and wine (especially red).

As with any other allergen, your body reacts to alcohol as a foreign invader and produces antibodies in response. These antibodies trigger the release of histamines, which cause redness and itching. Unfortunately, if the body can’t effectively process and break down these histamines, a build-up occurs, which can cause these painful skin conditions.

Heart beat

If you start to feel flushed or hot, sweat on your forehead, or your heart starts racing, your body may be having an adverse reaction to alcohol due to an inability to metabolize it properly.

As with histamines, the problem comes down to a lack of enzymes — in this case, the enzymes needed 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 rate and body temperature skyrocket after drinking alcohol, your liver may not be able to handle the alcohol concentration in your body effectively.

Swelling of the face

If you start experiencing bloating while drinking alcohol, be warned. Again due to a reaction to histamines, it is not uncommon to experience swelling (think Will Smith inside). Hutch) when you have an alcohol intolerance.

Often, it’s swelling of the face of the lips and tongue, says Dr. Glitter. In some cases, it may require a trip to the ER. If you experience such swelling, “with difficulty swallowing and breathing, low blood pressure, and dizziness, this may indicate anaphylaxis and require immediate administration of intramuscular epinephrine.” The medicine is injected to quickly relax the muscles to open the airways.

wheezing

An alcohol allergy can cause your throat to feel tight, as if it’s closing up a bit. You may have a fit because of wheezing, shortness of breath, and coughing, says Dr. Glitter. In addition, “people with bone problems may also develop upper respiratory symptoms, including nasal congestion, stuffiness and facial pressure” when they drink.

So, if you have asthma, frequent colds, and other respiratory complications, a bad reaction to an alcohol allergy or any of these symptoms may be worse. It’s a good idea to get a second opinion from a doctor to see if your symptoms are caused by an alcohol allergy or worsen chronic respiratory problems.

Abdominal pain

If you experience stomach pain after drinking alcohol, it could be a sign of an alcohol allergy or intolerance. With allergies, the pain is more intense and debilitating and can come on suddenly. It can even happen in the first sips: As little as an ounce of alcohol or 1/3 of a mouthful of beer can be enough to trigger abdominal pain and other symptoms in people with alcohol allergies.

Diarrhea and nausea

If you have frequent trips to the bathroom accompanied by excruciating abdominal pain, diarrhea, nausea, vomiting, or other forms of indigestion, an alcohol allergy can be blamed, says Dr. Glatter.

Of course, digestive distress is an important symptom of many health conditions, so you’ll want to consult your doctor before self-diagnosing yourself with a tequila allergy. But, if it happens after drinking, without any other weird lifestyle or dietary changes, it’s more likely that the symptoms are linked to those spritzers of alcohol.

How to Test for Alcohol Allergy

If all or some of these symptoms sound familiar, it’s time to get down to it. A visit to an allergist can explain what’s going on. An allergist can perform a skin-prick test to determine if you’re actually allergic to alcohol, Dr. Glatter says. “If you develop a reaction to alcohol, you may have a raised bump known as a wheal or hives,” he explains. “An oral alcohol challenge test in the presence of an allergist is another option, along with specific blood tests that can identify deficiencies of enzymes in alcohol metabolism.” (Read more: What you need to know about allergy testing)