Alcohol flush reaction is a condition in which a person develops flushes or blotches associated with erythema on the face, neck, shoulders, and in some cases, the entire body after consuming alcoholic beverages. The reaction is the result of an accumulation of acetaldehyde, a metabolic byproduct of the catabolic metabolism of alcohol, and is caused by an aldehyde dehydrogenase 2 deficiency.[4]
Alcohol flush reaction
Other names
Asian flush syndrome, Asian flush reaction, Asian glow, Asian red face glow
Facial flushing. Before (left) and after (right) drinking alcohol. A 22-year-old East Asian man who is ALDH2heterozygous showing the reaction.[1]
This syndrome has been associated with lower than average rates of alcoholism, possibly due to its association with adverse effects after drinking alcohol.[5] However, it has also been associated with an increased risk of esophageal cancer in those who do drink.[1][6][7]
"Asian flush" is common in East Asians, with approximately 30 to 50% of Chinese, Japanese, and Koreans showing characteristic physiological responses to drinking alcohol that includes facial flushing, nausea, headaches and a fast heart rate. The condition may be also highly prevalent in some Southeast Asian and Inuit populations.[1][2][3][8]
The back of an East Asian man showing alcohol flush reaction.
The most obvious symptom of alcohol flush reaction is flushing on a person's face and body after drinking alcohol.[4] Other effects include "nausea, headache and general physical discomfort".[9] People who experience the reaction may be less prone to alcoholism as it tends to discourage them from drinking.
Disulfiram, a drug sometimes given as treatment for alcoholism, works by inhibiting acetaldehyde dehydrogenase, causing a five-to ten-fold increase in the concentration of acetaldehyde in the body after drinking alcohol, as happens spontaneously in people subject to flush.[11][12]
Genetics
Metabolism of alcohol (ethanol) to acetaldehyde (ethanal) and then to acetic acid (ethanoic acid)
Alcohol flush reaction is a condition that is experienced more frequently by people of East Asian descent, giving rise to names such as "Asian flush" or "Asian glow".
Genotype frequency distribution of ALDH2 (rs671).
Around 30–50% of East Asians carry the rs671 (ALDH2*2) allele on chromosome 12, which results in a less functional acetaldehyde dehydrogenase enzyme, responsible for the breakdown of acetaldehyde, and accounts for most incidents of alcohol flush reaction worldwide. According to the analysis by HapMap project, 30% to 50% of people of Chinese, Japanese, and Korean ancestry have at least one ALDH2*2 allele, while it is rare among Europeans and sub-Saharan Africans.[8]
The rs671 allele is native to East Asia and most common in southeastern China. Analysis correlates the rise and spread of rice cultivation in South China with the spread of the allele.[5] The reasons for this positive selection are not known, but it has been hypothesized that elevated concentrations of acetaldehyde may have conferred protection against certain parasitic infections, such as Entamoeba histolytica.[13]
Additionally, in around 80% of East Asians, the rapid accumulation of acetaldehyde is worsened by another gene variant; in this case the allele ADH1B*2, which results in the alcohol dehydrogenaseenzyme converting alcohol to toxic acetaldehyde more quickly than other gene variants common outside East Asia.[5][14]
Pathophysiology
Those with facial flushing due to ALDH2 deficiency may be homozygotes, with two alleles of low activity, or heterozygotes, with one low-activity and one normal allele. Homozygotes for the trait find consumption of large amounts of alcohol to be so unpleasant that they are generally protected from esophageal cancer, but heterozygotes are able to continue drinking. However, an ALDH2-deficient drinker has four to eight times the risk of developing esophageal cancer as a drinker not deficient in the enzyme.[1][7]
Because most East Asians have a variant in the ADH gene, this risk is lowered somewhat because the ADH variant reduces the risk of esophageal cancer four-fold. However, ALDH2-deficient people who do not carry this ADH variant are at the highest risk of cancer as these risk factors act in a multiplicative manner through increasing exposure time to salivary acetaldehyde.[7]
The idea that acetaldehyde is the cause of the flush is also shown by the clinical use of disulfiram (Antabuse), which blocks the removal of acetaldehyde from the body via ALDH inhibition. The high acetaldehyde concentrations described share similarity to symptoms of the flush (flushing of the skin, accelerated heart rate, shortness of breath, throbbing headache, mental confusion and blurred vision).[15]
Diagnosis
For measuring the level of flush reaction to alcohol, the most accurate method is to determine the level of acetaldehyde in the blood stream. This can be measured through a breathalyzer test or blood test.[16] Additionally, measuring the amount of alcohol metabolizing enzymes alcohol dehydrogenases and aldehyde dehydrogenase through genetic testing can predict the amount of reaction that one would have.
