Is It Safe to Drink Alcohol With Hereditary Angioedema?

Note: While research on alcohol is evolving, the World Health Organization says drinking less or not at all is better for your health.

Managing hereditary angioedema (HAE) often means being mindful of possible triggers, including how alcohol might affect you. Alcohol is not recognized as a common or well-established trigger for HAE attacks in major clinical guidelines, says Leonard Bielory, MD, an allergist and immunologist in private practice in Springfield, New Jersey, and a professor at the Hackensack Meridian School of Medicine.

People process and respond to alcohol in different ways. Bielory recommends paying attention to whether attacks tend to follow drinking. If this happens repeatedly, it’s best to avoid alcohol and discuss it with your healthcare provider, he says.

How Alcohol Affects HAE

While alcohol isn’t considered a typical HAE trigger, it may contribute to swelling in some people, says Julia Montejo, MD, an allergist and immunologist at Parkview Health in Fort Wayne, Indiana. Alcohol is a vasodilator, meaning it widens blood vessels, she says, adding that this vasodilating effect may contribute to fluid leakage and swelling.

Swelling after drinking doesn’t necessarily mean that alcohol triggered an HAE attack. Researchers haven’t determined whether alcohol activates the bradykinin pathway or why some people report HAE attacks after drinking.

Bielory suggests paying attention to whether avoiding alcohol changes how often attacks occur. If they become less frequent when you stop drinking, that may indicate that alcohol is one of your personal triggers.

Is It Safe to Drink During an HAE Attack?

Does Alcohol Interact With HAE Medications?

Alcohol isn’t known to interact directly with approved HAE medications, and drinking doesn’t change the HAE treatment approach, Bielory says.

“Currently available medications that are used to treat and prevent HAE attacks are mostly processed through the liver,” says Montejo. The liver also breaks down alcohol, which raises the possibility that drinking could affect how the body handles certain HAE medications, she says. But researchers haven’t thoroughly studied this possibility.

• berotralstat (Orladeyo) and sebetralstat (Ekterly) These oral kallikrein inhibitors are processed by the liver.

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   Alcohol may cause similar symptoms, which may make side effects, such as vomiting, diarrhea, or headache more noticeable.

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• C1 inhibitor treatments (Berinert, Cinryze, Haegarda, and Ruconest) These are protein-based treatments. The body breaks them down differently from alcohol, which is processed mainly by the liver.

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• icatibant (Firazyr), ecallantide (Kalbitor), lanadelumab (Takhzyro), and garadacimab (Andembry) These peptide- or protein-based medications also don’t depend on the liver enzymes that process alcohol.

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• donidalorsen (Dawnzera) This preventive medication is broken down naturally by the body rather than by the liver enzymes that process alcohol.

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• danazol (Danocrine) This is an older preventive medication that’s processed by the liver and can cause serious liver problems.

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   Because alcohol can also harm the liver, your care team may recommend limiting or avoiding it if you take this medication. Danazol is no longer routinely prescribed for HAE because safer and better-tolerated treatments are available.

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Ask your HAE specialist whether alcohol presents concerns based on your HAE medication, liver health, and other medications you take, and check with them before stopping or changing your medications.

Are Some Alcoholic Drinks Safer for HAE Than Others?

Currently, no research shows whether one type of alcoholic drink is safer than others when it comes to managing HAE. Montejo notes that people with HAE may respond differently even to small amounts of alcohol, depending on their individual tolerance, overall health, and other factors. If you choose to drink, she recommends keeping the amount as small as possible.

• 12 ounces (oz) of regular beer containing 5 percent alcohol (about a standard bottle)
• 5 oz of wine containing 12 percent alcohol (about one glass)
• 1.5 oz of distilled spirits containing 40 percent alcohol (about one “shot”)

Safe Drinking Practices for People With HAE

Montejo recommends discussing alcohol use with your allergist. Together, you can consider how well your symptoms are controlled, your personal triggers, your attack history, and your overall health. “Any illness, such as bacterial or viral infection, or any significant stressors, can be significant contributing factors in having an attack,” she says, so it may be best to avoid alcohol during these times.

If you choose to drink, here are some things to consider:

• Set a limit beforehand. Keep the amount small and choose a drink with a lower alcohol content, Montejo recommends.
• Stay hydrated. Have water or another alcohol-free beverage alongside alcohol to help offset fluid loss.

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• Keep your on-demand medication with you. HAE guidelines recommend carrying your medication at all times and having at least two standard doses available.

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   Follow your treatment plan for when and how to use each dose.

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• Track how your body responds. Record what and how much you drank, when symptoms began, and which areas were affected. If you notice a consistent pattern, stop drinking and discuss it with your allergist, says Bielory.
• Consider an alcohol-free alternative. Sparkling water or another alcohol-free beverage lets you take part in a toast without alcohol, Montejo says.

Talk to your care team if you need help stopping or cutting back on alcohol. You can also contact the Substance Abuse and Mental Health Services Administration National Helpline at 800-662-HELP (4357) for support and treatment resources.