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Safe Flying With Food Allergies
By Sherry Coleman Collins, MS, RD, LD
The summer travel season can be one of the most exciting times of the year for families. But for those managing food allergies, it also can be scary, especially on airplanes as families fly to their vacation getaways.
Eating meals and snacks while flying produces a great deal of anxiety for food-allergic clients because of the fear of a reaction in a restricted area far from emergency assistance. Policies for addressing and accommodating travelers with food allergies vary greatly by airline, forcing many to carefully prepare for reaction-free travel.
Few studies have been conducted on in-flight food allergies, and limited data exist on their prevalence. And only four surveys on self-reported in-flight reactions have been done.
To help clients and patients manage food allergies during travel, dietitians must know how to put the risk in perspective. All the studies published to date have focused on peanut and tree nut allergies.
What the Research Says
The first survey, conducted by Sicherer and colleagues, questioned participants in a national registry of individuals allergic to peanuts and tree nuts.1 At that time, less than 2% of respondents (62 of 3,704) reported having had a reaction in-flight. In 2008, Comstock and colleagues conducted telephone interviews and discovered that approximately 9% of respondents had in-flight reactions, including one that required diversion of the plane.2 A 2009 survey by Greenhawt and colleagues found that 33% of respondents reported a reaction consistent with anaphylaxis.3
Studies generally have reported that the majority of individuals who have allergic reactions don’t report them to airline personnel and don’t require the use of epinephrine to treat their reactions. No fatal reactions have been reported.
A 2013 study by Greenhawt and colleagues, published in The Journal of Allergy and Clinical Immunology, which examined food-allergic individuals who traveled by air internationally among 11 different countries, found that just under 11% of 3,273 respondents had a reaction to peanuts or tree nuts (the only allergen surveyed) during a flight.4 Fortunately, only 13.3% required epinephrine, with most reactions being less severe, and no deaths were reported.
In this study, the researchers provided the following eight strategies to help individuals with food allergies reduce the risks of reactions while flying:
1. Notify the airline in advance of the traveler’s food allergy.
2. Ask for a buffer zone between traveling companions who don’t have food allergies. People can sit in a row adjacent to the food-allergic individual or one to two rows before or after.
3. Request an announcement that passengers refrain from eating the potential allergen.
4. Order an allergen-free meal.
5. Wipe the tray table with a disposable cleansing cloth.
6. Bring food from home.
7. Don’t use a pillow provided by the airline.
8. Don’t use a blanket provided by the airline.
Inhalation vs. Ingestion
In the 2013 study, the researchers stated that controversy exists concerning the potential for reactions due to inhaling allergens (such as peanut dust) and suggest that the more likely culprit for reactions is unknown ingestion due to residues on surfaces or due to anxiety.
Most experts agree that inhalation presents little risk to those with food allergies, likely resulting in hay-fever-type reactions rather than anaphylaxis. What the research indicates so far is that the potential for reactions during air travel is real, and action should be taken to limit the risk as much as possible. Fortunately, it also appears that reactions, if they occur, are likely to be less severe.
Sharing this information and the above suggestions to reduce your clients’ risk will enable them to travel safely and confidently while flying.
— Sherry Coleman Collins, MS, RD, LD, is the senior manager of marketing and communications for the National Peanut Board. She’s worked in clinical pediatrics and school foodservice, where she gained hands-on experience working with students, families, and staff to manage food allergies.
References
1. Sicherer S, Furlong T, DeSimone J, Sampson H. Self-reported allergic reactions to peanut on commercial airliners. J Allergy Clin Immunol. 1999;104(1):186-189.
2. Comstock SS, DeMera R, Vega LC, et al. Allergic reactions to peanuts, tree nuts, and seeds aboard commercial airliners. Ann Allergy Asthma Immunol. 2008;101(1):51-56.
3. Greenhawt M, McMorris M, Furlong T. Self-reported allergic reactions to peanut and tree nuts occurring on commercial airlines. J Allergy Clin Immunol. 2009;124(3):598-599.
4. Greenhawt M, MacGillivray F, Batty G, Said M, Weiss C. International study of risk-mitigating factors and in-flight allergic reactions to peanut and tree nut. J Allergy Clin Immunol. 2013;1(2):186-194.