While the COVID-19 pandemic is no longer in the crisis stage globally, many people—including some wine lovers—continue to feel its effects. Anecdotal evidence has indicated a potential link between COVID infection and increased alcohol sensitivity. That sensitivity can cause headaches, severe hangover-like symptoms and other effects, including intoxication at low levels of consumption.
Now, new research adds to our understanding of how so-called ‘long COVID’ may impact people’s enjoyment of alcohol. The study, conducted by researchers at Stanford Health Care and published in the journal Cureus late last year, reports that some people with long COVID experience a dramatically decreased ability to tolerate alcohol, even in small amounts. The study reports the cases of four people who had long COVID and experienced acute alcohol sensitivity, which led to changes in their drinking habits.
What Is Long COVID?
Long COVID (formally known as post-acute sequelae of SARS-CoV-2) is a group of symptoms experienced after acute viral infection with COVID-19. Symptoms and their severity vary widely, and they can last anywhere from a few months to over a year.
Patients commonly report headache, fatigue, disrupted sleep and more. These symptoms are also common in other conditions associated with previous viral infection, including Hodgkin’s lymphoma, myalgic encephalomyelitis/chronic fatigue syndrome and complications from Epstein-Barr infection.
Long COVID and Alcohol Sensitivity
Alcohol sensitivity is also emerging as a possible symptom of long COVID, but very little medical research has looked into the phenomenon. The new study is limited, analyzing the cases of four Stanford patients who had long COVID symptoms lasting longer than a month, but offers a serious look at the possible link. Their experiences varied widely, from mildly increased sensitivity to alcohol to severe intolerance.
One patient, a 60-year-old man, drank alcohol twice a month, without any issues, before getting COVID. After having COVID, he experienced chronic, daily headaches as part of his long COVID symptoms; drinking alcohol was an additional trigger of these headaches. Another patient, a 36-year-old woman, reported drinking socially without any issues before COVID. Now, she says similar amounts of alcohol cause “flushing and headache.”
The two other patients experienced drastic changes in their alcohol tolerance. One, a 49-year-old woman, used to consume several drinks per week before getting COVID. Now, her tolerance has decreased so dramatically that she has not had any alcohol for seven months. On one occasion, one glass of wine caused such a bad reaction that she felt she could not move. She described her symptoms as similar to a “bad hangover,” with a headache, grogginess, and “overwhelming” fatigue the next day. A week later, a single drink led to similar symptoms.
What Causes Alcohol Intolerance in Long COVID?
It’s unclear why long COVID appears to cause alcohol sensitivity in some people. One possibility is that alcohol worsens orthostatic intolerance, a condition increasingly associated with long COVID. Orthostatic intolerance results from inadequate blood flow to the heart and brain when a person stands or sits up. Because alcohol dilates blood vessels and is a diuretic, it may exacerbate low blood pressure, further limit blood flow and make various long COVID symptoms worse.
Other potential mechanisms include disruption of the gut microbiome, which has been reported in long COVID and can also be caused by alcohol. This disruption could affect alcohol absorption and trigger inflammation in the liver, brain and elsewhere. That inflammation, in turn, may be connected to aggravated symptoms and patient discomfort.
Alleviating Symptoms
The authors say that current recommendations for managing alcohol sensitivity in long COVID include “abstinence, avoidance or the use of antihistamines to see if the severity of the reaction may be reduced.” They note that patients may be counseled to avoid the specific drink or ingredient triggering symptoms, and that more study is needed to determine whether different types of alcohol affect people differently.
Dr. Linda Geng, a clinical associate professor of primary care and population health at Stanford and one of the study’s authors, told Wine Spectator, “We recommend that people who experience new alcohol sensitivity following COVID infection talk to their doctor and consider avoiding alcohol until cleared to resume per their doctor’s guidance. We do not understand what causes the alcohol sensitivity at this time, so specific medications or therapies cannot be recommended.”
The authors acknowledge several limitations of the study. Since this is a case report of just four patients, no causality can be established between long COVID and alcohol sensitivity. Additionally, all four patients identified as white or Hispanic. The authors believe their findings highlight the need for larger-scale studies.
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