Peanut Alergies and Flying

[dewarg]

Recently a friend was traveling on a Canadian airline and prior to the flight he purchased a snack which contained nuts. The flight attendant observed him eating his snack and asked if it contained nuts. When he replied it did he was told to put it away as she was allergic to nuts.

Was this a valid concern?

[gingernut]

Yes.





And for the sake on lengthening this message by ten words, is she in the right post?

[AMEandPPL]

Was this a valid concern?

It should be a GREAT concern. Least of all simply because of the individual's freedom to choose and consume a snack of his own preference.

More importantly, though, one has to question whether the member of cabin crew is fit to be doing that job, in that environment.

IF (and it would need verifying) she was so allergic to nuts that it was justifiable for her to ask a passenger not to consume them, then she might be at risk of a major anaphylactic reaction when in close proximity to nuts. This is a potentially life-threatening emergency, and ample grounds for an in-flight diversion. What if the aircraft was over the mid-Atlantic ?

IF it were true, that individual should not be doing that job. If she were NOT that allergic, then why has she bothered mentioning it at all ? Mere proximity is unlikely to be a problem, only if she ATE any herself.

[MzGuilty]

Told to put it away, or asked? Geez, take a chill pill. It is not unusual for us to have passengers who are allergic to nuts, and we always make a PA asking people not to eat any nut products and explain why. I've yet to receive a complaint from a passenger who objected to this. Some passengers bring their own food, so as to be sure they don't come into contact with nuts. They too cause a risk of needing to divert. Do we stop all people with an allergy from flying or just discriminate against crew? It may well be she had a minor allergy to nuts, causing breathing problems, but no serious risk, just very uncomfortable.

[gingernut]

It may well be she had a minor allergy to nuts, causing breathing problems, but no serious risk, just very uncomfortable.

Unfortunately that's a contradiction in terms.

I'm not sure it's a case of discrimination, more a question of reasonableness.

No more unreasonable than not having air traffic controllers with a stammer.

Personally, I'd always err on the side of the employee, but I'm not sure that it's safe to employ someone in such circumstances. I may be wrong.

[AMEandPPL]

No more unreasonable than not having an air traffic controller with a stammer.

Fantastic ! That's a really great comparison ! Thanks !

It's really not a question of discrimination. In an operation such as an airline, passengers are transient, constantly changing, and pretty much unpredictable. Sure, diversions happen occasionally because passengers are taken ill in flight. But we should expect much higher standards of reliability in the regular staff. Anyone who has a significant risk of an anaphylactic reaction occurring at FL 370 SHOULD NOT BE CREW - PERIOD.

[AMEandPPL]

Interesting to note that this topic is not new. This discussion
on similar lines was over three years ago :

http://www.pprune.org/forums/cabin-crew/162380-allergies-when-cc.html

Then it was an employer who (in my view, very sensibly) turned down someone for employment as cabin crew who had known food allergy.

[MzGuilty]

Umm I don't think the cabin crew in question claimed she'd have anaphylactic shock if she came into contact with nuts. Also, it isn't a contradiction in terms to say she'd "just suffer breathing problems". Just as anyone with hayfever can have a mild reaction or extremely severe, the same goes for allergy to anything. She may well have had a mild allergy that left her uncomfortable. So you are saying it's ok for a passenger with an extremely severe allergy to nuts to travel at 37,000 feet (we've had quite a few travel with us who have severe allergy and carry an Epipen), but not OK for a crew member with a mild allergy. Gotya.

[gingernut]

Gotya.

If it makes you happy, then you've got me.:)


But I'm not quite sure that breathing problems constitutes a "mild allergy."

It sounds like you may have been on the end of a decision you don't agree with.

Post the facts, and we'll be glad to advise, without discrimination or confrontation.

[AMEandPPL]

but not OK for a crew member with a mild allergy. Gotya

Well, no, that's not really what I said at all ! If an allergy is MILD, and proven to be so, and not life-threatening, then the cabin crew would have no problem working, AND FURTHERMORE would NOT have to interfere with a passenger's personal choice of on board snack.

it's ok for a passenger with an extremely severe allergy to nuts to travel at 37,000 feet (we've had quite a few travel with us who have severe allergy and carry an Epipen)

That's NOT QUITE in the spirit of what I said either ! If a passenger is known in advance to be very likely to suffer a life-threatening episode in flight, then no airline in its right mind should carry them ! My point was that, unlike staff, they fly infrequently, and facts are unpredictable, and often not known until the flight is well on its way.

Any "problem with breathing", especially at high altitude, is hardly well associated with the word "mild". The third line of Gingernut's very succinct post may well be the key to this one. I agree with his last line too.

[MzGuilty]

Ginger, no I haven't been on the end of a decision regarding allergies, but I have worked in health care and know people with allergies, so understand the problems. I have no idea how this cabin crew member reacts, but if it's anything like my daughter, her eyes will get sore and water, and nothing more. (not a peanut allergy) It's certainly not life-threatening, but quite definitley uncomfortable. The other allergy my daughter has makes her breathing "tight", but again, not life threatening in any way, more like hay fever.

We carry a fair few passengers who we know have severe allergies and carry an Epipen with them. We are told at the pre-flight breifing and we simply make a PA asking passengers not to eat any products containing nuts. Fortunately we don't have stroppy passengers who can't live without nuts for a few hours.

I really don't see the fuss in asking people not to eat nuts for a few hours. Would the friend have complained if he'd been told a passenger had an allergy to them? No doubt the crew member has been passed fit to fly by staff health, as the last thing she'd want is to put her own life at risk. I hope she asked the friend nicely, that of course makes all the difference.

[gingernut]

I can see your point, s'pose you need to be able to define "allergy."

[AMEandPPL]

Fortunately we don't have stroppy passengers


So, obviously don't work for BA, then . . . . . . . . .

Was there EVER such a spoilt BRAT ? ?