Rosacea, also known as gin blossoms, is a chronic facial skin condition in which capillaries are excessively reactive, leading to redness from flushing or telangiectasia. Rosacea has been mistakenly attributed to alcoholism because of its similar appearance to the temporary flushing of the face that often accompanies the ingestion of alcohol.
Degreaser's flush – a flushing condition arising from consuming alcohol shortly before or during inhalation of trichloroethylene (TCE), an organic solvent with suspected carcinogenic properties.
Carcinoid syndrome – episodes of severe flushing precipitated by alcohol, stress and certain foods. May also be associated with intense diarrhea, wheezing and weight loss.
^ abcdeBrooks PJ, Enoch MA, Goldman D, Li TK, Yokoyama A (March 2009). "The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption". PLOS Medicine. 6 (3): e50. doi:10.1371/journal.pmed.1000050. PMC2659709. PMID 19320537.
^ abLee H, Kim SS, You KS, Park W, Yang JH, Kim M, Hayman LL (2014). "Asian flushing: genetic and sociocultural factors of alcoholism among East asians". Gastroenterology Nursing. 37 (5): 327–36. doi:10.1097/SGA.0000000000000062. PMID 25271825. S2CID 206059192.
^ abJ. Yoo, Grace; Odar, Alan Y. (2014). Handbook of Asian American Health. Springer. p. 132. ISBN978-1493913442.
^ abBrooks PJ, Enoch MA, Goldman D, Li TK, Yokoyama A (March 2009). "The alcohol flushing response: an unrecognized risk factor for esophageal cancer from alcohol consumption". PLOS Medicine. 6 (3): e50. doi:10.1371/journal.pmed.1000050. PMC2659709. PMID 19320537.
^ abcPeng Y, Shi H, Qi XB, Xiao CJ, Zhong H, Ma RL, Su B (January 2010). "The ADH1B Arg47His polymorphism in east Asian populations and expansion of rice domestication in history". BMC Evolutionary Biology. 10: 15. doi:10.1186/1471-2148-10-15. PMC2823730. PMID 20089146.
^Oota, Hiroki; Pakstis, Andrew J.; Bonne-Tamir, Batsheva; Goldman, David; Grigorenko, Elena; Kajuna, Sylvester L. B.; Karoma, Nganyirwa J.; Kungulilo, Selemani; Lu, Ru-Band; Odunsi, Kunle; Okonofua, Friday; Zhukova, Olga V.; Kidd, Judith R.; Kidd, Kenneth K. (2004). "The evolution and population genetics of the ALDH2 locus: random genetic drift, selection, and low levels of recombination". Annals of Human Genetics. Wiley. 68 (2): 93–109. doi:10.1046/j.1529-8817.2003.00060.x. ISSN 0003-4800.
^Eng MY, Luczak SE, Wall TL (2007). "ALDH2, ADH1B, and ADH1C genotypes in Asians: a literature review". Alcohol Research & Health. 30 (1): 22–27. PMC3860439. PMID 17718397.
^Wright C, Moore RD (June 1990). "Disulfiram treatment of alcoholism". The American Journal of Medicine. 88 (6): 647–55. doi:10.1016/0002-9343(90)90534-K. PMID 2189310.
^. Archived from the original on 2014-02-21. Retrieved 2010-07-29.
^Boulton P, Purdy RA, Bosch EP, Dodick DW (February 2007). "Primary and secondary red ear syndrome: implications for treatment". Cephalalgia. 27 (2): 107–10. doi:10.1111/j.1468-2982.2007.01270.x. PMID 17257229. S2CID 31973969.
External links
Wikimedia Commons has media related to Alcohol flush reaction.
