Episode 33 | Allergies, Asthma & Military Eligibility: What Parents Need to Know
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Dr. Meagan Shepherd: Many parents are surprised to learn that allergies and asthma can affect military eligibility long before their child ever talks to a recruiter. Families are often told it's just allergies, or they'll outgrow it without understanding how medical history is evaluated years later, especially when the conditions involve things like asthma, food allergy, and venom allergy.

So this is a topic that I have wanted to talk about for a while because there are, I think, more doctors and families who are faced with this than what we had ever thought about in the past before joining our allergy fellowship. Is that something that both of you guys would also say? 


Dr. Amber's Personal Military Eligibility Scare
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Dr. Amber Patterson: I mean, my only experience was applying for like when I knew I was going to med school, so I had looked at doing one of the military scholarships for med school. And this exact thing got me because in high school I played soccer, in high school, there was like a time where I had some shortness of breath and I went to see my doctor and he was like, "Try the albuterol, see if it helps."

And then, you know, I don't have asthma, so I didn't end up needing it. But when I had requested my records for the Navy, they saw that and they were like, "You're out. You had an inhaler prescribed." And years later meeting our mentor, Dr. Bryan Martin, who was in the military and gave us perspective on that. He's like, "Oh, well you could have probably seen another doctor to like prove that you didn't have asthma," but I didn't know that.


Our Mentor: Dr. Bryan Martin (Walter Reed & World Allergy Organization)
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Dr. Meagan Shepherd: That's why this is such an important topic, and we talk about Dr. Bryan Martin. He was the program director for the Allergy Immunology Fellowship at Walter Reed, the military hospital, for nearly 20 years before he came to the, he retired from the military and moved to the Ohio State University where he was our program director.

And he eventually moved on to becoming very well known in the allergy world. He was the president of the World Allergy Organization most recently. Extremely active and involved, and so knowledgeable. So one of the things that we learned is that sometimes having a history of something like asthma or food allergy or allergy to a stinging insect, anything like that, that could potentially affect going into the military.

And when I was in clinical practice, actually starting as a fellow, we had several patients come in then that we would talk to about this. First, let me say, I don't want anyone to hear this episode and think, oh my gosh, my child can't have a label of asthma, or can't have a history of an albuterol inhaler. That's what we're gonna talk about about, yes. 

Dr. Amber Patterson: What we're bringing this up for is just if you have anything like that on your record, like concern about asthma, food allergy, environmental allergies, venom allergy, that go see your board-certified allergist to kind of clear that up, see where things stand because as long as you get records updated to say, no, you don't have peanut allergy anymore, or asthma's stable, or whatever the case may be, that can be used to help you get through that process.


Clearing Asthma & Food Allergy for Military Applications
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Dr. Meagan Shepherd: Exactly. That's the biggest thing that I probably see is I have a lot of people who are seniors in high school looking into going into the military after high school, and they have a history of asthma. And it is actually one of the neat things now, and I don't know what it was like back whenever you were trying to do this yourself Dr. Patterson, but what the military recruiters seem to do now is they try to help you, they don't want to exclude you. So if you have a history of asthma, they send you to a doctor. A lot of the time it will be an allergist or a pulmonologist. If not, it's in your best interest to seek that out because there is testing that we can do that can say whether or not you are still likely to have asthma or not. And so that could easily be updated, people outgrow asthma all the time. And so that is something that we can easily clear for you. 

Dr. Amber Patterson: Same for food allergy. I see patients pretty regularly that they have even life-threatening food allergy as a child, and they've just then avoided it and not really followed up with an allergist because they're like, what's the point? I'm just avoiding this, getting my epi refilled once a year by my primary care.

But the point is that some people outgrow it or outgrow it to a point where if you can even eat a little bit of the food, then that's proving that you can tolerate it and I can get it off of your past medical history list for heading into the military application.


Different Branches Have Different Allergy Rules
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Dr. Meagan Shepherd: One of the cool things that I wanted to point out though, and this is actually something that I more recently became privy to this knowledge, but different branches of the military actually have different requirements. So that's something that I very recently learned. My first experience with food allergy in the military is I had a patient who wanted to be a fighter pilot in the Air Force and brilliant, brilliant child. One of those people that you really want serving in our military who, you know, makes us safe and allows us to live the lives that we do. And he had a persistent nut allergy tree nut that had continued unfortunately into being a teenager.