[MzGuilty]

Def don't work for BA, I wear red. I have to say 99.9% of our passengers are very nice, the remainder I just think, "God help your other half". Anyway, I think it's all been said now, so ... I'm off to work :)

[AMEandPPL]

Anyway, I think it's all been said now

Agreed ; thanks for a good debate Mz. :D

I'll get on with work too ! :ok:

[dunelmitepilot]

Hi all,

Been waiting for a thread of this sort to come about: I have wanted to be a professional pilot since I was very young-yet I do have what I beleive to be an intolerance to peanuts. My situation is that so long as I don't consume them, which when I last did about 13 years ago, made me be sick after about half an hour or so of consuming it. I am perfectly ok if I'm at a party and there are nuts etc on the table, and their presence does not make by breathing difficult nor my skin itch. I know loads of foods especially biscuits like to have the label saying not suitable for nut allergy sufferers and so on, but I could consume packets of those until the cows go home! I have been told from a former airline pilot (been retired for about 5 years) that with this being the case-so long as I discuss this properly with the AME at the medical, I should not have a problem obtaining it.

I did think this may have been the case as I have read about people with more serious complaints such as asthma and diabetes etc who can still obtiain a class 1

My health meets all the other medical requirements as well.

If anyone can provide me with some more info/advice on this I would really appreciate it.

Thanks,

Adam.

[gingernut]

I think you really need to be clear about the difference between an intolerance to something and a true allergy.

I'm intolerant to lemon meringue, it also made me sick some years ago, but I'm not allergic to it.

And I didn't declare this to my AME.:)

[dunelmitepilot]

Thanks gingernut. I may take it further and get an allergy test booked but the former airline pilot I mentioned in the previous post said it did sound like and intolerance rather than an allergy. He also mentioned that airlines try and refrain from serving food with nuts/nut oil in anyway due to the number of people who have the really bad allergic reactions-whereby if they just inhale the smell it can set them off!!!

I can't say I'd run the risk of not declaring it to an AME though-but fair play to you for doing it!!

A.

[MzGuilty]

Definition of allergy: "an abnormal reaction of the body to a previously encountered allergen introduced by inhalation, ingestion, injection, or skin contact, often manifested by itchy eyes, runny nose, wheezing, skin rash, or diarrhoea".

Can't say I blame her if she was trying to avoid any of these reactions to nuts.

[JCBeadle]

Hi everyone,

Ok so here's my story - I attended a Class One Medical at the CAA at Gatwick last December and passed everything including an exercise spirometry test for my asthma. So all well and good! BUT I have a nut allergy, and the CAA wanted me to see an immunologist, so I did and sent the report back to the CAA who advised me before that the likelihood is that my medical would just limit me to working in multicrew (which is fine, because I want to work for the airlines anyway!) I got a call from them today and they told me that they could only issue me an unrestircted Class two medical which would be fine for private flying etc, and that it would last 5 years. But this is the problem, I don't understand why they won't issue me a class one medical? They are sending me a letter to explain but it was all gobble di gook over the phone! They also said to me that when Easa bring in new rules next April, there is a possibility that they could refuse my application to upgrade my Class 2 into a Class 1?!

My nut allergy is not severe before everyone says I told you so! In fact the results were interesting. My peanut allergy came out really weak, Cashews came out negative. The main reaction was with brazil nuts which is much easier to avoid than peanuts, and also adding the fact that i havn't had a major reaction for almost 20 years and have never been incapacitated or taken to hospital because of it.

Please, if anyone has had any experience of this PM me, I would like to hear other people's experiences or criticisms, as I am really stuck as what to do. I will probably go and get some advice from an AME near Gatwick and see if I can argue my case that my nut allergy really isn't that severe. (I won't die from being in the same room as a nut, but making sure that nut isn't the person sitting next to me trying to work my epipen!)

I appreciate all responses and please PM me if you have naything to say!

[Loose rivets]

I'm astonished to read this. I have flown with someone that had a severe peanut reaction.

[Piltdown Man]

I'm sorry to hear about your plight. And whilst I fully realise how unpleasant a nut allergy is, I'm truly glad that I don't fly with anyone who has one. To be incapacitated in flight for due to a nut allergy is not acceptable. There are too many sources to contaminate crew food and I think the likelihood of ingestion is too great a possibility. When your medic confirms that you'll neve, ever need an Epipen, that'll be different. Unfortunately, this isn't a normal job.

[Loose rivets]

The thing is that anyone can have a severe reaction for the first time after a lifetime of no symptoms.

By the grace of God, I'd finished flying when I went into severe Anaphylactic shock. First symptoms were severe itching of my hands while driving, of all places, from hospital.

I put a huge amount of work into finding out just what happened, and the only thing I could come up with is the strong soap in the hospital lavatory. To this day, my hands react to washing up liquid.

My GP told me of his father who also happened to be a GP. They were leaving a Chinese restaurant together, when his father suffered his first ever reaction. It was totally disabling.

I wrote this in a funny vein for JB, but believe me, it was far from funny.

http://www.pprune.org/jet-blast/297324-delicate-question-manners-part-ii-2.html#post3654185

[JCBeadle]

Loose Rivets - That really must have been terrifying from reading your post! (Touch wood) I have never gone into Anaphylactic shock, so cannot fully appreciate how scary it really is. The problem with allergies is that there is no real hardcore evidence to suggest what causes them, although there are a few theories. One of which is that we are all living in a disinfected world where we are less in contact with dirty bacteria. But doesn't mean to say I'm going to be rolling around in dirt and eating worms because it is a lot more complicated than that. Probably why the CAA don't have anything on their website regarding allergies.

Anyway straying off the point a bit, I am still going to go for my PPL and Night rating, and tackle the Class 1 Med after then. The more flight experience I get without encountering any medical problems, the better case I could have to argue against my Multi crew limitation and upgrade to a class 1. I fully appreciate that the CAA are there to help rather than hinder when it comes to health issues and at the end of the day it is the general public's safety which is priority. But i'll push on and see what happens. I'm just glad that I'm not hypersensitive to nuts, or I would be living in a bubble!

