Alcohol flush reaction refers to facial flushing after drinking alcohol. If the body cannot metabolize alcohol effectively, too much acetaldehyde can build up. This is toxic and can cause a histamine release, resulting in flushing and other symptoms.

People with certain genetic features have a higher likelihood of flushing.

Flushing does not cause immediate health problems, but it may signal an increased risk of some serious health issues, such as high blood pressure and certain types of cancer.

In this article, we examine why some people experience facial flushing from alcohol while others do not, the risks of this side effect, and how to prevent it.

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Facial flushing after drinking alcohol is a symptom of high alcohol sensitivity, which means that the body is less tolerant of alcohol.

All alcoholic drinks contain ethanol. After a person drinks alcohol, their body begins to break down the ethanol into other substances, or metabolites, to make it easier to flush out. One of these metabolites, acetaldehyde, is toxic to the body.

If a person is sensitive to alcohol or has a lot to drink, their body may not be able to manage all of those toxins, and acetaldehyde can begin to build up. The buildup can cause a histamine response, leading to a range of symptoms, including dilation of the facial blood vessels, causing skin discoloration.

On lighter skin tones, facial flushing may result in visible reddening, whereas in darker skin tones, it may cause discoloration or darkening of the affected area.

While the flush itself is not dangerous, people who experience it are at higher risk of high blood pressure and other health problems.

A 2022 study of Korean men looked at the differences in blood pressure between men who did and did not experience facial flushing when they drank alcohol. Researchers found that people who changed from having little or no facial flushing to having a flushing reaction had a significantly increased risk of hypertension.

Studies also associate drinking alcohol with certain types of cancer.

For example, in a 2017 study, researchers looked at the link between cancer and facial flushing after drinking in people in East Asia. Men with facial flushing had a higher risk of cancer, particularly cancer of the throat, which is also called esophageal cancer. The researchers did not find the same association in women.

Whether or not a person’s face flushes after drinking may have a genetic component.

A liver enzyme called aldehyde dehydrogenase 2 (ALDH2) breaks acetaldehyde down into less toxic substances. Some people have a genetic condition that prevents them from making this enzyme.

As a result, acetaldehyde builds up in the body after alcohol consumption, which causes the characteristic flushing of the face. Although anyone can lack this gene, it is more common for people from East Asia not to have it.

There is no way to change the genes or enzyme deficiency. The only way to prevent this flush and the associated risk of high blood pressure is to avoid or limit alcohol intake.

Some people use over-the-counter antihistamines to reduce the discoloration, though this is not advisable. Although some may find the flushed skin embarrassing, it signifies that the body is accumulating toxic levels of acetaldehyde and that it is time to slow down and rehydrate with water.

It is important to recognize that even people who do not get this type of reaction when drinking are still at risk of the health complications of alcohol use. These include:

The facial flush that some people get while drinking alcohol may not seem serious. However, it can indicate that someone has a higher alcohol sensitivity and may have an increased risk of high blood pressure and certain cancers.

While taking antihistamines can help reduce symptoms, these drugs only hide the symptoms and do not address the underlying cause.

The Centers for Disease Control and Prevention (CDC) recommends that if people choose to drink, they do so in moderation. They define moderate amounts as one drink per day for women and two for men.

If a person has high alcohol sensitivity — or low tolerance to alcohol — they may feel the effects of alcohol more strongly and quickly and may benefit from drinking less alcohol. People with concerns about this symptom can talk with their doctor for advice.