Alcohol intolerance T78.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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alcohol intolerance; Alcohol intolerance

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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.

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

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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.

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  1. Sticherling M et al (1999) Alcohol: intolerance syndromes, urticarial and anaphylactoid reactions. Clin Dermatol 17: 417-422

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Last updated on: 29.10.2020