Alcohol intolerance explained

Synonym:Acute alcohol sensitivity

Alcohol intolerance is due to a genetic polymorphism of the aldehyde dehydrogenase enzyme, which is responsible for the metabolism of acetaldehyde (produced from the metabolism of alcohol by alcohol dehydrogenase).[1] [2] This polymorphism is most often reported in patients of East Asian descent.[3] [4] [5] [6] Alcohol intolerance may also be an associated side effect of certain drugs such as disulfiram, metronidazole, or nilutamide. Skin flushing and nasal congestion are the most common symptoms of intolerance after alcohol ingestion. It may also be characterized as intolerance causing hangover symptoms similar to the "disulfiram-like reaction" of aldehyde dehydrogenase deficiency or chronic fatigue syndrome.[7] [8] [9] Severe pain after drinking alcohol may indicate a more serious underlying condition.[10]

Drinking alcohol in addition to consuming calcium cyanamide can cause permanent or long-lasting intolerance (nitrolime disease),[11] [12] contributing (in conjunction with other substances) to the accumulation of harmful acetaldehyde in the body by inhibiting the acetaldehyde dehydrogenase enzyme.

Signs and symptoms

Individuals with alcohol intolerance will experience unpleasant reactions immediately after drinking alcohol.[13] Common signs and symptoms of alcohol intolerance include nasal congestion, skin flushing (redness), headaches, low blood pressure, nausea, and vomiting.

Causes

Genetics

ALDH1 is an isozyme of aldehyde dehydrogenase. A structural mutation in the gene of ALDH1, commonly found in East Asians, results in low levels of functional ALDH1 enzyme and thus, higher blood acetaldehyde levels.[14] Higher blood acetaldehyde levels have been associated with facial flushing caused by an increase in heart rate and blood flow to the face from vasodilation of the blood vessels. Individuals that have the ALDH2*2 allele, a variant that has a mutation when compared to the wild-type ALDH2 isozyme, are known to have higher blood acetaldehyde levels.[15] [16] Individuals that have either mutation in the ALDH1 or ALDH2 genes may have slightly different blood acetaldehyde levels among others carrying a similar mutation and may experience varying degrees of alcohol intolerance symptoms.[17] [18] [19]

Risk factors

Various genetic and environmental factors exist that can lead to an increased risk for developing alcohol intolerance. Individuals with two copies of the ALDH2*2 allele are known to have high blood acetaldehyde levels and experience “hangover” symptoms such as heart palpitations for longer durations, even with low alcohol consumption. Individuals who work with DMF have shown a dose-related increase in alcohol intolerance complaints.[20] Exposure to DMF can also cause facial flushing and increased sensitivity to alcohol.[21] [22]

Diagnosis

Ethanol patch test

In an ethanol patch test, different concentrations of ethanol are applied onto lint pads and attached to the inner surface of the upper arm for several minutes. If skin redness occurs after 10 - 15 minutes, the individual is deemed to have a lack of ALDH1 associated with alcohol intolerance.[23]

Difference from alcohol allergy

Alcohol intolerance is not an allergy.[24] There are often misconceptions that alcohol intolerance and alcohol allergy are the same, but they are not. Alcohol intolerance is an inherited genetic disorder that impairs alcohol metabolism.[25] The increased accumulation of acetaldehyde in affected individuals due to deficient aldehyde dehydrogenase enzymes often leads to the characteristic symptom of having flushed skin.[26] [27] On the other hand, the more uncommon alcohol allergy is an immune system reaction to alcohol (specifically ethanol) that causes symptoms such as rashes, difficulty breathing, and anaphylaxis in severe cases.[28] [29] Nausea is a symptom common to both alcohol intolerance and alcohol allergy. Remarkably, inhaled isopropyl alcohol can be used to provide nausea and vomiting relief.[30] [31]