[AnthonyGA]

It sounds like the CAA is overreacting, perhaps because nut allergies are so much in fashion these days.

There are a couple of things to keep in mind. First, you don't know if you have an allergy until your first allergic reaction, so there may well be pilots with severe allergies flying who don't know about them. Second, food allergies generally only produce a reaction when the allergic person actually consumes the food. The mere proximity of that food or the smell of that food isn't enough, despite many apocryphal stories that assert otherwise. Third, anaphylaxis is rare in food allergies (actually it's rare for all allergies); you're more likely to stroke out during a flight than you are to experience anaphylaxis, even if you actually munch on a food to which you are allergic (unless you actually have a prior history of anaphylaxis). Fourth, psychology is important in allergies: allergic reactions can be psychogenic as well as physiological … a person with asthma can experience an attack simply from emotional stress, for example, even in the absence of any allergen. And a reaction trigger by an allergen can be worsened by psychological stress. This makes it hard to prove that an attack actually results from exposure to an allergen, in some cases.

The priorities of aviation medical authorities mystify me at times. It's as if they base their disqualifications on what they can detect, as opposed to basing them on what might actually incapacitate a pilot. Smoking is a lot more likely to kill a pilot during a flight than a food allergy, and yet being a smoker doesn't disqualify someone from being a pilot.

[homonculus]

This is confusing! It sounds from your post that you were formally tested for various triggering agents. If so, was there a reason? What actual reaction did you have, how severe was it and what treatment did you have?

Once that is established, why is the CAA restricting you? It may be gobbledegook to you but if you pm me I can give you some advice. If you havent been told, ask. Certainly I know of many pilots flying with allergies that are not restricted so there must be a reason.

Finally the suggestion that nobody knows what causes an allergic reaction is wrong. We know very well what happens, and the various types of immune response. We also have well developed methods both of finding out why a reaction is happening (providing samples are taken immediately) and also of testing patients afterwards to see what they react to.

[Loose rivets]

It's an interesting subject, and one that's caused me more than a little trouble over the years.

I'm not convinced by any means, but I'm suspicious that early childhood programming has a lot to do with it. A sensitive and intelligent child can pick up on all sorts of parental ramblings, and start to fear all sorts of things. "Sitting in a drought will give you a bad back." And it does - despite the fact you were hanging over the side of a sailboat in a force five for hours, and it left you felling like Superman. A far-fetched analogy, but you know what I mean.

Migraine is horrific, and so often comes at a time that tallies with long term worry. So counter-productive. Yet something seems to not just trigger the onset, but actually plans it. (a recent paper )

That something is very real, and I confess multiple sentience is a hobby-horse of mine, but I think there's a lot of sub-processing going on based on reasoning that has no place in a modern world; a world filled with new and exotic molecules. 'It' hasn't a clue how to react productively.

I'm now in a situation where I can't touch wheat. Yep, and that includes best malt :{ Not even a little bit. I'm scared stiff of washing up liquid, and using cheap soap makes me ill within an hour. There was a hint of it when I was c 40, but it went away after extensive tests by AVM Cook, head of aviation medicine. They didn't find a thing wrong, but the mystery took its toll on my career despite being very transitory.

I was in my early 60s when the main issues started, and the first experience would have left me on the floor of the flight deck. It was totally disabling for 10 of the 30 mins it lasted.

[homonculus]

'but it went away after extensive tests by AVM Cook'

Nope. An allergy is an abnormal learned response of the im,mune system. Once you have an allergy it doesnt go away (unless you are desensitised - a rare and far from simple procedure).

A significant proportion of patients who tell me they are allergic arent. Period. There is also controversy as to whether allergy is increasing in frequency or occurance or frequency of diagnosis.

[Loose rivets]

I concede the last statement. Very difficult to get a level analytical playing field over long periods of time.

I'm not really able to understand the 'memory system' of immune cells. I just phoned my son for a briefing, (stress and the immune system is one of his focus subjects.) but he was driving, so I'll have to wait for that.

What does seem strange to the layman, is the level of 'learning' within the cells themselves. So, it takes me away from a direct control of some misguided processing in the brain - as so much is going on at cell level. However, I still think there is a high likelihood there is some sort of master control that becomes confused. It so often seems to be linked to factors like stress.

I claimed at the time I felt wholewheat bread made me ache. It seemed to be 100% hit rate. I went on to enjoy years of eating such bread.

It was the period all those years ago that prompted me to try not eating wheat this time around - with almost total success. (the soap thing blurs the certainty.)

Another issue is the products they use on the wheat. A Uni professor neighbor can't touch the stuff, but she can eat bread again when she's in a different state (of the US). Clearly that slews any results from hit and miss self help.

I'll try to get a clearer picture, then steer back to the OP's point of sudden and disabling reactions.

[trevelyan]

Hello all,

I am posting this on behalf of a young friend who would like to pursue a career in Aviation, but has a severe allergy to Peanuts. He says the allergy is severe enough for it to be fatal, and he carries an EpiPen in case of accidental ingestion. Whilst specific to Peanuts, his GP has advised he stay away from all nut types.

I have looked about on here, and did the usual Google searches but cannot find any specific information as to if he is likely to be able to fly professionally in a commercial environment. I believe he has enquired with the UK RAF and the answer was (not surprisingly) a flat “absolutely no chance”.

I have held a Class 1 medical previously, but for all the medical scenarios I have read about I have absolutely no idea what the potential limitations could be in this instance. My gut instinct is that it won’t be good news.

Appreciate any pointers,

Kind Regards.

T

[jackieofalltrades]

My gut instinct would be 'no'. But there is always the possibility (at least in the UK/Europe) that your friend could argue he is being discriminated against under the Human Rights Act and Discrimination From Disabilities Act.

