DATE To Whom it May Concern:

PATIENT FULL NAME is a AGE/GENDER who suffers from a life-threatening allergy to SPECIFIC ALLERGENS LISTED. This is a severe allergic reaction that makes it medically necessary for HIM/HER to carry an antihistamine and EpiPen®, which is an autoinjector of epinephrine, at all times. EpiPen® autoinjectors are prescribed by a licensed medical professional. PATIENT NAME should have this life-saving medication with HIM/HER at all times, especially during times of travel away from home. In the event of an exposure to even a minute amount of ALLERGEN a severe allergic reaction may occur. Every minute is critical in using this medication to treat the allergic reaction and to prevent a life-threatening reaction. Use of the EpiPen® can be life saving. Please allow PATIENT NAME to have the EpiPen®(s) with HIM/HER on board the airplane.

{{SUGGESTED TEXT FOR ASTHMATICS}}

PATIENT NAME is also asthmatic and requires the use of an albuterol inhaler in the event of an asthma attack or allergic reaction. Please allow PATIENT NAME to carry HIS/HER albuterol inhaler on board the airplane. Additional information may be obtained from PHYSICIAN NAME at PHONE or FAX.


Respectfully signed,


____________________________________________, M.D.

M.D. OFFICE STAMP

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