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Can You Develop Alcohol Intolerance?

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If you’ve recently found yourself unable to enjoy a drink or two like you did previously, you may be pondering the question: Can you develop alcohol intolerance? 

In fact, alcohol intolerance can develop at any stage of life, and it’s something that can happen to anyone. Symptoms of alcohol intolerance can range from mild (such as face reddening), to severe (anaphylaxis). Once an intolerance has developed, the only way to eliminate symptoms is to avoid alcohol altogether. 

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A sudden inability to handle alcohol may be of concern for various reasons. Some people may become worried about a more significant medical reason for not being able to drink like they used to, while others may feel social or career-related pressures to drink.

Many people who develop alcohol intolerance simply enjoy the occasional drink, though some may have an alcohol dependence and become especially distressed at the onset of these symptoms. This may actually be helpful in quitting drinking. (The drug disulfiram, for example, causes this reaction on purpose as part of treatment for alcohol use disorder). But if you are unable to stop drinking alcohol, this reaction can be a serious problem indeed.

Whatever your concerns are, we aim to address them fully in this article, and explain exactly what alcohol intolerance entails!

Why Can’t I Tolerate Alcohol Anymore?

The most common cause of alcohol intolerance is an aldehyde dehydrogenase (ALDH2) deficiency. ALDH2 is used to break alcohol down in the liver, turning it into acetic acid. 

This deficiency affects 8% of the world’s population, but is much more common in people of East Asian descent (at 35-40% of the Asian population). This is why it is sometimes referred to as “Asian glow” or “Asian flush.”1 The most common symptom is facial redness—which explains the nickname—but intolerance can also cause a rapid heartbeat, nausea, and headaches. 

Alternatively, people may experience sensitivity to certain components of alcoholic drinks.2 This can mean reactions to preservatives such as sulfites, chemicals, grains, or histamines (a byproduct of fermentation). In this case, individuals may still be able to enjoy some forms of alcohol that don’t contain the specific ingredient they are reacting to.

Lower Tolerance vs Intolerance 

Alcohol intolerance stems from genetic causes, the symptoms of which can appear at any time in life. 

Alcohol intolerance means that the body is unable to break down the toxins found in alcohol, so it remains in the system for longer. The symptoms result from the body’s increased effort to metabolize the alcohol. 

Keep in mind that not being able to stomach alcohol like you used to is not the same thing as having an allergy to alcohol. With an allergy, the body’s immune system fights the substance, as it perceives it as a threat. When it comes to an intolerance, the body simply isn’t up to the task of breaking it down. Alcohol allergies are very rare, while intolerance is quite common. 

Intolerance is also different from what we often call “low tolerance.” Someone with a low tolerance feels the effects of alcohol more strongly than others, but their bodies don’t have a problem with actually processing the alcohol. Reasons for low tolerance can include lower body weight, genetics, overall health, and the body not being used to metabolizing alcohol.3 

A low alcohol tolerance is nothing to be concerned about. People who find they become intoxicated off a few drinks should limit their consumption accordingly, and not try to “keep up” with others. However, they don’t need to avoid alcohol altogether. 

On the other hand, it would be best for people with alcohol intolerance to stay away from alcohol completely, as this is the only way to avoid symptoms and side effects. 

Signs You Are Developing Alcohol Intolerance

The following symptoms may occur shortly after drinking alcohol if you are beginning to develop alcohol intolerance:

  • Warm, red face
  • Skin breaking out into hives
  • Nasal symptoms such as a running or stuffy nose
  • Feeling faint upon standing (due to a drop in blood pressure)
  • Stomach upset—including nausea, vomiting, or diarrhea 
  • Shortness of breath, particularly for those who already have asthma
  • Migraines
  • Severe allergic reactions such as anaphylaxis (in rare cases)

If your reaction is due to the other components within alcoholic beverages, you’ll experience symptoms only when consuming certain types of drinks. For instance: If it is due to grain, you may react to beer but not wine. If it’s due to sulfites, you might find you don’t react if you try an organic, sulfite-free wine.

If it’s important to you to continue to drink on occasion, you can try different types of beverages to see if any work. If you are vomiting after drinking a number of rounds with friends, and they all seem okay, you may simply have a lower tolerance than they do.

Can Your Alcohol Tolerance Vary?