My reason for my gut instinct being no is that even if the airline introduced a total 'no nuts' policy in their on-board food and snacks, it would be extremely difficult to enforce what every passenger brings on with them.

I don't think the allergy itself would prevent him from getting the required medical certifying him for flight, more it would be the airlines concern with his allergy on board.

Do keep us updated on this, I would be curious to know the outcome.

[trevelyan]

Hey, jackieofalltrades,

Appreciate the reply. Many thanks.

You raise a couple of interesting points - maybe ok to achieve the Class 1- based on current criteria, but individual (read probably all) operators may have the issue where by they cannot achieve 100% guaranteed containment, as you say they cannot dictate what pax bring on-board. I guess from a risk perspective there is the dual crew scenario, but that would remove any chance of single Pilot ops, what if a 2 crew jet had 2 pilots with the same allergy?

Interesting, will get him to ring the SRG at Gatwick and see if he can get some clarity on this. (he is still a teen and not aware of what the system has or how it works)

I will keep you up to speed on the outcome, and thanks again for asking.

Kind Regards.

T

[Lamb Chop]

I've looked all over the place for an answer to this, but so far it's been :ugh:, so hope someone on here might be able to cast some light. I'm aware that other posters already working as pilots have asked about suspected allergies and renewal of medical certificates etc. but this enquiry refers specifically to submitting to the medical for the first time, with awareness of this particular condition. Can you even be considered for a Class 1 certificate with it, or would you face immediate rejection?

Brief background - my son's been talking for some time about a career as a commercial pilot and is just about to embark on GCSE options etc.
He's done some research and already has a few ideas in mind for achieving his ambition. However, the fly in the ointment is that some years ago he was diagnosed with peanut allergy. The fact that it hasn't even occurred to him that he might not pass the medical shows how it's become part of his routine...he manages simply by avoiding certain foods and carrying an Epipen. So far he hasn't had a severe reaction or needed to use the Epipen (touch wood!!!), but of course the condition can be potentially serious in the event that the allergy is triggered. Since EASA Class 1 is required from the outset in order even to apply for training (and, presumably, for any flying-related activities in the meantime), is his allergy likely to make this particular ambition a non-starter? The condition already excludes him from any type of military career in the future, though joining the Air Cadets is still a possibility (we think!).

I'm aware that entry to the profession is extremely competitive anyway, and I hate to crush ambition, but would rather do it sooner rather than later if this particular medical barrier really is insurmountable! Any ideas greatly appreciated. :)

[Ulster]

However, the fly in the ointment is that some years ago he was diagnosed with peanut allergy

A very interesting question ! The possible scenario is :- No peanut ingestion = 101% fit and well ; whereas, possibly even a tiny trace of peanuts in an otherwise innocuous crew meal might = major, life-threatening, anaphylactic reaction at any time at all !

How certain is the diagnosis ? Some I have known in the past have been very uncertain to say the least. The great majority of nut allergies produce much less dramatic effects. It's those tiny number of really serious ones which occasionally hit the headlines !

Must admit that I can't see any reference on the CAA medical website to allergies. So, it's the usual advice that's given on here so often : phone or e-mail the CAA medical department, and ask what the current position is. I, for one, would be very interested to hear their answer, and I'm sure lots of others would be too. :D

[Lamb Chop]

The possible scenario is :- No peanut ingestion = 101% fit and well ; whereas, possibly even a tiny trace of peanuts in an otherwise innocuous crew meal might = major, life-threatening, anaphylactic reaction at any time at all !

Thanks for getting back to me, Ulster! Your above point certainly hits the nail on the head. Unfortunately the diagnosis is certain - he attended a clinic some years ago with his older sister, who seems to be more badly affected and has been hospitalized. My son tested positive for peanuts, cashews and (to a very small extent) Brazil nuts, but OK for all other nuts and other common allergens. There's a slim chance he might grow out of it, and we haven't investigated desensitisation yet - though with the incidence in the UK at around 1 percent and increasing, the hope is that medical research will come up with an answer before long. There must be many people walking around with this condition who never have it diagnosed, or are at least aware they have a problem but are not prescribed Epipens – these are often the cases you tend to hear about in the news.

In the meantime I'll follow your advice and contact the CAA medical department for their opinion. I've seen one of their forms which asks about allergies but nothing to indicate "what happens if...". I'll certainly let you know what they say.

The good news is the local Air Cadets officer got back to me this morning and said that there is nothing stopping my son joining up if he wants to as long as he knows how to use his medication. So not all bad news.:)

[AngioJet]

It'd be interesting to know exactly how allergic your son is to peanuts. Given that he carries an epipen then presumably he is suspected of anaphylaxis but if he's never had a serious reaction then it may not be as bad as that.

Also, has he ever considered hyposensitisation treatment?

But as always, get in touch with the CAA and get the word 'straight from the horse's mouth' as it were, like Ulster says, it'd be interesting to hear what they have to say on the matter!

[Ulster]

Whilst not directly related to aviation certification, this site

Peanut and Tree Nut Allergy - Allergy UK (http://www.allergyuk.org/peanut-and-tree-nut-allergy/peanut-and-tree-nut-allergy)

seems to have some common-sense information and advice about the fairly low incidence of life-threatening anaphylaxis, and about causative foods etc, and about avoidance measures. Definitely worth a look ! :ok:

[Lamb Chop]

I submitted a detailed response in reply to Ulster’s first post (or at least I thought I did) but it’s disappeared – must have pressed the wrong button :O – so will try and reproduce the gist…

Many thanks for responses so far! The diagnosis is definite, I'm afraid - he attended a clinic some years ago and tested positive for peanuts, cashews and (to a very small extent) Brazil nuts, but OK for all other nuts and other common allergens. Even though his symptoms had been relatively mild he was sent along for testing with his sister who had suffered a serious reaction requiring hospitalisation, so if not for her then he might never have been diagnosed in the first place. (Apparently a sibling of an allergy sufferer has a higher chance of developing the same allergy). There must be many people walking around with this condition who never have it diagnosed, or are at least aware they have a problem but are not prescribed Epipens – these are the cases you tend to hear about in the news. Something like 1 school-aged child in 70 now has a peanut allergy, so it's a bit of a time bomb being stored up for the future.

