Hay Fever or Allergy - Medical History

[My Flight Surgeon]

This is the fifth of a series of threads regarding the history portion of the FAA Form 8500-8 that you complete every time you get a flight physical. For the vast majority of you, this will be just informational and you will not be affected. As with many of the conditions discussed here and elsewhere in these threads, there is a requirement for the pilot to provide medical records and physician documentation regarding the medical condition being reported. I would suggest that if you are unsure of how to answer these questions in Item 18, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.

Item18e. Hay fever or allergy

Hay fever or allergy

If you have hay fever or allergies you should report frequency and duration of symptoms, and whether they have been incapacitating by the condition. Mention should also be made of treatment and side effects. Hay fever controlled solely by desensitization (allergy shots) without requiring antihistamines or other medications is not disqualifying. Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking a sedating antihistamine. Non-sedating antihistamines loratadine (Claritin) or fexofenadine (Allegra) may be used while flying, after adequate individual experience has determined that the medication is well tolerated without significant side effects. The problem with these allergies is the swelling of the opening to the Eustachian tube in the middle ear or to the sinuses. If either of these is obstructed, one can develop pain and/or dizziness associated with the blockage and as we all know, dizziness can lead to spatial disorientation.

If the allergies are severe and require surgery for removal of polyps or systemic corticosteroids (like prednisone) then the decision regarding flight status is made by the FAA.

The important take home points regarding hay fever and allergies include: 1) allergy shots or desensitization by itself is not disqualifying, 2) your may fly with the non-sedating antihistamines loratadine (Claritin) or fexofenadine (Allegra) once you have determined they do not produce side effects for you, 3), you may fly 24 hours after taking sedating antihistamines such as Benadryl or Zyrtec, 4) you may not fly within 24 hours of experiencing the symptoms of allergy or hay fever, and 5) there are nasal sprays (Afrin) that can relieve the symptoms of nasal congestion and ear blockage for a short period of time.

*Italicized sections are excerpts from FAA documents.

[Swen]

Good stuff Doc!

I've been taking loratadine and overall I feel it does a decent job controlling my seasonal allergies. But once-in-awhile I will have a terrible day in regards to allergies, such as two days ago. It seems as if the pill does not work for a day even though I have been taking it regularly every day for about 1.5 months. Is this to be expected? Would it be worthy to give fexofenadine a try?

[My Flight Surgeon]

It may just be an extra high allergen load day. I would try to add Afrin for a day or two then stop it. The nice thing about loratidine (at least at Costco) is the cost of the generic ($11.56 for 300 tablets). If it quits working entirely, you can go to Allegra but cost will be more. I am always interested in keeping the cost down if possible (although I know rich pilots don't worry about money ).

Another option if there is a particular season that is worse (like right now with fall hay fevera), you could add a nasal steroid spray like Flonase with good results.

[Swen]

Thanks for the help Doc, I'll try some of what you recommended.

[My Flight Surgeon]

You are welcome.

[Airdale]

I have an issue. This year I have had really bad Nasal Congestion due to allergies. I've never had this kind of allergy before in my life. I've dealt with itchy/watery eyes, sneezing, itching nose and throat - but never sinus congestion.

Well I saw a doctor yesterday and he prescribed Astelin. I told him I was a pilot and needed something non-drowsy and safe to use when flying. He stated that this has been a really bad year for nasal allergies. I've only been using Astelin for a day now, and so far it hasn't done much for congestion, he says it could possibly take a week before it starts to work. Do you have any experience with Astelin and how long it usually takes before it provides relief for congestion? I Flight Instruct almost everyday, so if it doesn't clear up my congestion I'm going to take Afrin as well.

Secondly, it Astelin approved to use?

I am worried that this sinus problem will be a recurring problem through the seasons and I hope this does not effect my ability to obtain a First Class Medical and on top of that, I don't need an ear drum blowing out when I start flying jets 3 times higher then I fly now.