If you usually handle alcohol fine, remember that many factors can influence your tolerance on a day-by-day basis! Factors such as when you last ate, the type and amount of food you had, when you last exercised, and the medications you’re currently taking can all alter alcohol’s effects. 

Some people can tolerate cocktails easily, but get drunk off just a couple of glasses of wine. One bad night doesn’t necessarily mean you are intolerant to alcohol. 

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Why Some People Develop Alcohol Intolerance

group of female friends drinking beer together and laughing
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Alcohol intolerance has a genetic component. Even if we handled alcohol well in early adulthood, this can change as we age. It is similar to any other allergy and intolerance that develops later in life.

One idea is that our immune system is more resilient when we are young and can handle these foods better in our early years. Another is that an event such as using antibiotics, a period of high stress, or other health-related issues can also trigger an intolerance.

Certain factors can also increase your risk of experiencing alcohol intolerance. These include: 

  • Being a person of Asian descent
  • Having food allergies, particularly to grains 
  • Having hayfever
  • Suffering from asthma
  • Hodgkin’s lymphoma, or other serious health conditions

What Is Sudden Onset Alcohol Intolerance?

Sudden onset alcohol intolerance is when an alcohol intolerance that was not present from birth occurs abruptly later on in life. Most people with ALDH2 deficiency will notice some effects from the first time they take a drink, but there’s often no known reason as to why an alcohol intolerance develops.

In some cases, sudden onset alcohol intolerance is triggered by the presence of a new disease. This is common in the case of Hodgkin’s Lymphoma, where those with this condition will feel pain after drinking.4 This is due to enlargement of the lymph nodes, resulting in swelling and pressure placed on the nerves. 

Ovarian and breast cancers have also been shown to sometimes result in alcohol intolerance.5 

Developing sudden-onset alcohol intolerance does not mean you have a medical condition. However, it’s always a good idea to be checked by a doctor—especially if you’ve noticed any other concerning symptoms in your general health.

Why Your Overall Tolerance For Alcohol May Drop

There are plenty of explanations as to why alcohol tolerance can become lower than it was previously. These include:

  • Changes in our metabolism due to aging
  • We can build tolerance in young adulthood, only for it to fall as we drink less
  • Weight loss 
  • Certain medical and health conditions

Some may find that if they lose weight, their tolerance will drop. Certain medical and health conditions (like those mentioned in the above section) can also make alcohol more difficult to tolerate. 

With a serious illness, it’s better to abstain from alcohol to avoid further taxing the body. Doing so will also give it the best chance of fighting the illness effectively. Some people may find that their alcohol tolerance becomes higher with time. This is likely due to “practice” as they continue to use alcohol regularly.

A high tolerance can be a symptom of an advanced alcohol use disorder, which can lead to many health-related and social implications and should be addressed immediately. 

In Conclusion

Those with lower alcohol tolerances do not need to worry, but should still be aware of their limitations and drink appropriately if they choose to drink. It may be a good idea for those with a full alcohol intolerance to see a doctor to rule out any potential medical causes, and to undergo allergy testing. 

If you are alcohol intolerant, the only way to avoid symptoms is to stop drinking alcohol altogether. Having an alcohol intolerance does not need to have a major impact on your life. You can still socialize with others who are drinking, and simply drink alcohol-free beverages instead! 

If you’re particularly concerned about bringing attention to the fact that you aren’t drinking, a common ‘strategy’ is to choose beverages with the same appearance as the alcohol others are drinking. If you have an alcohol intolerance (or a lowered tolerance) but are struggling to give up alcohol, get in touch with Ria Health for further advice and guidance. 

We help people to give up alcohol for good—and all from your smartphone. You don’t even have to leave home!

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Written By:
Ria Health Team
Ria Health’s editorial team is a group of experienced copywriters, researchers, and healthcare professionals dedicated to removing stigma and improving public knowledge around alcohol use disorder. Articles written by the “Ria Team” are collaborative works completed by several members of our writing team, fact-checked and edited to a high standard of empathy and accuracy.
Reviewed By:
Evan O'Donnell
Evan O’Donnell is an NYC-based content strategist with four years’ experience writing and editing in the recovery space. He has conducted research in sound, cognition, and community building, has a background in independent music marketing, and continues to work as a composer. Evan is a deep believer in fact-based, empathic communication—within business, arts, academia, or any space where words drive action or change lives.
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