What Causes Flushed Cheeks After Drinking Alcohol?

The technical term for experiencing facial flushing immediately after drinking alcohol is alcohol flush reaction.

Alcohol flush reaction is also sometimes referred to as Asian flush syndrome, Asian flush, or Asian glow because of the approximately 36% of East Asians (Japanese, Chinese, and Koreans) that exhibit such facial flushing after drinking alcohol.

The degree of symptoms varies from person to person, but generally, symptoms of alcohol flush reaction include:

• Developing flushes or blotches associated with erythema (superficial reddening of the skin caused by dilatation of the blood capillaries, usually in patches).
• Nausea
• Headaches
• Rapid heart rate
• Missing out on the buzzed feeling usually experienced after drinking alcohol

Alcohol flush reaction can occur on:

• The face
• The neck
• Shoulders,
• In some cases, the entire body

After consuming alcohol, an enzyme called alcohol dehydrogenases (ADH) converts alcohol into acetaldehyde, a toxin that is the byproduct of metabolized alcohol, which another enzyme called aldehyde dehydrogenase 2 (ALDH2) then metabolizes into a less harmful substance called acetate.

Facial flushing is a reaction that occurs in people with a deficiency in ALDH2, where alcohol is metabolized and processed up to 100 times faster than the average human. A deficiency in the ALDH2 enzyme means that acetaldehyde builds up in the body, causing flushing and other symptoms such as increased heart rate and nausea.

ALDH2 is the same enzyme that is also responsible for processing histamine—the chemical involved in allergic reactions—and if you have a deficiency in the gene that helps break down alcohol, you get an alcohol flushing reaction. About 5-7% of people with alcohol flush reaction are actually missing the gene entirely.

In studies, alcohol flush reaction has been associated with lower than average rates of alcoholism (possibly due to the association with adverse effects after drinking alcohol) and the dilated capillaries and flushed cheeks are of themselves a painless reaction. However, alcohol flush reaction is a condition that has been associated with an increased risk of esophageal cancer in those who drink.

ALDH2-deficient individuals are at a much higher risk of developing esophageal cancer (specifically squamous cell carcinoma) from drinking alcohol than individuals with fully active ALDH2 enzymes.

It is not possible to replace the ALDH2 enzyme, though there are many marketed drinks and potions that claim to help you metabolize acetaldehyde. In order to prevent alcohol flush reaction you must change your drinking habits with a few simple ways:

• Eating a meal before drinking alcohol may slow down the metabolism of alcohol in your system by reducing the buildup of acetaldehyde and preventing alcohol flush reaction.
• Not drinking more than one alcoholic drink per hour and drinking slowly. This allows your body to flush out the acetaldehyde, especially if you guzzle water in between alcoholic beverages.
• Taking a histamine H2-receptor antagonist, such as Pepcid AC or Zantac will blunt the flushing reaction, but there is controversy over the use of antihistamines while continuing to drink alcohol as this practice does not address the toxic levels of acetaldehyde in the system.