It was somewhere around my third year of college when I began to develop a taste for wine as opposed to, say, marshmallow-flavored vodka. It was also around this time I started to notice my face sometimes felt weird after drinking certain types of alcohol. After a glass or two of red wine, in particular, my face would suddenly become bright red—an annoying detail, sure, but the real annoyance was just how hot it felt after drinking. Sometimes, this was accompanied by a slightly stuffy nose, too. Am I allergic to red wine? I would ask myself, only to answer my own question the next time I drank wine with no side effects whatsoever. Then, as soon as I’d experience the flushed feeling again, the same questions arose. I decided to talk to some experts to find out exactly what was happening to my face when I drank alcohol.
"Flushing happens when someone doesn’t digest alcohol completely," Dr. Abisola Olulade explains, going on to say that it happens because of a genetic mutation that causes a decrease in the expression of an enzyme called ALDH2. "Some people may have a deficiency in ALDH2 (lower levels of ALDH2), which causes an inability to break down acetaldehyde, which then builds up in the body and can cause unpleasant effects, one of which is flushing but also nausea and headache." As Dr. Maxine Warren explains, a similar enzyme deficiency happens in AFS or Asian Flushing Syndrome. This affects 20-50% of individuals of East Asian Descent.
However, if like me, you aren’t of East Asian descent and experience flushing (sometimes, but not always) while drinking alcohol—it may have to do with the specific types of alcohol you’re drinking and how your body is reacting to it. According to Dr. Dendy Engelman, something as simple as dehydration and a “poor water balance” could contribute to flushing. "Alcohol leads to dehydration by inhibiting an antidiuretic hormone, which results in a net loss of water from the body," Dr. Engelman says. "Poor water balance can lead to swelling, puffy eyes, under-eye circles, and dull-looking skin. Hydration is important to keep toxins flushed and fluid moving efficiently through the capillaries."
Dr. Engelman also shares the key to getting to the bottom of what’s causing your flushing is often as simple as keeping track of which drinks trigger reactions. Dr. Olulade echoes this advice, explaining that different alcohols contain different ingredients, which could be more flush-inducing than others.
The key to getting to the bottom of what’s causing your flushing is often as simple as keeping track of which drinks trigger reactions.
"For example, red wine contains more tannins than white wine, and if someone is allergic (more serious and happens much quicker) or intolerant/sensitive to this, then it can cause them to have flushing,” Olulade says. "Some wines also have more sulfites than others, and this can also create flushing. However, sulfites are naturally present in many things that we consume, including food, so their effects may be overestimated." Flushing could also occur for other types of intolerances, like those who have gluten intolerance and experience flushing while drinking beer.
Another thing to consider if you experience flushing is the possibility of rosacea, Dr. Olulade says. “Rosacea is a chronic inflammatory skin disorder that can cause facial redness from enlarged blood vessels on the face, especially in the cheeks. Red wine has long been known to trigger flare-ups of rosacea because it causes an enlargement (dilation) of the blood vessels,” Dr. Olulade explains. “However, a study published in the American Journal of Dermatology in April of 2017 showed that white wine could also trigger a flare-up of this condition.”
As Dr. Warren explains, flushing caused by rosacea is particularly hard to treat and common in people who are fair-skinned with a northern European background. "Those affected may suffer from persistent Centro facial redness with the tendency to blush or flush easily and severely," Dr. Warren says. "Other symptoms may include a burning or itching sensation, dryness, swelling, and increased skin sensitivity."
The Bottom Line
Dr. Warren suggests avoiding spicy foods, and extra hot showers as these can also trigger similar looking and feeling rosacea flare-ups. "Avoidance of known triggers, including alcohol, is really the key, and can be difficult," Dr. Warren explains.
After speaking to three experts, it seems like rosacea could very well be the culprit to my weird, sporadic symptoms when drinking alcohol. The next step? Dr. Olulade recommends seeing a doctor. "If you get flushing after drinking alcohol, it’s important to let your doctor know because it may be a sign of an underlying allergy or insensitivity, and it may be because it is making rosacea worse," Dr. Olulade explains. "We can talk to you about possible testing for this and also guide you about how to avoid getting this response."
Hendershot CS, Neighbors C, George WH, et al. Aldh2, adh1b and alcohol expectancies: integrating genetic and learning perspectives. Psychol Addict Behav. 2009;23(3):452-463.
Li S, Cho E, Drucker AM, Qureshi AA, Li W-Q. Alcohol intake and risk of incident rosacea in US women. J Am Acad Dermatol. 2017;76(6):1061-1067.e2.