Flying and Food Allergies – a Polarizing Topic
I was recently asked to answer questions about flying and food allergies. The article was published on November 7, 2023, by Fox Business. I was asked about this topic in light of this heartbreaking story.
Here is the link to the Fox Business article.
In light of how polarizing this topic can be, I wanted you – my dear readers and wonderful Kiddo community – to see my email with my answers to the posed questions. Love y'all!
Question: “Would other passengers eating peanuts potentially put an allergic person in danger, if they were in different areas of the plane?“
Answer: “This is a complex issue. To answer the question: no, eating peanuts across the plane from someone with a peanut allergy would not cause a peanut-allergic person to have anaphylaxis. That is because, except in specific circumstances such as cooking seafood, rarely do food allergens become airborne. Peanut dust is relatively heavy, so it does not go airborne – it simply falls down.
“That said, it is reasonable for food allergy families to be concerned when flying if their allergens are on the plan. Bluntly stated, if a peanut nearly killed your child, would you want the person sitting next to her chowing down on a packet of airline-provided peanuts? For most people, flying is stressful to start with, and flying with a child with food allergy (or if you as an adult have a food allergy) adds to that stress because there is always the “What if my child has a life-threatening reaction at 40,000 feet?”
“From a physiologic standpoint, when someone sees or smells their allergen, it can trigger panic, which can cause symptoms such as increased heart rate, trouble breathing, nausea, and skin flushing – all of which are symptoms that can occur with a severe allergic reaction. If this happens to any food allergy patient, and especially to a child, it can be difficult to differentiate anaphylaxis from a panic attack, and nobody wants to see their fellow passenger suffering or to have to make an emergency landing. This underscores the importance of non-allergic passengers displaying support and understanding for passengers with food allergies, and for passengers with food allergies to have open and honest discussions with their board-certified allergists about how to fly safely, such as carrying their epinephrine auto-injectors.
Question: “Can food allergens be airborne? Or do they have to be consumed by or in contact with the person who is allergic?“
Answer: “Rarely do food allergens go airborne. The most notable exception is when an allergen is being openly cooked, such as cooking seafood on a stovetop in an open pot or pan. Ingestion of the food allergen is nearly always required for food allergen-induced anaphylaxis to occur. That said, contact reactions can occur when an allergen comes in contact with an allergic person’s skin. A contact reaction is a reaction that stays local to the contact point, such as developing hives on the skin where the allergen touched.
Question: “Anything else important to share about this topic?”
Answer: “This is a polarizing topic riddled with misinformation and emotion. Food allergy families want and deserve to be safe when they travel. Food allergy-related policies should be clear and adopted across airlines so that families have clear expectations and can plan accordingly – being caught off-guard and/or being told one thing by one airline employee then being told something different when on board is unacceptable, whatever the issue. Permitting food allergy individuals and their families to pre-board is imperative as it allows them to clean their seating area, removing any residual allergen left behind by previous passengers. Pre-boarding is especially important for families with young kids as young children may place their hands between the seats and pull up an allergen such as a peanut, which could be a life-threatening allergen as well as a choking hazard.
“Furthermore, it’s important not only for passengers to self-carry their emergency medications but also for airlines to stock epinephrine in the form of an auto-injector. Auto-injectors are significantly safer than the ampule-and-syringe method of administering epinephrine for many reasons: 1) auto-injectors contain the correct concentration of epinephrine, 2) auto-injectors will administer the correct amount of epinephrine, and 3) auto-injectors can only be administered intramuscularly. This is opposed to the ampule-and-syringe approach, which requires the user to select the correct concentration of epinephrine, draw up the correct amount of epinephrine, and inject it correctly.
“Also, flight crew should be afforded the same liability protections – “good Samaritan” laws – as other non-medical personnel who administer life-saving medications. Across the US, trained school personnel are able to administer stock epinephrine and are covered from liability by the same legislation that empowers them to save a life with stock epinephrine. Working together, airlines, allergists, and food allergy families can develop evidence-based policies that help all passengers have a safe and enjoyable flight.”
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A note from Dr. Hoyt
I have talked about a non-profit…
Pam and I volunteer with the non-profit The Teal Schoolhouse. Its primary program is Code Ana. Code Ana equips schools for medical emergencies like anaphylaxis.
Code Ana’s Online Epinephrine Training Program helps support that goal. Through this program, you will educate yourself while you support this important mission!
A medical emergency response plan is important for everyone at any school. Code Ana's program Med-E Ready is a comprehensive approach to school-focused medical preparedness. This program guides schools through the process of creating a medical emergency response plan. A response team is also developed! This is one of the most important components of a school's food allergy policy!
Does your kiddo’s school have Code Ana?
You've just read our post “Airlines and Food Allergies: My Follow-Up to the Fox Business Article.”
Remember, Dr. Hoyt is an allergist, but she isn't your allergist, so talk with your allergist about what you've just learned!