ALCOHOL FLUSHING RESPONSE
By Gary M. White, MD
Alcohol may provoke flushing, more commonly in patients of Asian descent. These people have less active aldehyde dehydrogenase (ALDH) which degrades acetaldehyde--the first metabolite of alcohol. High levels of acetaldehyde cause flushing. Antabuse and metronidazole may cause a flushing response to alcohol, as may diabetics on chlorpropamide or tolbutamide.
- In one study [Circulation. 2015 May 12;131(19):1665-73], East Asian variant ALDH2*2 genotypes and, hence, deficient ALDH2 activity were associated with coronary spastic angina in Japanese .
The best treatment is to avoid alcohol. However, a combination of an antihistamine (e.g. chlorpheniramine 4 mg or terfenadine 60 mg) and an NSAID (e.g. aspirin, indomethacin 25 or 50 mg) may suppress the reaction. Antihistamines may potentiate the affects of alcohol and NSAIDs might contribute to alcoholic gastritis.
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