Anyway I'm going to ask the GP to refer our son for retesting, as there’s a chance he might grow out of it. We’ve considered desensitisation treatment but I don’t think this is available on the NHS locally so will probably have to look into going down the private route.

I’ve followed your sage advice and have e-mailed the CAA to ask them about this, and will let you know what they say when I hear back. :)

[Lamb Chop]

Woah - earlier post has now reappeared, so apologies for duplication in the later one! :oh:

[Ulster]

I submitted a detailed response in reply to Ulster’s first post (or at least I thought I did) but it’s disappeared

Explanation : Your first reply IS there (timed 13.46), it's your status of "new here" that's caused the delay ! For the first few posts when a new person joins PPRuNe the content is monitored by a human before being put up on the forum !

Looking forward to hearing what response you get from the CAA medics ! :ok:

[Bad medicine]

Thanks Ulster. Spot on :ok:

[Radgirl]

It would be helpful to know why your son went to the allergy clinic and whether it was a clinic in an NHS hospital or equivalent. I note he went with his sister which may indicate it was a just in case visit

If he has just been routinely tested but never had a reaction he is in a different situation from having had anaphylaxis.

Some private clinics seem to never get a negative response, so you might be want to discuss the results with your GP to ensure the written report is shall we say up to scratch! There may not be the problem you think.......

[Lamb Chop]

Thanks, Radgirl. We're definitely going to try and get our son retested, now that he's thinking about his future career and knowing that this problem could close certain options to him. We're hopeful he may be among the one in five children who grow out of the allergy, especially as he thinks he may have come into contact with the allergen with no ill effects, but we would need to have it medically confirmed.

To answer your question: he really did react to peanut butter as a toddler - he was covered in hives, but that's as far as it went. Then, when he was about seven, someone was handing out Celebrations chocolates at school and he managed to pick the Snickers one (:rolleyes:) and promptly came out in hives again and threw up. The hives and vomiting are early stages of anaphylaxis (subsequent attacks can be more severe) so he was an obvious candidate for testing with his sister, who has always been much more sensitive to the allergen. This was confirmed in the skin-prick test, when the blister that came up on her arm was much bigger than the one on her brother's (of course they had to compare them!!!) The tests were carried out at our local NHS hospital, so no real incentive for a positive result especially as the two of them now have to be kept stocked up with Epipens! I have two other children who are not affected at all, including a 20 year old who's at university and tucks into peanut butter ad infinitum now she's left home.

[Radgirl]

Thanks Lamb Chop for the extra information. It does seem to be a proper allergy, and I am afraid you cant grow out of an allergy to a specific allergen, although you may become less atopic generally with age.

In this case I think we return to threads that have been posted before, although with no definitive answer. As far as I am aware allergy is not a specific question but obviously the investigations have to be declared so it is a simple question: will the CAA allow a pilot to have an allergy? The answer is clearly yes - my relative has an allergy to one drug but sailed through his medical. Posters have suggested that it may depend upon

1 whether the pilot can be expected to avoid contact. Clearly yes if it is an antibiotic, no if it is sugar, but murky for peanuts. My patients who have dramatic peanut allergies - anaphylaxis etc - seem to avoid exposure with no problem. I have never had a peanut allergy patient on my intensive care either.......

2 the level of response. The existence of hives in itself is not worrying to me. Many of my patients get hives with intravenous drugs but it goes no further and my pulse does not rise. Vomiting is not an allergy and provides no further information, but oral ingestion may cause vomiting. If there was no wheezing or loss of consciousness I cannot see how you can differentiate this response from any other 'mild' allergy even though we accept that future exposures may cause a greater response

But at the end of the day it is up to the regulator. You son will have to pop the question, but I wouldn't take a refusal lying down

The interesting issue is what happens if you have got your medical and then get an allergy? You may get a rash but neither seek medical advice nor know what caused it. Most people would not put it on their next application, but even if they did I suspect no AME would pay it much interest in the absence of other symptoms.

Good luck

[SheepPilot]

Hello,

Before I give up in being a pilot,I would like to know what everyone thinks of a pilot with a nut allergy?I have a mild nut allergy, but I read mixed reports on pilot with a nut allergy and airlines hiring pilot with a nut allergy.

I can obtain a First Class Medical easy apart from I have a nut allergy! I mean, seriously do the airlines think that I might feel like eating a nut at 30,000 ft? NO! I wont! Plus its a mild nut allergy so could that help with my employability?

Thanks

[Lamb Chop]

I said I would come back with the answer, so here it is!

According to the Medical Department at Gatwick, the answer certainly isn't a straight "no". It depends on the severity of the current condition and reassessment by an independent immunologist would probably be needed. If a medical certificate were to be awarded it would probably be with Operational Multicrew Limitation. I'm not at all sure what implications this might have for prospects in training, sponsorship or employment, though. For the time being we are returning to the immunologist for retesting and an up-to-date report of the condition, as the last time my son was tested was about five years ago.

The Sheep Pilot might also be interested in this!

[much2much]

Are Lamb chop and the Sheep pilot related,:confused:!!

good luck guys, :ok:

aero med at Gatwick seem to be the only people getting more helpful, all be it slowly .

[Radgirl]

Thanks Lamb Chop

I presume the CAA response is specific to peanut allergy as opposed to other allergies, but I can't help thinking this is rather clutching at straws. An allergist can certainly help determine if there is an allergy or not. In hospital practice perhaps 70% of so called allergies don't exist - either a misunderstanding of what constitutes an allergy or poor association.

What will be more difficult for the allergist is to determine the severity. There are a number of fairly recent papers showing this cant be done. Importantly the risk is the initial allergic response - peanut based drugs are used in surgery and one of the most dangerous situations we can face, but there is evidence that subsequent responses are milder.

