Flushing occurs when the blood vessels dilate and increase the blood supply to the skin. It is manifested as rapid reddening of the skin usually associated with a feeling of warmth. The episodes usually last for a few minutes at a time, but can last longer. If the blood vessels are dilated due to the activity of the nerves on them, flushing is also accompanied by sweating. Irritant chemicals and allergens may also directly act on the vessels producing “dry” flushing. Common triggers of flushing:
- Hot beverages and/or spicy food may cause flushing in normal people.
- “Gustatory” flushing usually involves the face and can be associated with increased tear production, salivation, and nasal secretions, commonly seen after eating a hot pepper.
- Injury to a parotid gland (a salivary gland) can cause flushing, warmth and sweating on one side of the face. This is called “Frey’s Syndrome” or “Auriculotemporal Nerve Syndrome.”
- “Dumping syndrome”: Flushing of the face, sweating, diarrhea, increased heart rate, and fatigue may occur after eating a meal in people who have had certain types of surgeries on their stomachs.
- Certain fermented alcoholic beverages like beer and wine contain tyramine or histamine, which can cause flushing reactions.
- Some Asians have a defective enzyme which leads to a build-up of acetaldehyde which causes flushing after consumption of alcohol. It is referred to as the “Asian Flush Syndrome.”
- A few drugs like Antabuse (disulfiram), Flagyl (metronidazole) and cephalosporin antibiotics can also contribute to alcohol-induced flushing when used with alcohol.
- “Chinese restaurant syndrome” refers to generalized flushing caused by MSG (monosodium glutamate) which is used a lot in Chinese restaurants in the U.S.
- Sulfites, especially potassium metabisulfite, used as a preservative in beers, dried fruits, ciders, dairy products, wines, shrimp, and canned fruit and vegetable products, can induce flushing and wheezing. Asthmatics and people with aspirin sensitivity are more likely to react to sulfites.
- Nitrites and nitrates in cured meats may cause flushing and headache in susceptible individuals.
- Niacin (nicotinic acid) present in many multi-vitamin preparations in large doses can result in recurrent flushing. These episodes can be effectively blocked by aspirin or ibuprofen.
- Medications used to lower blood pressure like vasodilators and calcium channel blockers, thyroid hormones and certain oral steroids can also produce flushing.
- Spinal cord lesions above T6 level
- Brain tumors
- Parkinson’s disease
- About 80% of postmenopausal woman have flushing associated with sweating.
- Chronic flushing from any cause can develop into rosacea. Individuals with rosacea typically have flushing of the cheeks and nose and occasionally on other areas of the face.
Scombroid fish poisoning:
- Bacteria acting on inadequately refrigerated fish like mackerel, tuna, etc. convert the naturally occurring amino acid, histidine, in the fish to histamine which causes abdominal cramping, diarrhea, vomiting, hives, and flushing on consumption. The histamine can survive cooking so cooked and even canned tuna may also cause facial flushing.
- High levels of circulating histamine released from excessive numbers of mast cells in one’s body causes flushing, fainting, and shortness of breath.
- Carcinoid tumors, (mostly of the stomach, small intestine, pancreas, ovaries, testis, and lung) can cause flushing in addition to wheezing, sweating, diarrhea, shortness of breath, palpitations of the heart, and abdominal cramping. If the primary tumor metastasizes to the liver, serotonin production is increased which causes severe flushing reactions.
- Adrenal tumors like pheochromocytoma secrete catecholamines (epinephrine and norepinephrine) which induce flushing episodes.
- Brain tumors
As the treatment depends on the cause, an attempt should be made to establish the precise underlying cause in all cases of recurrent flushing reactions with help of a detailed history, physical examination, and relevant blood and urine tests. The board certified allergists at Black & Kletz Allergy have had many decades of experience diagnosing patients who suffer from flushing. Once the cause is identified, the patient is told to avoid the offending trigger or they are referred to the appropriate specialist to treat the underlying condition. If you suffer from flushing, please do not hesitate to call us at Black & Kletz Allergy for an appointment. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, all with on-site parking. Our Washington, DC and McLean, VA locations are also Metro accessible. Alternatively, you can Request an Appointment and we will respond within 24 hours of the next business day.