Hay Fever, Allergy, and Asthma

Dr. Robert Kurrle, M.D., Senior AME

Is There a Difference? How Does the FAA View It?

Hay fever, allergy, and asthma – a lot of people use these terms interchangeably. In reality, they are completely different disorders. Use of the terms and medications incorrectly can have far reaching implications, including possible grounding by the FAA. Treatment is often available, both by over the counter and prescription medicines, but only a few medications may be used while flying.

Allergy is a general term that describes an inappropriate or exaggerated reaction of our immune system to substances that cause no symptoms for most people. Our immune system normally protects us from potentially harmful, infectious microorganisms. An allergen is a specific type of antigen that triggers an immune or allergic response in a sensitized individual. This response includes the release of histamines, which are responsible for the symptoms of runny nose, sneezing, itching, and in severe cases, narrowing of the airways in the lungs.

Hay fever or allergic rhinitis is probably the most common allergy response and is often seasonal. It is estimated 25% of the population is affected. It is an inflammation of the mucous membranes of the nasal passages that is often due to an allergy to pollen, dust, or other airborne substance. Many individuals become sensitized over a number of years. Symptoms include sneezing, itching, runny nose and nasal congestion. If chronic and not controlled, it can often lead to a secondary bacterial sinusitis.

Asthma is potentially the most serious and can be life threatening in certain individuals. Asthma is a chronic recurrent inflammatory lung disease. People with asthma have acute episodes or attacks, where the airways in their lungs get narrower leading to wheezing and breathing difficulties, often requiring a trip to the emergency room. Some episodes of asthma can be triggered by allergies, although infection, exercise, cold air and other factors can be important triggers. For asthma, treatment is aimed at keeping the airways open. Avoidance of the stimulus, treatment of the underlying disease, and inhalers can often help.

Allergic rhinitis can be treated very successfully. The first step is to identify the allergens. A physician specializing in allergy can do a series of skin or blood tests. The most effective treatment is avoidance of the allergen. This is often not possible if it's the family pet or pollutants in the air. Medical treatment can be very successful and often includes immunotherapy (allergy) shots as well as over the counter and prescription medicines. The medication is aimed at blocking the body's reaction to the allergen. The majority of over-the-counter medicines contain an antihistamine combined with a decongestant, with significant drowsiness as a side effect. There are several antihistamines that are non-sedating. The nasal symptoms can often be effectively controlled with prescription nasal sprays containing low dose steroids that are safe and effective, even in the long term.

The FAA approves some of the medicines available. Prescription steroid nose sprays are approved and include Flonase, Beconase, and Nasacort. These should not be confused with over-the-counter nasal decongestant sprays such as Afrin and Dristan, which are not permitted by the FAA. Allergy desensitization shots are approved. Because of the side effect of drowsiness, the FAA does not approve the use of oral anti-histamines sold over the counter. A pilot should wait at least twice as long as the dosing interval following the final dose before flying, i.e. for a dose of every 4 hours, wait at least 8 hours. Non-sedating antihistamines are available by prescription and are approved by the FAA while flying, provided there are no side effects. Currently approved medicines include Allegra, Claritin and Seldane. Seldane and Hismamal have recently been removed from the market. Claritin became available without a prescription in December 2002. The FAA currently does not approve the use of Zyrtec and Singulair. Over-the-counter decongestants are approved provided they are not combined with antihistamines (read the label carefully!). Approved medication may be reported at the next FAA physical in block 17, "medication". It is important to list "no side effects" under explanation.

For asthma, the FAA will approve mild cases that cause only mild, seasonal symptoms. The periodic use of most inhalers is acceptable on a case-by-case basis. More serious episodes must be deferred to Oklahoma for review, and will usually require a detailed report by a specialist with pulmonary function studies. If issued, certain restrictions and special follow-up evaluations may be required.

Seasonal hay fever and asthma can be well controlled in most cases. Select the treatment carefully with help from your physician. Choose medicines from the FAA approved medications, if you will be flying when using the medication. If you are using unapproved medication, be certain to wait at least twice the dosing interval after the last dose before you resume your pilot duties. Happy flying.