Any suggestions/options sir? Thanks

[My Flight Surgeon]

Sorry, Astelin is not approved. The "approved" list is:

• Afrin (Pseudoephedrine)
• Atrovent (Ipratropium) CASE BY CASE ONLY
• Beconase (Beclomethasone Dipropionate)
• Flonase (Fluticasone Propionate)
• Nasalcrom (Cromolyn Sodium)
• Nasalide (Flunisolide)
• Vancenase (Beclomethasone Dipropionate)

I would suggest using one of the "steroid" sprays such as Flonase AND Claritin or Allegra. As previously stated, at Costco, generic Claritin (loratidine) is $11.56 for 300 tablets, pretty cheap. By the way, Zyrtec is also NOT approved for use.

The steroid sprays will take 48-72 hours to be effective. Use the Arin till the steroid takes over.

Good luck.

[Airdale]

Originally Posted by My Flight Surgeon

Sorry, Astelin is not approved. The "approved" list is:

• Afrin (Pseudoephedrine)
• Atrovent (Ipratropium) CASE BY CASE ONLY
• Beconase (Beclomethasone Dipropionate)
• Flonase (Fluticasone Propionate)
• Nasalcrom (Cromolyn Sodium)
• Nasalide (Flunisolide)
• Vancenase (Beclomethasone Dipropionate)

I would suggest using one of the "steroid" sprays such as Flonase AND Claritin or Allegra. As previously stated, at Costco, generic Claritin (loratidine) is $11.56 for 300 tablets, pretty cheap. By the way, Zyrtec is also NOT approved for use.

The steroid sprays will take 48-72 hours to be effective. Use the Arin till the steroid takes over.

Good luck.

Thanks doc. I read something that said Pseudoephedrine has side effects including drowsiness, I'm surprised to see it on the approved list. I'll make sure my doctor knows Astelin is not approved, and to maybe get a prescription for Flonase.

I use Afrin quite a bit, because it acts extremely fast and clears up 100% of the issues. I'm affraid to take it daily though, for fear of becoming addicted or even worse, damaging my nose. Do you think it is safe to use Afrin whenever nasal congestion is present, even if it is daily for a week or so? Is Afrin considered a Steroid and is its use required to report on a Medical? What medication is considered a Steroid?

Sorry for all of the questions, its just I don't want to risk getting into trouble with medications and flying, and I certainly don't want to injure my ears flying, which is why I have been taking Afrin almost daily so that I have stress free (in the ears) flying.

Thanks again Doc! This is a great addition to this forum!

[My Flight Surgeon]

Afrin does not make you sleepy, it is a relative of adrenalin. It is also the precursor for methamphetamine.

You can use Afrin twice a day for 5 to 7 days but longer than that causes habituation with a rebound effect when you try to stop it.

Afrin is not a steroid.

Best of luck

[TXaviator]

Originally Posted by My Flight Surgeon

Afrin does not make you sleepy, it is a relative of adrenalin. It is also the precursor for methamphetamine.

You can use Afrin twice a day for 5 to 7 days but longer than that causes habituation with a rebound effect when you try to stop it.

Afrin is not a steroid.

Best of luck

not to step on toes, but i think you meant to indicate that pseudoephedrine is a precursor used in some methamphetamine creation reactions....

[My Flight Surgeon]

You, Sir, are correct. I was just trying to keep it simple for the non-chemists.

[Swen]

Bump.

I didn't catch it before when you said Afrin is for nasal congestion. Seldom am I ever congested. It's just the sneezing and runny nose that are a PITA. I was close to buying the Afrin but go to thinking about this. Nonetheless, would the steroid still help? Are there any other antihistamines out there that I can take in addition to the Loratadine?

[Airdale]

I talked to my doctor, and he gave me a prescription for Flonase, so this is my second day on it already and can I just say - RELIEF!!! Finally a damn nasal spray thats worth a crap. I'm still using a small dosage of Afrin to help with the congestion, but the sneezing, itching painful nose is gone today after 24hrs on Flonase. God it feels good to breath. I've been taking half the dosage of Afrin (1 spray each nostril) as needed but not less then 12 hours apart. Seems to be working and in a few days hopefully I won't need Afrin.