The consensus is that proper training in avoidance and the use of for example inhaled epinephrine can provide safety. A paper earlier this year from Cambridge also demonstrated effective desensitisation in a small group and you should certainly discuss this before being labelled at Gatwick.

Bottom line - choose your allergist carefully, investigate the latest research, and ask to see the report before it is sent. A five minute consultation and one line report from a busy NHS clinic is not what you want. Proper discussion with your allergist or referral to a centre interested specifically in peanuts BEFORE the CAA get involved would be the route I would go.

[SheepPilot]

thanks for the information. Wow i'm really unsure on what to do!

And if its a mild allergy with only a rash does this still apply to the limitations of multi crew?

[SheepPilot]

thanks RadGirl. This is one of the most annoying things that I've ever had to deal with!

Since, I only have a mild allergy and don't carry an epipen could this mean that its easier to obtain a 1st Class Medical?

[gingernut]

Two opposing positions here sjburton.

True peanut anaphylaxis seems to be more common these day's, and probably not the best trait to have in a pilot.......common symptoms are sudden collapse, swelling of the structures involved in maintaining an airway, death etc.

Or you could just get an itchy rash when using peanut shampoo, (like I do).

I'd probably go back to whoever labelled you as having a "peanut allergy" and take it from there.

Generally, laboratory findings from immunological blood tests are unhelpful.

Your AME would be more interested in the bit at the top of my post :-)

[safelife]

Allergic to more foods than I could list, holding EASA and Chinese class 1 medical, and been holding FAA class 2, no issues.
I'm not prone to any kind of reaction that could incapacitate me, but that's my personal assessment. As said before there is no lab test that could accurately predict your immune reactions.
I do state my allergies with my AME, who said there is no general rule on this. (I however didn't tell the Chinese...)

[Binners93]

Hi Sjburton,

How strange to find someone else in an almost identical situation to myself as we speak. I am at a very similar stage of investigation as yourself so hope that my story may be of some help. In either case, if you are happy to I would be very interested in contacting you personally regarding this?

I am a private pilot who was flying on an unrestricted Class 2 medical and have been doing so uneventfully for the past 5 years. It only came to light when applying for an initial Class 1 that having this allergy may be a problem.

My 'diagnosis' was made in Eastbourne District General after I ‘puffed up’ as a very young child when given a peanut butter sandwich. My parents were advised of a moderate allergy to peanuts and subsequently given EpiPens to prevent a possible anaphylaxis situation in later life.
I have been fortunate enough for the past 20 years to have never required the use of these pens, though I feel this may be more due to a possible misdiagnosis/change of circumstances surrounding my severity. I have mistakably eaten Satay Chicken (without knowing what Satay was), Hazelnuts (as part of a noodle snack) and have always been able to comfortably eat walnuts without issue as well as almond products - who knew about Bakewells...:rolleyes:

Due to this, 5 years ago I requested a blood test to confirm my allergy which came back positive but was advised the test only confirmed sensitivity, not the resultant reaction. I also have mild Eczema which I have been told can sometimes elevate the blood test result. This blood test unfortunately has provided more confusion than guidance due to a conflict of two separate food mixes used to test for a reaction, both containing peanuts and both providing different results.

I was referred to the CAA medial department by my new AME and as such they recommended contact with their immunologist advisor; Dr H. Kariyawasam (hope it's ok to put names on here?). He is unfortunately on sick leave until mid March, but according to the CAA is aware of the type of reports they will require and how to produce them. I can only hope that whatever tests he does can hopefully confirm a non severe allergy, if one exists at all!

On a biased note, I of course understand the need to ensure the safest of conditions for flight crew and if that means preventing a severe reaction in the flight deck then so be it. It does however seem mad that just because we've been 'diagnosed' from a time when giving out those pens seemed the norm; we are now penalized from gaining our medical certificates! Having flown with several passengers, one of which began quite happily eating a peanut butter sandwich next to me - knowing about this 'allergy'! - I can't help but feel the CAA are a little too quick to panic and assume the worst from those of us who know to avoid certain foods!

I wish you the best of luck with your follow ups. I'll keep you updated with my progress should it be of aid to you?

[Flyin'Dutch']

Those with allergies requiring the carrying of an Epipen (or equivalent) are unlikely to be able to obtain an unrestricted Class One certificate due to the risk of incapacitation.

[Radgirl]

Would you like to define 'requiring' FD?

So anxious headmistress, West coast USA and the little darling gets an epipen. Third world upbringing and no money and no epipen. Now both end up asking for a class 1. The severity of the allergy has nothing to do with the carrying of an epipen. Even the frequency of use of any epipen is not really an indicator of the severity. And the number of instances of symptoms merely reflects the ability to avoid exposure.

This all seems a lottery.

[Flyin'Dutch']

Don't know what the criteria are for issuing an Epipen or similar is in the various countries around the world but in the UK they are generally not issued unless someone has had an anaphylactic reaction.

[Radgirl]

That is my very point FD. There are no criteria!!! Unlike aviation there is no SOP for an epipen. Some people have reactions and never have an epipen, others may be misdiagnosed and have one. now take the differing countries where the applicants may have resided in the past and you see the nonsense

[Flyin'Dutch']

Radgirl - I don't make the rules, I just happen to know how the UK CAA usually deals with people who have had an anaphylactic reaction, the majority of which if residing in the UK will have been issued with an Epipen.

If you don't like the way they deal with it I propose you take it up with them.

[Piltdown Man]

I feel for you but there are some jobs some people can not do. This is one job where your health should not compromise the safety of those in your plane or those on the ground. Be it a peanut allergy, dicky heart, or epilepsy it doesn't matter. If there is a reasonable chance you will have a seizure you cannot do this job. If a medic states you will not have seizure through contact with peanuts then that's fine. But if not, then you may have to accept that flying without restrictions is not possible.