March 04, 2023
alcohol, flush, reaction, condition, which, person, develops, flushes, blotches, associated, with, erythema, face, neck, shoulders, some, cases, entire, body, after, consuming, alcoholic, beverages, reaction, result, accumulation, acetaldehyde, metabolic, bypr. Alcohol flush reaction is a condition in which a person develops flushes or blotches associated with erythema on the face neck shoulders and in some cases the entire body after consuming alcoholic beverages The reaction is the result of an accumulation of acetaldehyde a metabolic byproduct of the catabolic metabolism of alcohol and is caused by an aldehyde dehydrogenase 2 deficiency 4 Alcohol flush reactionOther namesAsian flush syndrome Asian flush reaction Asian glow Asian red face glowFacial flushing Before left and after right drinking alcohol A 22 year old East Asian man who is ALDH2 heterozygous showing the reaction 1 SpecialtyToxicologyFrequency36 of East Asians 2 1 3 This syndrome has been associated with lower than average rates of alcoholism possibly due to its association with adverse effects after drinking alcohol 5 However it has also been associated with an increased risk of esophageal cancer in those who do drink 1 6 7 Asian flush is common in East Asians with approximately 30 to 50 of Chinese Japanese and Koreans showing characteristic physiological responses to drinking alcohol that includes facial flushing nausea headaches and a fast heart rate The condition may be also highly prevalent in some Southeast Asian and Inuit populations 1 2 3 8 Contents 1 Signs and symptoms 2 Genetics 3 Pathophysiology 4 Diagnosis 4 1 Differential diagnosis 5 References 6 External linksSigns and symptoms Edit The back of an East Asian man showing alcohol flush reaction The most obvious symptom of alcohol flush reaction is flushing on a person s face and body after drinking alcohol 4 Other effects include nausea headache and general physical discomfort 9 People who experience the reaction may be less prone to alcoholism as it tends to discourage them from drinking Many cases of alcohol induced respiratory reactions which involve rhinitis and worsening of asthma develop within 1 60 minutes of drinking alcohol and are due to the same causes as flush reactions 10 Disulfiram a drug sometimes given as treatment for alcoholism works by inhibiting acetaldehyde dehydrogenase causing a five to ten fold increase in the concentration of acetaldehyde in the body after drinking alcohol as happens spontaneously in people subject to flush 11 12 Genetics EditH C H H C H H O H ADH H C H H C O H ALDH H C H H C O H O H displaystyle ce H overset displaystyle ce H atop underset atop displaystyle ce H ce C overset displaystyle ce H atop underset atop displaystyle ce H ce C ce O H gt ce ADH H overset displaystyle ce H atop underset atop displaystyle ce H ce C overset displaystyle ce H atop underset atop displaystyle ce O ce C ce gt ce ALDH H overset displaystyle ce H atop underset atop displaystyle ce H ce C overset color white displaystyle ce H atop underset atop displaystyle ce O ce C ce O H Metabolism of alcohol ethanol to acetaldehyde ethanal and then to acetic acid ethanoic acid Alcohol flush reaction is a condition that is experienced more frequently by people of East Asian descent giving rise to names such as Asian flush or Asian glow Genotype frequency distribution of ALDH2 rs671 Around 30 50 of East Asians carry the rs671 ALDH2 2 allele on chromosome 12 which results in a less functional acetaldehyde dehydrogenase enzyme responsible for the breakdown of acetaldehyde and accounts for most incidents of alcohol flush reaction worldwide According to the analysis by HapMap project 30 to 50 of people of Chinese Japanese and Korean ancestry have at least one ALDH2 2 allele while it is rare among Europeans and sub Saharan Africans 8 The rs671 allele is native to East Asia and most common in southeastern China Analysis correlates the rise and spread of rice cultivation in South China with the spread of the allele 5 The reasons for this positive selection are not known but it has been hypothesized that elevated concentrations of acetaldehyde may have conferred protection against certain parasitic infections such as Entamoeba histolytica 13 Additionally in around 80 of East Asians the rapid accumulation of acetaldehyde is worsened by another gene variant in this case the allele ADH1B 2 which results in the alcohol dehydrogenase enzyme converting alcohol to toxic acetaldehyde more quickly than other gene variants common outside East Asia 5 14 Pathophysiology EditThose with facial flushing due to ALDH2 deficiency may be homozygotes with two alleles of low activity or heterozygotes with one low activity and one normal allele Homozygotes for the trait find consumption of large amounts of alcohol to be so unpleasant that they are generally protected from esophageal cancer but heterozygotes are able to continue drinking However an ALDH2 deficient drinker has four to eight times the risk of developing esophageal cancer as a drinker not deficient in the enzyme 1 7 Because most East Asians have a variant in the ADH gene this risk is lowered somewhat because the ADH variant reduces the risk of esophageal cancer four fold However ALDH2 deficient people who do not carry this ADH variant are at the highest risk of cancer as these risk factors act in a multiplicative manner through increasing exposure