background

Doing Battle with Allergies
While Flying Safely

Those with allergies usually know it. The other 98% with allergies usually don’t know it or have blamed something else.

OK dudes and dudettes, read up: if you have had a “cold” for a week or two, it ain’t a cold. If you have had no fever, t’ain’t a cold either.  A viral illness (like a cold) runs its course in 3-5 days and is always accompanied by a fever, even if low grade and only for a few hours.  Anything that makes you stuffy, sneeze, wheeze, snot, snort, stop up at night, ears itch (way down in the canal), scratchy throat, cough when you laugh (especially worse at night), sneeze three times or more in a row, etc., and NO fever, is an ALLERGY until proven otherwise.

I am going to bore you with a few of the mechanics of what is going on, we will get to the ‘fix it’ portion in a minute. What ever you are sensitive to, be it something growing outdoors (seasonal), your wife’s perfume, your husband’s shaving lotion, the indoor cat, tobacco smoke, etc., causes the body to over react with its natural defenses. The first thing the respiratory tract (from your nose to the last little air sac in the lungs) does is produce more mucous to help move the irritant out of the airways. Mucous is usually thought of as that nasty, thick stuff you blow out of your nose or cough up. Well, it is, but it starts out as a thin, watery material (not unlike tears) that keeps the airway linings moist.

As extra mucous is produced it begins to fill up the smaller air passages and obstruct the easy flow of air. You have to work a little harder to breathe. The upper air passages may actually swell a little (there isn’t any way to swell outward, so your nose gets stuffed up). After a few hours, the thin watery stuff has lost its water content and has become thick and sticky. It’s now a lot harder for the body to get rid of, therefore, the increase coughing, nose blowing, etc. There is only one way out and that is towards the air intake. If your nose is stopped up, you have to switch to ‘alternate air source’ (you young kerosene burners may not remember your recip engine days when you could switch to alternate air if you were icing up) or, for your body, mouth breathing.

The body does all this shifting of the mechanics of breathing automatically. You don’t have to think about it, you just do it naturally. There are some other signs and symptoms that are a tip off to me when I am suspicious of allergies. One of the tip offs is: awakening tired ‘all the time’ yet certain that one slept all night. Yup, I am sure you slept, but did you REST? Sleep and rest are two different things that usually go together but can get ‘separated’ by outside interference. Nope, you were coughing, tossing, turning because you were not getting restful sleep in turn related to difficulty getting that air in and out easily. An example: remember as kids when gramps was snoring loudly and nothing would wake him up? Just pinch his nose (cut off the air) and you would have a wide awake fight in 5 seconds. Nothing interferes with restful sleep more than airway congestion !

Beginning to make sense yet ?

When your chest gets to the point you can hear wheezing, you are past the point of getting any useful sleep at all, you really feel like crap. Remember we are NOT dealing with an infection but rather an irritation or inflammation. If you cannot laugh (or talk on the phone) or take a deep breath without coughing, you are at the same point. This is where a lot of folks go to a health care professional and not infrequently are given an antibiotic prescription. I do not know what the rationale for an antibiotic is because there is no infection. Unfortunately, medications for relief of the inflammation are overlooked. Read on…

OK, enough of that, let’s talk about some things to help fix it.

Number one: an antibiotic will NOT help an allergy !!! Yet it is sought by sufferers 90% of the time due to misunderstandings of the causes (see above, it is NOT an infection but an inflammation). An antibiotic does NOT address the cause and secondly, does not relieve the inflammation.

We have got a lot of things to talk about. Now, some of these issues I discuss may not apply to you specifically but, because there are so many different irritants and so many individual reactions, you will need to pick what applies in your case.

For seasonal air borne allergy, nothing beats air conditioning. BUT don’t make the honest mistake of trying to $ave a few buck$ by turning off the air and opening the windows at night. Here’s why and I think this will make perfect sense. During the heating of the day, the pollens, dust, whatever, gets dispersed in the lower air layers near the earth’s surface. Opening the windows at night lets in that concentrated, allergy laden air in the lower 30-50 feet of atmosphere right into your living space. Feel your nose stopping up yet? Air conditioning knocks down the humidity which reduces the potency of the stuff floating in the air also.

If you have an indoor cat, it isn’t the cat hair or “dandruff”, it’s the dried saliva from the cat’s grooming that has a protein that people get allergic to. Have a long talk with the cat and see if the two of you can arrange a bath weekly and this will frequently make the two of you tolerable. No kidding. (It CAN be done; been there, done that.)

