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Allergies

Introduction

Terminology

Immune System and Allergic Responses

Preventive Medication- Nasal Steroids

Prevention by Avoidance

Non-steroid Nasal Sprays

Preventive Medication - Over-the Counter Antihistamines

Antihistamines work by a different mechanism from nasal steroids, but also result in
blocking the body?s allergic response. Antihistamines are available over-the-counter
(OTC) or by prescription.
Very few OTC antihistamines are authorized by the FAA for pilots when flying, if they
have previously tested the medication and do not have any side effects. The primary
OTC antihistamine, Claritin, was formerly available by prescription only. It is the same
medication as the prescription formulation Clarinex. See a summary of its effectiveness
in the American Family Physician article, Desloratadine for Allergic Rhinitis (Nov 1,
2003).
The over-the-counter products such as chlorpheneramine (Clortrimaton, CTM) and
diphenhydramine (Benadryl) found in many commercial products cause drowsiness.
Likewise, Zyrtec (certirazine) may cause drowsiness. They are not permitted by the FAA
and a pilot should wait at least twice as long as the dosing recommendation after the last
dose to fly. For example, if the directions read take every six hours", the pilot should wait
at least twelve hours after the last dose before considering flying. These medications may
have subtle adverse effects for much longer in some individuals. Chronic treatment with
over the counter antihistamines requires a 24 hour wait after the last dose before flying,
according to the FAA Guide for Aviation Medical Examiners.
A study published in the Annals of Internal Medicine on 7 March 2000 demonstrated that
the effect of taking Benadryl, an OTC antihistamine, impaired driving performance
significantly more than a blood alcohol concentration of 0.1% (legally intoxicated) or
Allegra, a "non-sedating" antihistamine. It also demonstrated that subjective drowsiness
was not an accurate measure of driving performance. Two of the study's authors are
consultants to the manufacturer of Allegra.
Preventive Medication - Prescription Antihistamines

The non-sedating antihistamines are available by prescription only. The FAA will allow a
pilot to use some of these medications and fly if they tolerate them without any side
effects after a ground testing period of several days. The currently approved medications
are Allegra, Clarinex and Claritin. Seldane and Hismanal have been removed from the
market by the manufacturer. Claritin became available without a prescription in
December 2002.
Zyrtec and Xyzal, additional medications in this category, are not approved by the FAA.
A 24 hour wait is required after the last dose of Zyrtec is required before flying.
Astelin, a nasal spray form of antihistamine, is not approved for use when flying. Just as
with Zyrtec, a 24 hour wait after the last dose is required before flying.
Like the nasal steroids, the use of the approved medications may be reported at the
airman?s next FAA physical. Those approved medications that are combined with
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pseudoephedrine, the active ingredient in Sudafed, are also approved by the FAA. They
include Claritin-D, Clarinex-D and Allegra-D.

Decongestants

Desensitization - Shots - Immunotherapy

FAA Reporting Requirements

VFS Aeromedical Assistance



Related Links:

Allergies: Information from WebMD
American Academy of Allergies, Asthma, & Immunology
FSF Human Factors article for allergies
Clinical Practice Guidelines for Rhinitis

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