A 36-year-old businessman from Agra who developed rashes all over his body, experienced giddiness and a persistent, dry cough after a recent night of partying in Hyderabad, was rushed to an allergy centre in the city for emergency care. Close examination by allergists revealed that the man had experienced a similar reaction two months ago, after consuming the same brand of whiskey.
Dr Vyakarnam Nageshwar, the chief allergist and immunologist from Aswini Allergy Centre, who attended to the case, says that the man had a very high level of serum immunoglobulin E (IgE) (antibodies produced by the immune system in response to an allergen).
The doctor ran an alcohol oral challenge test on him, where he consumed the suspected alcohol under medical supervision. Later, after an allergen skin prick test, he was diagnosed with an alcohol allergy.
“This person had been getting rashes on and off for the past five years,” says Dr Nageshwar.
He points out that whenever the man consumed whiskey, he would develop symptoms like flushing and redness of the face, swollen eyes, rashes and a dry cough. These symptoms appeared 30 minutes to an hour after taking the drink. But the doctor notes that this was a rare case of alcohol allergy in which the person presented with severe allergic reactions. Dr Nageswar says that in the 36-year-old man’s case, he had a strong family history of allergies and also suffered from asthma and allergic urticaria.
“It is the atopic nature [a strong family history of allergies making one more prone to developing allergies] of this person that caused this. He had in-built allergies and off late, he developed hyperreactivity to a particular whiskey. When he takes another type of liquor, like beer, for instance, he does not develop any reactions,” he says.
Allergy to alcohol is rare. Dr Nikhil Paul, assistant professor of emergency medicine at Sree Gokulam Medical College, Thiruvananthapuram, says that he has not seen any cases of alcohol allergy in his day-to-day practice. “In this case, since the person reported a history of allergic reactions, he could develop hypersensitivity to alcohol among other things,” he says.
Dr Nageshwar adds, “This was a very rare presentation. But as an allergist and immunologist, I suspect there are thousands of patients undiagnosed. Because we have never probed much into these conditions, we may not be aware. Through simple investigation and assessment, we may be able to detect more such cases.”
Signs and symptoms of alcohol allergy
Experts say that some of the common signs of an alcohol allergy include:
- Rashes or hives
- Swelling of the face
- Heaviness of the head and chest
- Dry cough or a nasal congestion
- Difficulty breathing
- Giddiness or dizziness
Dr Nageswar says that other causes for an adverse reaction to alcohol include a reaction to certain ingredients found in the alcoholic beverage such as preservatives, histamine, wheat and barley among others. “There is also an enzyme deficiency condition, caused by a deficiency in the ALDH2 enzyme, which affects how the body metabolises alcohol. This is a condition in which there is a genetic predisposition to alcohol sensitivity,” he says.
Alcohol allergy treatment
The Australian Society of Clinical Immunology and Allergy (ASCIA) says that cases of severe alcohol allergies, which could result in anaphylaxis, should be managed similarly to food allergies; people must identify and avoid the cause and carry an emergency supply of epinephrine auto-injectors (a medical device used to treat severe allergic reactions).
Alcohol intolerance vs alcohol allergy
The main difference between alcohol allergy and alcohol intolerance is that alcohol intolerance is not an immune reaction, says Dr Nageshwar.
“In alcohol intolerance, the reaction or response happens in one’s gut. It’s a reaction in which an irritant goes to your gastrointestinal system, wherein a particular ingredient/chemical/fragrance or element is causing an irritation in the gut. It doesn’t involve an immune system response,” he adds.
The symptoms of alcohol intolerance include:
- Nausea
- Vomiting
- Diarrhea
- Bloating of the abdomen
- Severe headaches
Dr Paul says, “Alcohol is metabolised by the body in a two-step mechanism. Anything that interferes with this process of metabolism can cause alcohol intolerance. This includes conditions such as gastroesophageal reflux disease (GERD) [where the contents in the stomach leak into the food pipe].”
Symptoms such as severe gastritis, nausea, vomiting and retching could also occur because of binge drinking. “Severe vomiting can cause esophageal rupture. It can also cause ulcers – small tears in the stomach. Binge drinking can also cause pancreatitis,” points out Dr Paul.
Takeaways
Alcohol allergy is a condition in which the body develops adverse allergic reactions such as rashes and difficulty breathing after the consumption of alcohol.
The condition is rare and can be managed by identifying the triggers and avoiding alcohol. In cases where people develop severe allergic reactions, they may require the administration of epinephrine (medication used to treat such reactions).
