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    Alcohol-Induced Erythema aka "Asian Glow"

    • Pathway:
      • alcoholBreakdown.gif
    • "Asian Glow" -- accumulation of acetaldehyde, causing widespread histamine release, which creates an anticholinergic reaction (see symptoms below).  Evidence is high that acetaldehyde is the culprit because people that use anti-alcohol abuse drug called disulfuram (Antabuse) (works by inhibiting aldehyde dehydrogenase) have increased anticholinergic symptoms, and hence are less likely to drink more.
      • Tachycardia
      • "Flushed" appearance
      • Blurry vision
      • Dry mouth 
      • Mneumonic: "Blind as a bat, mad as ahatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone."
    • Two ways to get "Asian Glow"
      • In Asian people the alcohol dehydrogenase enzyme is considerably more active
      • Also in many Asians the aldehyde dehydrogenase may not be as effective due to a polymorphism.
    • How to counter asian glow:
      • Use H2 blockers such as Zantac (ranitidine) or Pepsid AC (famotidine).  No one really knows how they work, but there are several theories:
        • 1. They reduce the effectiveness of released histamine by blocking peripheral H2 sites.
        • 2. They inhibit cofactor NAD+ binding of Alcohol dehydrogenase, thereby reducing the effectiveness of the liver to convert ethanol to acetaldehyde.  This causes alcohol to avoid the first-pass metabolism, and accumulate way faster in the blood.  I do believe there is evidence that higher alcohol concentration in bloodstream following H2 blockade.
        • 3. They inhibit NAD+ binding to alcohol dehydrogenase in GI only.  This decreases breakdown of alcohol in the GI system, thereby slowing absorption and breakdown of alcohol.  Theoretically these people would absorb alcohol slowly, resulting in being less drunk but perhaps being drunk longer .
      • Studies in rats show that consumpton of glucose and fructose cause a decrease in alcohol breakdown through a yet-unknown pathway.
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