Oh, by the way, did I mention that an antibiotic will NOT help?

Being realistic in your expectations (you can’t clean ALL cat dust or grass pollen out of the house in one cleaning, it is a progressive thing) is essential and will help avoid frustration.

Do not expect instantaneous miraculous improvement. If I sealed you in a sterile room where every single thing you are allergic to was eliminated it might take 2-3 WEEKS for your symptoms to die out !!!!! This is especially true if you have developed a tight chest (wheezing) or allergic bronchitis. The body just doesn’t send its defenses off duty until the threat really appears to be gone.

OK, Doc, I can’t live in a sealed room, what now?

In the last fifteen years there have been some real breakthroughs in treating the symptoms of allergies (but remember avoiding the CAUSE if at all possible is still the numero uno goal). I am referring to several categories of medications that are just about completely free of side effects and offer considerable relief. 

The first medications that come to mind are the “non-sedating” antihistamines. There are three common ones that are commonly available however the FAA only approves two of them: Allegra (generic name: fexofenadine) and Claritin (generic name: loratidine). The third one, Zyrtec, WILL CAUSE DROWSINESS in some people and therefore is not FAA approved to be used while flying.

Claritin (loratidine) was the first to hit the market and is now a non-prescription item. It is not quite as effective as Allegra (in my opinion) however will work pretty well for the majority of users. Due to its low cost (SAMS Club™ and Costco™ -and probably others- have generic loratidine 100 ten milligram tablets for less than $20.00 at this writing ) it is worth try. Again, being consistent with the daily dose is essential.

Allegra is no longer a prescription item, the generic version is fexofenadine. You can get 120 tablets for about $30.00 at SAMs Club™. Get the 180 mgm strength and take it once a day.

THIS IS A VERY IMPORTANT COMMENT REGARDING THESE TWO MEDICATIONS

THEY ARE NOT NEARLY AS EFFECTIVE IF THEY ARE TAKEN “CASUALLY”, IE., ONLY “WHEN NEEDED”. THEY WORK MUCH BETTER IF TAKEN DAILY. I USUALLY RECOMMEND STARTING DAILY USE A COUPLE OF WEEKS BEFORE YOUR ALLERGY “SEASON” STARTS AND CONTINUING UNTIL THE SECOND, HARD FREEZE. If you have not had symptoms for a couple of weeks and want to try without, then go ahead, but resume at the first sneeze!

If you take Zyrtec, wait 36 hours before you fly.

ALL of the over the counter medications that have a warning about potential drowsiness are not safe to use and fly UNLESS you wait at least three times the ‘dose interval’ from the last dose. For example, if the directions say “… every 4-6 hours” then take the longest interval, 6 hours, multiply times three = 18 hours before bending the throttles.

The standard “pilot’s friend” Sudafed® has been around for years. It is great for relieving some of the upper congestion (nose, “sinuses”), but does nothing for the chest. It will help one breathe easier while the problem is getting under control with other treatment. Unfortunately Sudafed® (pseudo-ephedrine) is the stuff the dope-heads make ‘crystal meth’ from, so the pharmacy may look at you cross-eyed and ask you to sign for it. (A practice that does not seem to have reduced the meth street stuff, just complicate living for us law abiders). Sudafed treats symptoms only, does not cause drowsiness, and can be used with Claritin or Allegra.

Nose sprays have long been used to get our heads opened up. Many of us carry or have carried nose spray in our flight bag “to get home” or in case of a ‘sinus block’ while flying. There is nothing wrong with this category of symptom-relievers (note these do NOT do anything for the cause) but they do have to be used properly for best results and safety. I have not seen any of the short acting sprays on the shelves for years, so let’s talk about the “12 hour” variety. “Afrin®” was one of the original long acting sprays. It is still available over the counter along with scores of generics and other ‘knock offs’.

The long acting sprays are OK (with qualifications !). They will open up a stuffy head in 10-30 minutes after use. Initially they will keep congestion reduced for 12-16 hours. This desired effect only lasts for about 2-3 days, 5 at the most, then the interval of benefit starts getting shorter, like 6-8 hours. If you give in and use the spray three or four times a day to get relief, you quickly get into the problem of rebound congestion. This congestion is worse than what you were originally treating and is a bugger to get rid of. Therefore, do NOT use the 12 hour or long acting sprays any longer (3-4 days) than to just get the other treatments working (such as Claritin, Allegra, Sinus Rinse, etc.).