time to salivary acetaldehyde 7 The idea that acetaldehyde is the cause of the flush is also shown by the clinical use of disulfiram Antabuse which blocks the removal of acetaldehyde from the body via ALDH inhibition The high acetaldehyde concentrations described share similarity to symptoms of the flush flushing of the skin accelerated heart rate shortness of breath throbbing headache mental confusion and blurred vision 15 Diagnosis EditFor measuring the level of flush reaction to alcohol the most accurate method is to determine the level of acetaldehyde in the blood stream This can be measured through a breathalyzer test or blood test 16 Additionally measuring the amount of alcohol metabolizing enzymes alcohol dehydrogenases and aldehyde dehydrogenase through genetic testing can predict the amount of reaction that one would have Differential diagnosis Edit Alcohol induced respiratory reactions including rhinitis and exacerbations of asthma appear in many cases due to the direct actions of ethanol Rosacea also known as gin blossoms is a chronic facial skin condition in which capillaries are excessively reactive leading to redness from flushing or telangiectasia Rosacea has been mistakenly attributed to alcoholism because of its similar appearance to the temporary flushing of the face that often accompanies the ingestion of alcohol Degreaser s flush a flushing condition arising from consuming alcohol shortly before or during inhalation of trichloroethylene TCE an organic solvent with suspected carcinogenic properties Carcinoid syndrome episodes of severe flushing precipitated by alcohol stress and certain foods May also be associated with intense diarrhea wheezing and weight loss Red ear syndrome 17 thought by many to be triggered by alcohol among other causes citation needed References Edit a b c d e Brooks PJ Enoch MA Goldman D Li TK Yokoyama A March 2009 The alcohol flushing response an unrecognized risk factor for esophageal cancer from alcohol consumption PLOS Medicine 6 3 e50 doi 10 1371 journal pmed 1000050 PMC 2659709 PMID 19320537 a b Lee H Kim SS You KS Park W Yang JH Kim M Hayman LL 2014 Asian flushing genetic and sociocultural factors of alcoholism among East asians Gastroenterology Nursing 37 5 327 36 doi 10 1097 SGA 0000000000000062 PMID 25271825 S2CID 206059192 a b J Yoo Grace Odar Alan Y 2014 Handbook of Asian American Health Springer p 132 ISBN 978 1493913442 a b Brooks PJ Enoch MA Goldman D Li TK Yokoyama A March 2009 The alcohol flushing response an unrecognized risk factor for esophageal cancer from alcohol consumption PLOS Medicine 6 3 e50 doi 10 1371 journal pmed 1000050 PMC 2659709 PMID 19320537 a b c Peng Y Shi H Qi XB Xiao CJ Zhong H Ma RL Su B January 2010 The ADH1B Arg47His polymorphism in east Asian populations and expansion of rice domestication in history BMC Evolutionary Biology 10 15 doi 10 1186 1471 2148 10 15 PMC 2823730 PMID 20089146 Alcohol Flush Signals Increased Cancer Risk among East Asians Archived 2012 02 16 at the Wayback Machine March 23 2009 News Release National Institutes of Health NIH a b c Lee Chien Hung Lee Jang Ming Wu Deng Chyang Goan Yih Gang Chou Shah Hwa Wu I Chen Kao Ein Long Chan Te Fu Huang Meng Chuan Chen Pei Shih Lee Chun Ying 2008 Carcinogenetic impact of ADH1B and ALDH2 genes on squamous cell carcinoma risk of the esophagus with regard to the consumption of alcohol tobacco and betel quid International Journal of Cancer 122 6 1347 56 doi 10 1002 ijc 23264 ISSN 1097 0215 PMID 18033686 a b rs671 is a classic SNP Single Nucleotide Polymorphism SNPedia 18 November 2020 Archived from the original on 2018 10 22 Esophageal Cancer and the Asian Glow Dartmouth Undergraduate Journal of Science 21 November 2009 Archived from the original on 2016 01 12 Adams KE Rans TS December 2013 Adverse reactions to alcohol and alcoholic beverages Annals of Allergy Asthma amp Immunology 111 6 439 45 doi 10 1016 j anai 2013 09 016 PMID 24267355 Disulfiram MedlinePlus Drug Information Archived from the original on 1 October 2008 Retrieved 15 November 2012 Toxicity Disulfiram at eMedicine Oota Hiroki Pakstis Andrew J Bonne Tamir Batsheva Goldman David Grigorenko Elena Kajuna Sylvester L B Karoma Nganyirwa J Kungulilo Selemani Lu Ru Band Odunsi Kunle Okonofua Friday Zhukova Olga V Kidd Judith R Kidd Kenneth K 2004 The evolution and population genetics of the ALDH2 locus random genetic drift selection and low levels of recombination Annals of Human Genetics Wiley 68 2 93 109 doi 10 1046 j 1529 8817 2003 00060 x ISSN 0003 4800 Eng MY Luczak SE Wall TL 2007 ALDH2 ADH1B and ADH1C genotypes in Asians a literature review Alcohol Research amp Health 30 1 22 27 PMC 3860439 PMID 17718397 Wright C Moore RD June 1990 Disulfiram treatment of alcoholism The American Journal of Medicine 88 6 647 55 doi 10 1016 0002 9343 90 90534 K PMID 2189310 Alcohol and the Asian flush reaction Ye Studies by Undergraduate Researchers at Guelph Archived from the original on 2014 02 21 Retrieved 2010 07 29 Boulton P Purdy RA Bosch EP Dodick DW February 2007 Primary and secondary red ear syndrome implications for treatment Cephalalgia 27 2 107 10 doi 10 1111 j 1468 2982 2007 01270 x PMID 17257229 S2CID 31973969 External links Edit Wikimedia Commons has media related to Alcohol flush reaction Retrieved from https en wikipedia org w index php title Alcohol flush reaction amp oldid 1136171355, wikipedia, wiki, book, books, library,