[Radgirl]

Hang on FD. I am not the OP - I am just making observations. The OP in fact didnt need an epipen yet was refused a medical. The vast majority of those with allergies do NOT have an epipen in the UK. What constitutes anaphylaxis could start another thread.

And PM the issue is whether these individuals who may have had one unwitnessed episode decades before really constitute a risk

However until we know the parameters used by the CAA and more importantly the logic or otherwise behind it this is just rumour

[Flyin'Dutch']

Of course not everyone with an allergy or allergic reaction needs an Epipen.

But it is common practise in the UK by NHS clinicians to prescribe them to people who have had an anaphylactic reaction.

http://www.redbridgeccg.nhs.uk/downloads/For-health-professionals/Medicines-management/Guidance/BHR%20CCGs%20AutoInjector%20Prescribing%20Guidelines%202014. pdf

Without knowing the details of someone's case it is not possible to say why the CAA has decided that they cannot hold a Class 1.

[wiggy]

I feel for you but there are some jobs some people can not do. This is one job where your health should not compromise the safety of those in your plane or those on the ground. Be it a peanut allergy, dicky heart, or epilepsy it doesn't matter. If there is a reasonable chance you will have a seizure you cannot do this job. If a medic states you will not have seizure through contact with peanuts then that's fine.



Absolutely right, and for those thinking in terms of licence restrictions (e.g "as or with co-pilot") as a get around for this there may well be periods (depending on which company you fly for ) when you may well be alone for several minutes on the flight deck.

As PM has said the medics have to consider the safety of the x 100 people "down the back" in the event of an incapacitation, not just the rights or dreams of someone to be an airline pilot....that's why even serving pilots with long clear medical histories can suddenly lose their licence (and their jobs) due to them developing a condition that gets spotted in a medical....it's tough but anyone, newbie or an old timer can be deemed not fit to fly.

[Loose rivets]

I'm puzzled.

Circa 2002, flying career ended, thank God, it was less than two years before I had my first serious reaction. I had been in Clacton hospital to have me back stretched - no drugs and no breakfast yet. Lots of cheerful banter with the lovely physio. Get in car to head home having washed my hands in hospital soap.

5 minuets, hands itch like hell. 7 minuets, hands fat and red and itch like hell. 8 minutes, feel unwell. 10 minutes, feel so ill it's almost impossible to describe. Just able to holla on 999.

Now, end of 40+ years flying. No forewarning I was starting to react to, of all things, soap. So it seems, anyone can be disabled by a lot of things and no one is free from the possibility.

Last job, one of my FO's had the peanut thing on his JAR licence. Life threateningly severe reaction - presumably learned from experience. It gets worse, not better.

My GP refused a 3rd eppipen because of the cost. "why? It only buys you 10 minutes".


In haste, end, for tonight. I'll come back on this thread but just add that I had my second severe reaction last year. Although I don't usually use strong soaps, I used Mr Muscle, and what's more, sprayed it on the bath. I suspect the mist got me. 5 mins, stomach cramps and felt ill. This time I knew what had happened. I had the presence of mind to unlatch the front door - staggered back slowly collapsing. Just see grey with some white spots. Not being able to see made me get a 999 call in and fantastic young chap was telling me to "stay with me". He was in the house in 7 mins. I kept him waiting due to having a reaction like ten packets of Picolax at once.

BP was some silly figure that's impossible. Rate was 40-something. My temperature was falling. Apart from that, I was fine :-)

What's so odd is that during the intervening years, a young lady at Addenbrookes, a consultant, said I could not possibly have had anaphylactic shock. I would not have survived. She went on to say I must have got over excited about my fat red hands and made a fuss. I almost filed a formal complaint, but with other problems in my life, just didn't have the energy.

[Radgirl]

As you will see from this thread

The UK seems to have an issue with this allergy
The facts are unclear
The logic is even more obscure

I havent a clue what happens in Germany BUT are you saying you have been eating peanuts for 10 years with no issues, or you have avoided peanuts for 10 years? If the former, you dont have an allergy. Period. If the latter, it is a simple enough test to see if you are allergic - the degree of allergy will, I suspect be irrelevant as an allergy will be the disqualifying factor. However the result should only take a few days in any hospital

Good luck and let us know what happens - we clinicians are totally bemused about this

[miller745]

Has anyone heard of a pilot who is required to carry an epipen/jext being able to get a class 1 medical?

I've just got a class 2 with no major drama, had to see a specialist allergy doctor who said in his report "I certainly see no reason why this diagnosis should be a barrier to him becoming a helicopter pilot including piloting craft solo." But whether the CAA see it that way....

Current plan is to train under the class 2 then try to upgrade to a class 1 ASAP and see what happens. Can't get a class 1 currently due to eye astigmatism but the optician seemed confident that would decrease after wearing glasses for a year.

[AyrTC]

Hi Crist check your pm’s

[Loose rivets]

My reactions are getting worse and worse. Booked to see a specialist sometime soon. Last surprise was that apples could garotte me.

I grew up in an apple orchard, in fact the house was called Orchard Villa. I ate apples from the time the buds fattened, to when they were huge and wrapped in paper for Christmas. Why now?

It seems they're sprayed with stuff from hell to keep them on the trees. Then they're gassed - for weeks. Then they're probably injected by a dæmonic creature so as to kill old blokes. I made the last one up cos I like using diphthongs, but anyway, a week ago I opened a supermarket packet and washed one apple. Not enough it seems. I'd cut it into segments, and topped and tailed each piece cos the ends is where the chemicals might congregate. In a moment, my throat closed around the part-munched pieces and stopped me breathing, and moaning my fate. Being good in a crisis, I knew the air I'd got was going to give me one go. Suffice it to say, I covered half the kitchen floor in debris. I then spent the rest of the day with swollen tonsil roots and a feeling of being predisposed to hunting down folk with an AK47 that poison food. Ba:mad:tards.

