Alcohol intolerance - Altmeyers Encyclopedia

Synonym(s)

alcohol intolerance; Alcohol intolerance

Definition
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Acutely occurring, probably genetically determined, undesirable phenomena after ingestion of alcoholic beverages with marked individual and ethnic differences in reactions to low doses of alcohol.

Occurrence/Epidemiology
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Mongolian populations (e.g. Japanese, Chinese, Koreans) react to a much higher percentage than Caucasian populations.

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Etiopathogenesis
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The cause is increased acetaldehyde concentration in the body.
Lack of aldehyde dehydrogenase 2 activity (ALDH) leads to slower metabolism and consecutive accumulation of acetaldehyde.
In Asians, the rate of alcohol degradation is increased by alcohol dehydrogenase, which additionally raises the acetaldehyde level.
Increased acetaldehyde levels trigger catecholamine-induced vasodilatation with flush symptoms.
No evidence of aldehyde dehydrogenase enzyme abnormality in the Caucasian population.
Due to the lower alcohol tolerance, affected persons consume lower amounts of alcohol on average.
Some drugs can inhibit the ALDH activity of the liver (e.g. disulfiram, sulfonamides, chloramphenicol, griseofulvin, procarbazine).
Type I and type IV reactions are also discussed pathophysiologically.

Clinical features
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Flush, increase in heart rate, palpitations, feeling of heat in the stomach and muscle weakness.
Urticarial reactions can occur when the alcohol comes into direct contact with the skin (rarely described so far).
Anaphylactoid reactions (asthma, hypotension, unconsciousness) can occur even after consumption of small amounts.