Management

Avoiding or restricting alcohol is the most straightforward way to prevent the symptoms of alcohol intolerance. Tobacco use or exposure to secondhand smoke should be avoided, as smoking may increase levels of acetaldehyde. Certain medications may interact with alcohol and worsen symptoms. Antacid or antihistamines are used to reduce the symptoms of alcohol intolerance. However, these medications simply mask these symptoms.[32] Reducing alcohol consumption lowers the risk for cancer and other serious diseases.[33] [34] [35]

See also

Notes and References

  1. Book: Alcohol Metabolism, Alcohol Intolerance, and Alcoholism . 1990 . 57–59 . en . 10.1007/978-3-642-74904-9. Agarwal . Dharam P. . Goedde . H. Werner . 978-3-642-74906-3 . 46280438 .
  2. Harada . S. . Agarwal . D.P. . Goedde . H.W. . Aldehyde Dehydrogenase Deficiency as Cause of Facial Flushing Reaction to Alcohol in Japanese . October 1981 . The Lancet . 318 . 8253 . 982 . 10.1016/s0140-6736(81)91172-7 . 6117742 . 6468178 . 0140-6736.
  3. Mizuno . Yuji . Morita . Sumio . Harada . Eisaku . Shono . Makoto . Morikawa . Yoshinobu . Murohara . Toyoaki . Yasue . Hirofumi . 2013 . Alcohol Flushing and Positive Ethanol Patch Test in Patients with Coronary Spastic Angina: Possible Role of Aldehyde Dehydrogenase 2 Polymorphisms . Internal Medicine . 52 . 23 . 2593–2598 . 10.2169/internalmedicine.52.0894 . 24292747 . 0918-2918. free .
  4. Tsuritani . Ikiko . Ikai . Eriko . Date . Takayasu . Suzuki . Yasuhito . Ishizaki . Masao . Yamada . Yuichi . 1995 . Polymorphism in ALDH2-genotype in Japanese men and the alcohol-blood pressure relationship* . American Journal of Hypertension . 8 . 11 . 1053–1059 . 10.1016/0895-7061(95)00222-b . 8554727 . 0895-7061.
  5. Web site: Alcohol intolerance - Symptoms and causes . 2019-11-07 . Mayo Clinic . en.
  6. Aoki . Y. . Wehage . S. L. . Talalay . P. . November 2017 . Quantification of skin erythema response to topical alcohol in alcohol-intolerant East Asians . Skin Research and Technology . en . 23 . 4 . 593–596 . 10.1111/srt.12376. 28513003 . 34497300 .
  7. Book: De Sousa, Avinash . Disulfiram: Its Use in Alcohol Dependence and Other Disorders . Springer Singapore . 2019 . 978-981-32-9876-7 . 1st . Singapore . 9–10.
  8. Petersen . E. N. . November 1992 . The pharmacology and toxicology of disulfiram and its metabolites . Acta Psychiatrica Scandinavica . en . 86 . S369 . 7–13 . 10.1111/j.1600-0447.1992.tb03309.x . 1471556 . 21475637 . 0001-690X.
  9. Hald . Jens . Jacobsen . Erik . 2009-03-13 . The Formation of Acetaldehyde in the Organism after Ingestion of Antabuse (Tetraethylthiuramdisulphide) and Alcohol. . Acta Pharmacologica et Toxicologica . 4 . 3–4 . 305–310 . 10.1111/j.1600-0773.1948.tb03352.x . 0001-6683.
  10. Ma . Lucy . Varma . Sanskriti . Niranjan-Azadi . Ashwini . 2019 . Hodgkin lymphoma presenting as alcohol-induced back pain . BMJ Case Reports . 12 . 11 . e228440 . 10.1136/bcr-2018-228440 . 31780609 . 6887434 . 1757-790X.