And there are alternatives, like I said. And I recently had another person who was trying to do the same thing with a tree nut allergy. So for the first patient, he didn't end up going into another branch of the military service, but he ended up going to flight school. And the FAA has somewhat similar rules for people who fly, especially for commercial flight.

But by following along with an allergist and keeping up that relationship and making sure that he follows the rules, the FAA rules seem to be that if you do have a reaction, you have to be grounded for a month and see your allergist before you can return to flying. So that is another option that people with food allergies can do.

One of my other patients has recently talked about going into the Coast Guard instead of Air Force because and again, I have not studied this and looked at every requirement for each branch, but that it's different and they're more lenient with food allergies and there are different reasons why they have this.

I have to say, on behalf of the military, it seems sort of mean and exclusionary, but it is truly about risk and not putting The people in military at risk, because you're often put out in situations outside the country, you're out by yourself. What if you got trace contamination to a peanut and that kills you while you're out there? So there are different ways and one thing that I have also heard of for, and I don't know what branch this was, but I had a fellow physician who does food immunotherapy, say that they had done enough to figure out a child, I say a child, this was likely an 18-year-old young person, who had had a history of peanut allergy.

They were able to establish bite tolerance, like how much peanut protein could they eat safely if they accidentally had a bite of it with cross-contamination or something like that. They were then able to add Xolair, which is a food allergy treatment, to try to help decrease the severity of a reaction should you have an exposure and were able to rechallenge. And the patient was able to tolerate a full peanut challenge, oral food challenge at that time, and then was able to enter whatever branch of the military it was for this patient. And again, I'm not sure what branch because there are multiple, right? But I just, there's so many out there. I just don't want people to hear this and be told by a recruiter there's absolutely no way. If you get that response, you want to go talk to your allergist to see if that is something that you can be cleared of. Are there things that can be done? There's so many more treatments now than there were like 20 years ago. The world is different and so you might be eligable. 


Why Age 14 is the NEW Planning Trigger Point for Parents
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Dr. Amber Patterson: I wanna do a call out to parents of 14 year olds. If you are a parent of a 14-year-old, we are talking to you right now because I want you to think about if your child has asthma, food allergy, or environmental allergies, you have four years to help them tidy things up before they're out of the nest in most cases. And whether they're going into the military, going off to college, starting their own business, doing, you know, whatever their plan is, gap year, all kinds of stuff, you have four years to help send them off into the world with the least impact from their chronic disease. And so this is, you know, I know this episode's focused on military, but I think we often think about these conversations for older kids, like when they're 17 and they're gonna be leaving in a year or two.

But please start thinking about it now, just like other things that are like life trigger. Like when you have a baby, oftentimes people are like, oh, I need to get life insurance or set up a will. And when they start kindergarten, if you haven't already, people are like, oh, now's when I need to start that 529 to save for college.

So this is your new trigger point. Oh, my child's 14 and going into high school. I need to get in and see the allergist so we can either start immunotherapy to reduce their allergies, get their asthma in check and treat those food allergies.

Dr. Kara Wada: So important. And I just went this morning for my 10 year olds while child checkup, and so you're saying 14, and I'm like, oh gosh, that's only four extra years. Right? I'm already like spiraling. but I mean, it comes back so it, it goes so fast.

Dr. Meagan Shepherd: One more thing I'm gonna say before we close is whenever it comes to the US military, they were one of the largest providers of immunotherapy in the world actually, is what we were taught back when we were fellows because for environmental allergens, they like to get people under control immediately.


The U.S. Military is a World Leader in Immunotherapy
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Dr. Meagan Shepherd: And there's also good treatment for venom allergy, like if you're allergic to bees and wasp, things like that. But the end result is that if you're thinking about military, you do need to talk to an allergist, but they're also wonderful allergists as well. So the military allergists are some of the best in the world. So if you have a child who is going into the military or if you're making that decision for yourself, make sure that you listen to the recruiter, but also if you have any of these issues, reach out to your local allergist, and they should be able to help you with making that decision and moving forward and figuring out where your diagnoses are.

And if you have any questions or comments or experiences yourself, you can go ahead and put it in the comments and share this episode if you have someone that you think is gonna go through this. Thank you for listening to Allergy Actually.

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