Pepcid and Asian alcohol flush


With Halloween and its many festivities coming up, I thought it’d be fitting to cover the topic of Asian flush aka alcohol flush syndrome. Although I have been fortunate enough to not inherit the trait, I have grown up around various family members and friends who do possess the gene and turn uncomfortably red whenever they consume alcohol.

What happens when you drink alcohol?
Alcohol is absorbed from the intestines into the bloodstream and metabolized in the liver by two major enzymes: alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH). ADH converts alcohol into the toxic metabolite acetaldehyde, and ALDH breaks down acetaldehyde into harmless acetic acid (vinegar), and eventually water and carbon dioxide. Acetaldehyde is more toxic to the body than alcohol, and too much of it causes all of the unpleasant physical side effects of alcohol such as flushing, headaches, nausea, and dizziness.


What is Asian flush?
Asian flush is caused by a genetic defect in one’s ability to metabolize alcohol. The most common mutation is a defective ALDH2 gene called ALDH2*2, which slows down the liver’s ability to break down acetaldehyde, causing it to accumulate in the body. Roughly half of all Asians possess some form of ALDH2*2. Acetaldehyde also causes another compound, histamine, to build up in the body. Some research suggests that acetaldehyde interferes with histamine breakdown. Too much histamine can cause vasodilation of the blood vessels, producing a red flush on the skin since all of the blood rushes to the surface (like during an allergic reaction).

That sucks. Why does Asian flush exist?
It’s believed that carrying ALDH2*2 protects one from alcoholism. This makes sense, since the negative side effects of Asian flush would deter anyone from drinking excessive alcohol. As expected, alcohol dependence is pretty uncommon amongst Asians.

What’s the deal with Pepcid curing asian flush?
Histamine H2 blockers like Zantec or Pepcid AC have been shown to reduce skin flush by blocking the vasodilatory effect of histamine, so less blood rushes to the face.

So can I keep drinking alcohol if I just take Pepcid?
NO. Pepcid may reduce the facial flush, but acetaldehyde and histamine have other effects on the body not blocked by antihistamines. Also, ALDH2 enzymes are found throughout the body. Recent studies have shown that continued alcohol use in ALDH2*2 carriers may lead to higher risk of esophageal cancer.

What else can I do?
Make up is another popular way to hide facial flush. Avoid using a green base under your foundation, since you’ll just end up looking green or gray. Green concealers should be reserved for spot treatments for acne redness. Instead, use yellow-tinted primers or foundations like Clinique Superprimer Face Primers for better overall coverage. The yellow base will even out and neutralize the redness. 

Ultimately, it’s important to limit your alcohol intake, since Pepcid or cosmetics won’t prevent the other harmful effects of acetaldehyde and alcohol accumulation. Be smart and listen to your body! Stay safe this Halloween 🙂

Please use the information on this site for your general knowledge only. Its content is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider with any questions or concerns you may have regarding your medical condition.

Eriksson CJ. Genetic-epidemiological evidence for the role of acetaldehyde in cancers related to alcohol drinking. Adv Exp Med Biol. 2015;815:41-58.

Zimatkin SM, Anichtchik OV. Alcohol-histamine interactions. Alcohol Alcohol. 1999;34(2):141-7.

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