  11. http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_169.pdf Potential risks to human health and the environment from the use of calcium cyanamide as fertiliser
  12. Book: List of MAK and BAT Values 2012: Maximum Concentrations and Biological Tolerance Values at the Workplace. Report 48 . 2012-10-17 . Wiley-VCH Verlag GmbH & Co. KGaA . 978-3-527-66603-4 . Deutsche Forschungsgemeinschaft DFG . Weinheim, Germany . en . 10.1002/9783527666034.
  13. Crabb . D W . Edenberg . H J . Bosron . W F . Li . T K . 1989-01-01 . Genotypes for aldehyde dehydrogenase deficiency and alcohol sensitivity. The inactive ALDH2(2) allele is dominant. . Journal of Clinical Investigation . en . 83 . 1 . 314–316 . 10.1172/JCI113875 . 2562960 . 303676 . 0021-9738.
  14. Goedde . H. Werner . Agarwal . Dharam P. . 1987 . Polymorphism of Aldehyde Dehydrogenase and Alcohol Sensitivity . Enzyme . en . 37 . 1–2 . 29–44 . 10.1159/000469239 . 3106030 . 0013-9432.
  15. Peng . G. S. . Wang . M. F. . Chen . C. Y. . Luu . S. U. . Chou . H. C. . Li . T. K. . Yin . S. J. . August 1999 . Involvement of acetaldehyde for full protection against alcoholism by homozygosity of the variant allele of mitochondrial aldehyde dehydrogenase gene in Asians . Pharmacogenetics . 9 . 4 . 463–476 . 0960-314X . 10780266.
  16. Wüthrich . B. . 2018 . Allergic and intolerance reactions to wine . Allergologie Select . 2 . 1 . 80–88 . 10.5414/ALX01420E . 2512-8957 . 6883207 . 31826033.
  17. Thomasson . Holly R. . Crabb . David W. . Edenberg . Howard J. . Li . Ting-Kai . March 1993 . Alcohol and aldehyde dehydrogenase polymorphisms and alcoholism . Behavior Genetics . en . 23 . 2 . 131–136 . 10.1007/BF01067417 . 8512527 . 26462055 . 0001-8244.
  18. Enomoto . Nobuyuki . Takase . Shujiro . Yasuhara . Minoru . Takada . Akira . February 1991 . Acetaldehyde Metabolism in Different Aldehyde Dehydrogenase-2 Genotypes . Alcoholism: Clinical and Experimental Research . en . 15 . 1 . 141–144 . 10.1111/j.1530-0277.1991.tb00532.x . 2024727 . 0145-6008.
  19. Higuchi . S . Muramatsu . T . Shigemori . K . Saito . M . Kono . H . Dufour . M C . Harford . T C . 1992-03-01 . The relationship between low Km aldehyde dehydrogenase phenotype and drinking behavior in Japanese. . Journal of Studies on Alcohol . 53 . 2 . 170–175 . 10.15288/jsa.1992.53.170 . 1560668 . 0096-882X.
  20. Cai . Shi-Xiong . Huang . Mei-Yuan . Xi . Li-Qiang . Li . Yan-Lin . Qu . Jiang-Bin . Kawai . Toshio . Yasugi . Tomojiro . Mizunuma . Kazunori . Watanabe . Takao . Ikeda . Masayuki . 1992-01-01 . Occupational dimethylformamide exposure . International Archives of Occupational and Environmental Health . en . 63 . 7 . 461–468 . 10.1007/BF00572112 . 1577525 . 10246564 . 1432-1246.
  21. Lyle . W. H. . Spence . T. W. . McKinneley . W. M. . Duckers . K. . 1979-02-01 . Dimethylformamide and alcohol intolerance. . Occupational and Environmental Medicine . en . 36 . 1 . 63–66 . 10.1136/oem.36.1.63 . 1351-0711 . 1008494 . 444443.
