United States Department of Transportation
i
First-Generation H1 Antihistamines Found in Pilot Fatalities of Civil Aviation Accidents, 1990–2005
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2007-05-01
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[PDF-794.30 KB]
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Abstract:First-generation H1-receptor antagonists are popularly used for alleviating allergy and cold symptoms, but these antihistaminics cause drowsiness and sedation. Such side effects could impair performance and, thus, could be the cause or a factor in accidents. Therefore, the prevalence of these antagonists was evaluated in aviation accident pilot fatalities. During civil aircraft accident investigations, postmortem samples from pilots involved in fatal aviation accidents are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological analyses. These analytical findings are stored in a database. This CAMI Toxicology Database was examined for the presence of the first-generation antihistamines in pilot fatalities of civil aircraft accidents that occurred during a 16-year (1990–2005) period. Of 5383 fatal aviation accidents from which CAMI received specimens, there were 338 accidents wherein pilot fatalities (cases) were found to contain the antihistaminics brompheniramine, chlorpheniramine, diphenhydramine, doxylamine, pheniramine, phenyltoloxamine, promethazine, and triprolidine. Of the 338 accidents, 304 were general aviation accidents; 175 of the 338 pilots held private pilot airman certificates. Antihistamines were detected alone in 103 fatalities (1 antihistamine in 94 fatalities and 2 antihistamines in 9), while other drug(s) and/or ethanol were also present in an additional 235 fatalities. Thirty-five of the 338 fatalities had more than 1 antihistamine. The antihistamines were found in approximately 4 and 11% of the fatalities/accidents in 1990 and in 2004, respectively. Although blood was not available for the analyses in all 338 cases, the blood concentrations (ng·mL-1) were 5–200 (n = 8) for brompheniramine; 4–6114 (n = 67) for chlorpheniramine; 9–3800 (n = 125) for diphenhydramine; 10–1309 (n = 33) for doxylamine; and 4 (n = 1) for phenyltoloxamine. The use of antihistamine(s), with/without other drug(s) and/or ethanol, was determined by the National Transportation Safety Board to be the cause in 13 and a factor in 50 of the 338 accidents. The majority of the accidents were of the general aviation category. There was an overall increasing trend in the use of antihistamines by aviators during the 16-year span. Blood levels of the antihistaminics were in the sub-therapeutic to toxic range. Findings from this study will be useful in investigating future accidents involving antihistamines.
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