Is It Just 'Asian Flush' After A Night Out Or An Alcohol Allergy? Here's How To Tell, According To A Doctor

Does your face turn bright red after a few sips of wine, or do you break out in itchy rashes every time you have a drink? You might be dealing with alcohol intolerance or an alcohol allergy—and nope, they're not the same thing. You've probably heard of "Asian flush," a.k.a. that telltale redness some people experience after drinking. While it's commonly associated with alcohol intolerance, other reactions to alcohol can point to a whole different issue.

According to Makati Medical Center (MakatiMed), knowing the difference between an alcohol allergy and alcohol intolerance is important because they have different causes, symptoms, and potential health risks. So before you brush off that post-drinking redness or random itchiness as just part of your night out, here's what you need to know:

First things first: A true alcohol allergy is actually rare. It happens when your immune system mistakenly identifies alcohol as a threat and triggers an allergic reaction. However, some people who think they're allergic to alcohol may actually be reacting to other ingredients in their drinks.

These can include wheat, barley, rye, hops, yeast, grapes, preservatives, and sulfites, which are commonly found in different types of alcoholic beverages. So, that reaction you get after drinking wine or beer might not necessarily be caused by the alcohol itself.

According to Maria Socorro L. Agcaoili-De Jesus, MD, FPCP, FPSAAI, FPSRI, an Internal Medicine Specialist with a subspecialty in Child and Adult Allergy, Asthma and Immunology and Reproductive Immunology at MakatiMed, alcohol allergy and alcohol intolerance involve two different processes in the body.

"An alcohol allergy is related to the immune system, while alcohol intolerance is the body's inability to properly metabolize alcohol," she explains.

An allergic reaction can show up in different ways, including:

• Itchy skin or rashes

• Itchy mouth, eyes, or nose

• Swelling of the face or throat

• Coughing

• Difficulty breathing

In more severe cases, an alcohol allergy can trigger anaphylaxis. This is a life-threatening allergic reaction that causes the immune system to overreact to an allergen, potentially making your blood pressure drop and your airways narrow.

"Even a small amount of alcohol can induce symptoms in a person with alcohol allergy," says Dr. Agcaoili-De Jesus. She also warns that allergic reactions can escalate quickly, making it important to seek immediate medical attention, especially when swelling or breathing difficulties occur.

TL;DR: Don't wait for an allergic reaction to pass on its own, especially when it's affecting your breathing. Anaphylaxis is a serious medical emergency that requires immediate treatment.

Unlike an alcohol allergy, alcohol intolerance isn't an immune system response. It's an inherited condition that makes it difficult for your body to break down alcohol because of a deficiency in an enzyme called ALDH2. As a result, a toxic compound called acetaldehyde builds up in your body after drinking.

One of its most recognizable signs is the "Asian flush," also known as alcohol flush reaction. It causes your face, neck, and chest to turn red and feel warm shortly after drinking. It's more common among people of East Asian descent, particularly those with Chinese, Japanese, and Korean ancestry, but it can affect anyone.

You might also experience nausea, headaches, vomiting, low blood pressure, heart palpitations, and difficulty breathing. According to Dr. Agcaoili-De Jesus, that telltale redness is a sign that acetaldehyde is building up in your body. So, no, it's not necessarily just a sign that you have low alcohol tolerance. 🫣

Still not sure which one sounds more like what you're experiencing? The easiest way to tell them apart is to look at what's happening inside your body. An alcohol allergy involves your immune system reacting to alcohol or another ingredient in your drink, while alcohol intolerance means your body has trouble breaking down alcohol.

The symptoms can also look different. An alcohol allergy may cause itchy rashes, swelling, coughing, and difficulty breathing, with severe reactions potentially leading to anaphylaxis. Alcohol intolerance, on the other hand, is more commonly associated with facial redness, nausea, headaches, and heart palpitations because of the body's difficulty processing alcohol.

Another thing to remember: Even a small amount of alcohol can trigger an allergic reaction, while symptoms of alcohol intolerance typically appear shortly after drinking.

But of course, don't solely rely on these symptoms to figure out what's going on. The best way to know what's causing your reaction is to consult a medical professional, who can properly evaluate your symptoms and recommend the next steps.