The ethnic association: ethnic origin relates to the
deficiency of the mitochondrial form of aldehyde
deydrogenase (ALDH-2) that is a common polymorphism in east
Asians (Japanese and some Chinese: roughly 50% are ALDH-2
deficient: despite their reputation as spirit drinkers,
half of the Japanese do not drink). The deficiency is rarer
in northern European Caucasians (but still 'polymorphic':
Norwegians: about 1% deficient).
The first step of alcohol metabolism is alcohol
dehydrogenase, which converts ethanol to acetaldehyde. ALDH
deficiency results in inability to metabolise the latter to
acetic acid. Acetaldehyde is vasodilative and produces a
characteristic 'flushing syndrome' (this would help for
diagnosis of the patient).
It also produces headache etc. It is thought to be
responsible for the addictive aspects of alcohol. Aldehydes
are highly reactive and condense with amines: acetaldehyde
plus dopamine form salsalinol, a morphine analogue. This
further disrupts dopaldehyde breakdown and leads to
formation of further condensates which have been implicated
in addiction.
ALDH deficiency is not age-dependant, and so does not
explain the late onset of the alcohol intolerance (ALDH
people or 'flushers' know they can't take alcohol at an
early stage).
Some drugs inhibit ALDH and have been exploited as possible
treatment for alcoholism (as aversion therapy). Is the
patient taking any medications, especially
self-administered? (including Chinese medicines that may be
hepatotoxic).
Are her LFTs normal? Alcohol intolerance can be an early
sign of alcoholic hepatitis/sclerosis.
There must be other reasons also for alcohol intolerance,
but it may be wine intolerance. What is the colour of the
wine? ie, is it a red wine/histamine problem?
----------------------
Dr John A Duley
Purine Research Laboratory
Guy's Hospital
London SE1 9RT (GB)
-----------------------
On Tue, 3 Dec 2002
15:03:35 -0000 Myers Martin <[log in to unmask]>
wrote:
> what is the ethnic origin of the lady?
>
> -----Original Message-----
> From: ANGELA VEITCH [mailto:[log in to unmask]]
> Sent: 03 December 2002 12:30
> To: [log in to unmask]
> Subject: alcohol intolerance
>
>
> Can any one help please?
>
> We have a patient with apparently normal biochemistry who is becoming
> inceasingly intolerant to alcohol over the years. At present she can
> only take 1/2 a glass of wine before she developes a severe headache and
> other symptoms which can last for 2 days. About 10 yrs ago her tolerance
> was normal but this problem has gradually arissen with less and less
> alcohol. According to her GP her LFTs etc and liver are all normal and
> she does not suffer fro migraine. Apart from this problem she has no
> other known abnormalities neurological or physical. She is not elderley
> or very young.
>
> Any ideas as to what is happening to this lady.
>
>
> Angela Veitch
> Principal Biochemist
> Biochemistry Dept, Highland Acute Hospitals Trust,
> Raigmore Hospital, Inverness IV2 3UJ
> Tel. 01463 704210
> email. [log in to unmask]
>
>
>
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