Evaluation of systemic allergy in a jet aviator.
Cholinergic urticaria and exercise-induced anaphylaxis (EIA) are related conditions. Cholinergic urticaria is caused by a rise in body core temperature and usually results in pruritus, skin lesions and, rarely, in serious respiratory and cardiovascular compromise. EIA can result in a cardiovascular compromise and syncope. Ingestion of certain foods may be associated with EIA. A 41-year-old jet pilot complained of 3-month onset of pruritus and urticaria during treadmill exercise. On one occasion, after a routine exercise bout, albeit with pruritus and urticaria, he experienced two short episodes of syncope. Treatment with a nonsedating H1-receptor antagonist was started. He underwent a unique challenge test that we designed. This included passive warming as well as exercising in a hot (temperature of 40 degrees C at 40% humidity) environment. After passing this test uneventfully, the pilot was returned to jet flight with a copilot and, subsequently, to full active duty.
Carter
Dan
D
Israel Aeromedical Center, Israel Air Force, Tel Hashomer, Israel. carterd@zahav.net.il
Grossman
Alon
A
Pokroy
Russell
R
Azaria
Bela
B
Goldstein
Liav
L
D000328:Adult; D000337:Aerospace Medicine; D000707:Anaphylaxis / Q000209:etiology; D001831:Body Temperature; D015444:Exercise; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007159:Immunologic Tests / Q000379:methods*; D008297:Male; D013575:Syncope / Q000209:etiology
D039563:Histamine H1 Antagonists, Non-Sedating