AOPA Pilot Magazine - July 2014 - 22

FLY WELL

Sneezing and wheezing

BY DR. JONATHAN M. SACKIER

Avoiding allergy attacks
THE WORD ALLERGY means "different action" and
was coined by Dr. Clemens von Pirquet in 1905. He
maintained that immunity, the body's response to
external stimuli, could be helpful, or, when overblown, had adverse effects. Many infectious diseases,
including polio, flu, and tetanus, are controlled by
manipulating immune response. But 10 to 30 percent
of industrialized populations have allergies, hypersensitive reactions to numerous substances, and this
number is increasing.
For allergies to occur, on first meeting a provocative substance (allergen), sensitization occurs
and the patient's immune system says, "I don't like
that." Subsequent exposures inspire white blood
cells to produce immunoglobulins and histamine,
chemical messengers that induce mildly unpleasant symptoms such as red, watering eyes; facial

Peanut allergy is common, causing some airlines
to stop serving small packages of peanuts on their
flights-those were the only advantage I ever saw
to traveling that way.

DR. JONATHAN SACKIER

is a medical advisor
for the AOPA Pilot
Protection Services
program and an
active general
aviation pilot.

22 | AOPA PILOT July 2014

flushing; rashes; and itching. Occasionally, however, life-threatening anaphylactic reactions arise,
caused by throat swelling that impedes breathing
and cardiac problems.
Food allergies cause unpleasant symptoms: pain,
diarrhea, vomiting, bloating, wheezing, or swollen
lips. Peanut allergy is common, causing some airlines
to stop serving small packages of peanuts on their
flights-those were the only advantage I ever saw to
traveling that way.
Gluten, milk, soy, seafood, and others also can
stimulate allergic problems. If eggs affect you, tell
health-care providers before any immunization,
because eggs are used in vaccine production.
Sulfites are a byproduct of wine and beer production and can be found in many foods such as baked
goods, guacamole, and dried fruits. Reactions can be
mild or nasty. Lots of drugs cause allergic reactions;
antibiotics are common culprits. If you have had an
allergic reaction to one antibiotic, tell your doctor
prior to taking any antibiotic as crossover allergies
can occur.

Hay fever, a seasonal allergy, is common and
mild, usually presenting with itchy watering eyes,
sneezing, and scratchy throat. It can provoke
asthma attacks, so folks with that condition should
be more careful about exposure to allergens-listen
to pollen reports and avoid certain environments.
Some people are sensitive to fungi and various
molds. Other allergies include those to poison ivy,
oak, or sumac, or to cats and dogs.
Skin is our largest organ, a set-up for exposure
to environmental chemicals that may cause allergy.
For instance, latex in domestic (and surgical) gloves,
sunscreen, deodorants, or make-up all can cause
problems. Bee, wasp, or yellow jacket stings can
mimic an electric shock, but allergic responses can
occur and cause anaphylactic shock.
If allergies are suspected, testing protocols
involve exposing skin to a small amount of the
potential allergen and if local swelling, pain, or
irritation occurs, the cause is apparent; one can
also look for elevated immunoglobulin levels
in blood.
Avoiding allergens is ideal, but if symptomatic
contact occurs, antihistamine treatment squashes
histamine-induced effects. Steroids, delivered
locally to the site of problems, may also help. For
instance, allergic rhinitis is addressed by squirting meds up the nostril. Eye drops, creams, tablets,
and intravenous steroids are available. For anaphylaxis, epinephrine injections can assist and people
who are at risk keep epi pens with them. Efforts to
desensitize allergic patients by gradually exposing
them to increasing doses of allergens may work in
certain cases.
Why are some people allergic? There is no clear
answer, but there does seem to be a familial element-twins tend to have similar allergies. There
is also the "hygiene hypothesis"-kids from larger
families tend to have fewer allergies, potentially
because it is harder to keep everyone clean, so persistent exposure to many irritants does not lead to
allergy. As for flying? Don't fly if in the middle of an
attack and certainly do not fly if taking antihistamines. Discuss your condition with your physician
or AME and put safety first.
AOPA
EMAIL jonathan.sackier@aopa.org

AOPA Pilot Magazine - July 2014

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