The doctor was going to prescribe Nasonex, but I told him Flonase was the only one I could remember from the FAA list. Is Nasonex going to approved as well? Doctor said they were very similar meds but Nasonex might be a few bucks cheaper.

[My Flight Surgeon]

Yes, Nasonex or any of the nasal steroid sprays are approved. The cost is within a dollar for the two mentioned (according to www.drugstore.com ).

I like the Flonase because the name is easier to spell . Both are good drugs.

Happy to hear you are better already.

[Swen]

Maybe I need to sucker up and get a prescription again. I've done so before, about 4 times and ended up not being satisfied with with the results. They worked well for the first few months, then it deteriorated from there.

[My Flight Surgeon]

Swen

You can take loratidine (Claritin) or Allegra or Allegra-D. The Afrin can only be used for 5-7 days or you will get "hooked" on it. Using one of the aforementioned non-sedating antihistamines along with a nasal steriod spray may be the thing you need.

Also avoid irritants (smoke filled rooms, perfumed women, etc) and allergens such as reagweed pollen --> this will probably disappear in the next week or so in Wisconsin when you get a "killing frost". (Is 86 and sunny here today).

Good luck

[Swen]

That was quick....

As you've said about them dying down, the allergies seem too since my first post to you. Perhaps I can wait out the season just a bit more but I guess I will take another look at the spray afterall.

Thanks.

[CcrlR737AMT]

I take Clarinex during the hay fever times(no side effects from the medication, have taken it for more than a year) I talked to my doctor and she said Clarinex is similar to Claritin but is over the counter than prescription) should I change to another medcation or stick with it. I want to go back to flying so I can finish up and get my PPL in the spring.

Also is there a list of allergy medications that are not allowed by the FAA so I can talk to my doctor when I go back for it in the spring?

[My Flight Surgeon]

Clarinex is OK. You can also use Allegra or Allegra-D and and of the nasal steroid sprays (Flonase, etc). You cannot use any of the sedating antihistamines (Zyrtec is considered sedating).

Hope this helps.

[CcrlR737AMT]

Originally Posted by My Flight Surgeon

Clarinex is OK. You can also use Allegra or Allegra-D and and of the nasal steroid sprays (Flonase, etc). You cannot use any of the sedating antihistamines (Zyrtec is considered sedating).

Hope this helps.

Thanks a lot!

[My Flight Surgeon]

You are welcome. I hope this helps you.

[SlantG]

[quote=My Flight Surgeon;503851]4) you may not fly within 24 hours of experiencing the symptoms of allergy or hay fever[/quote]
Where is the 24 hour restriction on flying after experiencing a symptom of an allergy listed and which symptoms are they talking about?

[My Flight Surgeon]

When one looks at the pharmacologic properties of these drugs and their metabolism, it make sense to wait 24 hours. The Guide for Aviation Medical Examiners states Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking an antihistamines. See the link http://www.faa.gov/about/office_org/...ch/item26/amd/

Oh you doubting Thomas

[SlantG]

Originally Posted by My Flight Surgeon

When one looks at the pharmacologic properties of these drugs and their metabolism, it make sense to wait 24 hours. The Guide for Aviation Medical Examiners states Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking an antihistamines. See the link http://www.faa.gov/about/office_org/...ch/item26/amd/

Oh you doubting Thomas

I'm just making sure you didn't have another hidden source that could cause problems. Otherwise I'd never get to fly. It's the second paragraph of the link that rules for year-round allergies:

"However, non-sedating antihistamines loratadine or fexofenadine may be used while flying, after adequate individual experience has determined that the medication is well tolerated without significant side effects."

Thanks!

[My Flight Surgeon]

Actually the FAA does not say whether the allergies are seasonal or year round. They do say if you have no adverse effects from loratidine or fexofenadine you may use those drugs and fly.

Enjoy the flying