Last full reaction was to Mr Muscle. Blue light job and this time, all the readings to my GP. At last he finally believed me.

These reactions can be so bad it's as though two guys with baseball bats broke into your house and set about you. Nothing you can do to stop going down, and out. You get better quicker I suppose. If you survive.

My first one, as mentioned above, happened after I'd finished flying. Good job, I might just have found myself on the flight-deck with a lovely bloke who was similarly affected by peanuts. The two of us writhing about foaming would have been a somewhat misleading puzzle. Him affected by someone who did not believe, and would ignore rules anyway. There was the recent case of the peanut eater, defying all the pleas not to consume nuts on that flight. The vulnerable child was four rows ahead of the nut-eater, but still she was poll-axed by the mist of particles in the air. It was touch and go whether she survived.

It was a famous case, world-wide news, but what was important was the father of a lovely family himself, allowed the defiant munching of peanuts by one of his own. Didn't he care? How could a moment of utterly self-indulgent disregard risk the life of a child? Beats me.

Crews not fit for purpose? Tough one that. If you'd known the man I was referring to, you'd have done anything to see that his chosen career wasn't ruined. As said, lovely bloke, with more than his fare share of problems. Tearing away his life's love of flying on top of other issues would have been profoundly cruel. Tough luck? I don't think so. Just stop selfish, self indulgent people from stuffing totally unneeded junk into their faces, and we're good. As the Americans would say.

I'm just beating the same drum now, but remember, everyone . . . that is every single pilot on Earth, is a potential victim of their immune system. What is not known, is which one, and if and when the first attack will occur.

[givemewings]

Rivets, if you're reacting to cleaning products you may want to look into Multiple Chemical Sensitivity. Once you reach your "toxic threshold" you react to things that were previously ok. Its a matter of cutting out fragrances, dyes etc...

[Radgirl]

I am not a fan of Wikipedia, but it does seem quite accurate about Multiple Chemical Sensitivity. I thought it worth posting as peanut allergies are a real issue and we dont want this thread hijacked:

Multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerances (IEI), is a disputed chronic condition (https://en.wikipedia.org/wiki/Chronic_(medicine)) characterized by symptoms (https://en.wikipedia.org/wiki/Symptoms) that the affected person attributes to low-level exposures to commonly used chemicals.[2] (https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity#cite_note-Genuis2013-2) Symptoms are typically vague (https://en.wikipedia.org/wiki/Vagueness) and non-specific (https://en.wikipedia.org/wiki/Non-specific_symptoms). They may include fatigue (https://en.wikipedia.org/wiki/Fatigue_(medical)), headaches (https://en.wikipedia.org/wiki/Headache), nausea (https://en.wikipedia.org/wiki/Nausea), and dizziness (https://en.wikipedia.org/wiki/Dizziness).

MCS is not recognized as an organic, chemical-caused illness by the World Health Organization (https://en.wikipedia.org/wiki/World_Health_Organization), American Medical Association (https://en.wikipedia.org/wiki/American_Medical_Association), or any of several other professional medical organizations.[3] (https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity#cite_note-Sears-3)
[4] (https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity#cite_note-Gots-4) Blinded (https://en.wikipedia.org/wiki/Blinding_(medicine)) clinical trials show that people with MCS react as often and as strongly to placebos (https://en.wikipedia.org/wiki/Placebo) as they do to chemical stimuli; the existence and severity of symptoms is related to perception that a chemical stimulus is present.[5] (https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity#cite_note-Das-Munshi_2006-5)
[6] (https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity#cite_note-Bornschein-6) Some attribute the symptoms to depression, somatoform disorders (https://en.wikipedia.org/wiki/Somatic_symptom_disorder), or anxiety disorders (https://en.wikipedia.org/wiki/Anxiety_disorders).[7] (https://en.wikipedia.org/wiki/Multiple_chemical_sensitivity#cite_note-Bor2001-7)

[givemewings]

There are several well known specialists in the US dealing specifically with MCS as it relates to the aviation industry. I was merely providing a suggestion that he can look into if he wishes, since there was mention of hand soap and window cleaner. Hardly "hijacking" the thread, and I hope the phrase "peanut allergy is a real issue" was unintentional as it implies you think people with MCS are making it up. Wikipedia is hardly a bastion of accurate info... Johns Hopkins certainly haven't discounted the possibility of severe reactions due to exposure to everyday levels of common chemicals.

There are a number of airline crews presenting with symptoms that have been ruled out as allergies, food issues and other diseases coinciding with issue of new uniforms in several US airlines at the moment. Another thing antone interested can go read up on.

back to the peanut gallery...

[miller745]

Tried to get my class 2 OSL restriction removed, after a secondary review the CAA replied with "the need to have access to adrenaline still suggests an unacceptable risk" I've never used an adrenaline autoinjector and have a report from an allergy doctor who said I have a very low risk of anaphalyactic reaction! Hope this helps others. I doubt the doctor will remove the requirement to have access to adrenaline, but I will try. Anyone know of immunotherapy trials going on??

[miller745]

Progress! the Doctor at the CAA said in the appeal review letter he was happy to speak with the Professor who did my allergy test. So I asked the Prof, who was more than happy to help, and now I have an unrestricted class 2, with carrying adrenaline auto injectors.

[Loose rivets]

Well done, it's nice when people behave considerately and professionally.

In the meantime, I've just gone over givemewings' link to MCS and find I have ~70% of the symptoms. I let it drop because of the stress of moving house at my great age. It really was a difficult time.

Reading in has coincided with a six month wait to see a professor in the Royal Marsden only to find today that they're sending me back to Addenbrooks where I had the bizarrely silly consultation with a $@^$^$%%#&#% consultant. I am very easygoing but she is one of the few professional people I have ever really taken a dislike to.

This allergy problem is so far-reaching and the symptoms so lost in a mist of confusion that I don't suppose I'll ever really resolve it. Not so important at my age.