  22. Kilo . Sonja . Göen . Thomas . Drexler . Hans . 2016-11-01 . Cross-sectional study on N,N-dimethylformamide (DMF); effects on liver and alcohol intolerance . International Archives of Occupational and Environmental Health . en . 89 . 8 . 1309–1320 . 10.1007/s00420-016-1164-0 . 27587219 . 33581884 . 1432-1246.
  23. Murarnatsu . Taro . Higuchi . Susumu . Shigernori . Kenji . Saito . Masayoshi . Sasao . Mitsuo . Harada . Shoji . Shigeta . Yosuke . Yamada . Koichi . Muraoka . Hideo . Takagi . Satoshi . Maruyarna . Katsuya . Kono . Hiroaki . April 1989 . Ethanol Patch Test-A Simple and Sensitive Method for Identifying ALDH Phenotype . Alcoholism: Clinical and Experimental Research . en . 13 . 2 . 229–231 . 10.1111/j.1530-0277.1989.tb00317.x . 2658661 . 0145-6008.
  24. Web site: Acute alcohol sensitivity Genetic and Rare Diseases Information Center (GARD) – an NCATS Program . 2018-04-17 . rarediseases.info.nih.gov . en.
  25. 1987-01-01 . Acetaldehyde and Aldehyde Dehydrogenase . Alcohol and Alcoholism . 10.1093/oxfordjournals.alcalc.a044740 . 1464-3502.
  26. Web site: Alcohol Intolerance: Symptoms, Tests & Alcohol Allergy . 2022-10-26 . Cleveland Clinic.
  27. Thomasson . Holly R. . Crabb . David W. . Edenberg . Howard J. . Li . Ting-Kai . 1993-03-01 . Alcohol and aldehyde dehydrogenase polymorphisms and alcoholism . Behavior Genetics . en . 23 . 2 . 131–136 . 10.1007/BF01067417 . 8512527 . 26462055 . 1573-3297.
  28. Web site: Alcohol allergy - Australasian Society of Clinical Immunology and Allergy (ASCIA) . 2022-10-26 . www.allergy.org.au.
  29. Alcoceba Borràs . E. . Botey Faraudo . E. . Gaig Jané . P. . Bartolomé Zavala . B. . 2007 . Alcohol-induced anaphylaxis to grape . Allergologia et Immunopathologia . 35 . 4 . 159–161 . 10.1157/13108228 . 17663926 . 0301-0546.
  30. Merritt . Bret A. . Okyere . Charles P. . Jasinski . Donna M. . March 2002 . Isopropyl Alcohol Inhalation . Nursing Research . 51 . 2 . 125–128 . 10.1097/00006199-200203000-00009 . 11984383 . 40170944 . 0029-6562.
  31. Merritt . Bret A. . Okyere . Charles P. . Jasinski . Donna M. . 2002 . Isopropyl Alcohol Inhalation . Nursing Research . 51 . 2 . 125–128 . 10.1097/00006199-200203000-00009 . 11984383 . 40170944 . 0029-6562.
  32. Miller . N S . Goodwin . D W . Jones . F C . Gabrielli . W F . Pardo . M P . Anand . M M . Hall . T B . 1988-01-01 . Antihistamine blockade of alcohol-induced flushing in orientals. . Journal of Studies on Alcohol . 49 . 1 . 16–20 . 10.15288/jsa.1988.49.16 . 3347071 . 0096-882X.
  33. Boffetta . Paolo . Hashibe . Mia . 2006-02-01 . Alcohol and cancer . The Lancet Oncology . en . 7 . 2 . 149–156 . 10.1016/S1470-2045(06)70577-0 . 16455479 . 1470-2045.
  34. Bagnardi . Vincenzo . Blangiardo . Marta . Vecchia . Carlo La . Corrao . Giovanni . 2001 . Alcohol Consumption and the Risk of Cancer: A Meta-Analysis . Alcohol Research & Health . en . 25 . 4. 263–270 . 11910703 . 6705703 .
  35. Bajaj . Jasmohan S. . 2019 . Alcohol, liver disease and the gut microbiota . Nature Reviews Gastroenterology & Hepatology . en . 16 . 4 . 235–246 . 10.1038/s41575-018-0099-1 . 30643227 . 58006795 . 1759-5053.

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