Those horrible hangovers might not be just because you had one too many glasses of rosé.
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 really the greatest of friends, especially if you get some pretty nasty hangovers. Sure, there are a few hangover cures that might help the next day, but what if the usual stuff (ibuprofen, electrolytes, sleep) isn't doing the trick? Come to think of it, you didn't really drink that much, so why do you feel so awful? Well, you might wanna sit down for this news, but there's a possibility you could be allergic to alcohol. (And, if you're interested, here's how your body reacts to alcohol normally.)
In cases where your body just can't metabolize alcohol properly, it can lead to a slew of unfortunate symptoms, making you really regret that round of tequila shots. Symptoms can be treated 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. 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.
Here, 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.
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Difference Between an Intolerance and an Allergy
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First, know that an allergy to alcohol means any alcohol—wine, beer, and hard liquor are all potential threats. It's not necessarily the ingredients used to make the drinks, but the process that makes them alcoholic that can be the problem. (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, at that, along with wheezing, difficulty swallowing, low blood pressure, and heart palpitations, he says. An allergic reaction is also usually sudden and abrupt.
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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, which are 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, says Dr. Glatter.
If beer, specifically, 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.)
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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 along with itchy rashes or hives.
"Development of hives or red bumps are 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 the 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.
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If you start to feel flushed or overheated, begin sweating on your forehead, and/or your heart starts racing, you might be having an adverse reaction to alcohol due to your body's inability to properly metabolize it. (And, a heads up, you might experience heart palpitations from drinking excess caffeine, too.)
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, 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 effectively manage the concentration of alcohol in your body.
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You might covet the full-lip look of Angelina Jolie, but if they suddenly appear when you're 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. (Men can also experience penile swelling in instances of anaphylaxis.) 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, which is injected to quickly relax muscles to open up airways.
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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 of the chronic respiratory issues. (Symptoms of the flu, common cold, and seasonal allergies mimic one another, which can make it difficult to diagnose.)
Diarrhea and Nausea
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If you're making frequent trips to the bathroom with any of the following—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 an endless number of health conditions, (see: Surprising Things That Are Secretly Destroying Your Digestion), so you'll want another opinion. 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.
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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. "A skin prick test can be performed by an allergist 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. 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," he says.
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