Antihistamines : Rules for Pilots

Code of Federal Regulations (Legal Extract)

• First-Class Airman Medical Certificate: 67.105(b)(c)
• Second-Class Airman Medical Certificate: 67.205(b)(c)
• Third-Class Airman Medical Certificate: 67.305(b)(c)

Medical History: Item 18.e., Hay fever or allergy.
The applicant should report frequency and duration of symptoms, any incapacitation by the condition, treatment, and side effects. The AME should inquire whether the applicant has ever experienced any barotitis (ear block), barosinusitis, alternobaric vertigo, or any other symptoms that could interfere with aviation safety.

Aeromedical Decision Considerations:

• Item 26, Nose
• Aerospace Medical Disposition table
• Item 35, Lungs and Chest

Protocol:
See Disease Protocols - Allergies, Severe.

Pharmaceutical Considerations:

1. The nonsedating antihistamines loratadine, desloratadine, and fexofenadine may be used while flying if, after an adequate initial trial period, symptoms are controlled without adverse side effects.

2. Applicants with seasonal allergies requiring any other antihistamine (oral and/or nasal) may be certified by the AME only as follows:

   • With the stipulation that they do not exercise the privileges of airman certificate while taking the medication, AND

   • Wait after the last dose until either:

     • At least five maximal dosing intervals* have passed. For example, if the medication is taken every 4-6 hours, wait 30 hours (5x6) after the last dose to fly, or,

     • At least five times the maximum terminal elimination half-life has passed. For example, if the medication half-life* is 6-8 hours, wait 40 hours (5x8) after the last dose to fly.

     The FAA encourages AMEs and pilots to look up the dosing intervals and half-life.

   • For hay fever controlled by Desensitization, AME must warn airman to not operate aircraft until four hours after each injection.

   • Airmen who are exhibiting symptoms, regardless of the treatment used, must not fly.

   • In all situations, the AME must notate the evaluation data in Block 60.