Peanut Alergies and Flying

[Bad medicine]

Thanks Ulster. Spot on

[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 () 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]

Training to be a pilot with a nut allergy?

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,!!

good luck guys,

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...

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