The Scary Possibility of An Allergic Reaction While On-Board an AirplaneFlying on an airplane can be particularly dangerous for a person who is allergic to nuts. Peanuts and tree nuts are commonly served on airplanes -- and given the small space inside an airplane, accidental exposure to nuts eaten by a nearby fellow passenger is possible. In addition, medical resources are limited while flying on an airplane, so a person who is experiencing an emergency as a result of a peanut or tree nut allergy is at greater danger than a person who is not flying in an airplane. So it's important to identify ways to reduce a person’s accidental exposure to peanuts and tree nuts, and therefore reduce the chance that an allergic reaction will occur as a result.
There is no consistent policy on peanut and tree nut allergies for the major airlines based in the United States. In fact, in 1999, the U.S. government prevented funding assistance for airlines to make accommodations for people with nut allergies. And in 2011, the U.S. Department of Transportation decided not to involve itself in the controversial issue of serving nuts on U.S. airlines, as there is no data to suggest that this would actually reduce allergic reactions from exposure to nuts.
Reducing the Chance of an Allergic Reaction From Nuts While FlyingA recent study published in 2013 sought to determine the factors that can actually reduce the chance of a person's having an allergic reaction to peanuts or tree nuts while flying on a commercial airplane. The study surveyed over 3,000 people with nut allergies, and found that more than 10% reported having an allergic reaction to nuts while flying on an airplane. Of those experiencing an allergic reaction, approximately 13% received injectable epinephrine as a result — most commonly from the person’s own device. People experiencing cardiovascular symptoms (such as lightheadedness) or gastrointestinal symptoms (such as nausea or abdominal cramping) seemed to be more likely to receive injectable epinephrine compared to those with other types of allergic symptoms.
Several factors seemed to separate those who never experienced an allergic reaction from nut exposure on an airplane, compared to those that have. People were less likely to experience an allergic reaction to nuts aboard an airplane if they requested a nut-free meal, wiped down their tray table before use, avoided using airline-provided pillows or blankets, requested that the people around them not eat nuts, or if they brought their own food on-board the airplane. Of these factors, the biggest that seemed to cut the risk of an allergic reaction from nuts seemed to be either bringing one’s own food aboard the airplane, or requesting a nut-free meal from the airline. Surprisingly, flying with an airline that has a "nut-free" policy on-board their airplanes did not reduce the chance that injectable epinephrine would be required to treat an allergic reaction as a result of accidental exposure to nuts.
The recommendations I would give to a person with a nut allergy as a result of this study would be to always carry injectable epinephrine while flying, bring your own food from home on board the airplane (or request a "nut-free" meal or snack from the airline), and notify the airline of your special needs in advance. Following these few but important tips will hopefully allow those with a nut allergy to fly safely on a commercial airplane.
Greenhawt M, MacGilliyray 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: In Practice. 2013; 1(2): 186-194.
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