NEWER NOSE SPRAYS -- In the past few years some of the cortisone based nose sprays have beecome available without a presecrption. The first I think was Naso-cort followed by Flonase.  EIther of these is fine.  They work on prevention rather than forcing the nasal membranes to shrink.  Used once or twice a day (follow directions), they will, after 1-3 days, begin to PREVENT nasal congestion.  Like fexofenadine or loratidine, they mut be used daily in order to be effective.  The combination of non-sedating antihistamines and nasal steroids (cortisone) is the gold standard in preventing allergic symptoms when used according to advice.  BOTH  may be used together.  Don't forget, what you take today will tend to prevent symtoms TOMORROW.

Please give any treatment time to work. It might take 2-5 days for established congestion to begin to diminish after starting Claritin (or any other).

There are other types of medications that you will see advertised (Advair® inhalers, Singulair®, etc. These are prescriptions, work very well, have very few side effects but are for the tougher allergy cases.

For someone who is really stopped up, can’t breath, wheezing, coughing incessantly it is not unusual for the professional to give a short course of cortisone (prednisone, etc) to break up allergic process by stopping the inflammation. It absolutely will “bust up” the toughest case in often less than 24 hours but due to rare side effects, flying duty is held off for three days or so from the start of treatment. One must continue with other non-cortisone medication like Claritin, etc.

Antibiotics Do Not Work...

Did I mention that antibiotics do not work worth crap and only make your getting well more $$?

Here, boys and girls, is one of the simplest and safest things you can use to help get your upper pneumatics opened up and breathing again. The NeilMed™ Company makes a product called “Sinus Rinse®”. Every chain pharmacy in the US carries it. It is absolutely safe, you could drink it, take a bath in it, use it for a mixer, etc., and it will not harm you. It is a ‘buffered saline’ solution that you swish up your nose and through your sinuses. Before your toes curl up at the thought, it absolutely will NOT hurt – it’s the first initial use that will convince you. We have given out 100’s of samples from the office and have had nothing but rave comments later.

It is a system with a small plastic bottle that you fill with lukewarm water and then mix a packet of supplied powder (looks like a sweetener packet) into it. Mix and then flush per the instructions. The solution is carefully measured out to be exactly the same pH and salt concentration as natural tears. It can be used often as needed. Most report the sinuses draining promptly after use. Guaranteed it won’t hurt ya!

One other simple thing: increase your water intake (NOT coffee, iced tea, Pepsi, beer, etc.). Extra water helps loosen the thick, sticky mucous and move it out. If you take some of the “expectorant” over the counter medications, they will not work well without extra water. Even standing in the shower a few extra minutes and breathing some of the steamy air may help.

In closing

In closing, please remember allergies are extremely common and require constant vigilance. They are usually subtle and stubborn. Everybody has different symptoms. There is no one miraculous treatment. You may have symptoms one year and not the next. Who knows why? I sure don’t. Casual treatment of symptoms will always leave you 1-2 days behind. Constant preventative treatment will help avoid the problems to begin with. What works for someone else may not be worth a hoot for you. Antibiotics don’t work for allergy. Keep it simple, give any treatment a chance. Don’t combine multiple medications of the same category (for example decongestants, anti-histamines). It may take a combination of different types to give you some relief but its best not to start several at one time (if you think you are having a side effect, then which one is it?).

You may get only some relief and not a complete “cure” – hey, that’s life. Next year you may be completely free of symptoms. If an ad promises “miraculous relief” – it won’t !

If you are TRULY running a fever, checked by a THERMOMETER, not by “hand”, not over 100 and you are not hurting, give it another 24 hours. If your temperature (by thermometer) is 101 or more, and/or you’re hurting like the dickens, see your family doc. (I can’t over emphasize using a thermometer not a hand for accuracy – when your temp is dropping, the heat is coming “out”, - guess what your skin feels like ??)

A concept I wish to pass along is that there are several directions one can take to get to the goal of treating allergic symptoms. More than one medication, even several, can be used at one time (in other words, using separate types of medications simultaneously) to achieve relief. Using a separate type of drug will have different side effects but shares a desired beneficial result. When the same category of drugs are used (like using two antihistamines at the same time) the risk of side effects can be more than doubled without improving the benefit.

WOW, I got wound up on that topic didn’t I? Email me if I left something out or you still have questions: terrellmd@earthlink.net

WOW

WOW, I got wound up on that topic didn’t I? Email me if I left something out or you still have questions:
Contact Me