Nuts on the Plane

Nut allergies made safe through in flight precautions

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Traveling with peanut and tree nut allergies can be challenging.  Airplane flights can be especially difficult since nuts are so often passed out as snacks. But allergies shouldn’t keep you grounded.

A new study looked at what happens when people with peanut and tree nut allergies travel in airplanes and how they can minimize their chances for allergic reactions.

The researchers found that although the risk of an in-flight allergic reaction was small, there are eight precautions that might help prevent triggering allergies while in the air.

"Take precautions for nut allergies."

Matthew Greenhawt, MD, of the University of Michigan Medical School in Ann Arbor, and colleagues wanted to find out how often people with peanut and tree allergies had in-flight reactions and what they did to treat and prevent them.

To carry out the study, the researchers designed a 47 question, online survey to ask people with nut allergies about their international flying experiences.

The survey was posted on the Food Allergy & Anaphylaxis Alliance website where visitors and social media followers from all over the world could answer the questions.

The participants were asked about how they prepared for their flights, if they had allergic reactions during any flights and, if so, who they notified, if anyone.

They also asked about the details of participants’ most severe in-flight allergic reaction, including what their symptoms were, what medicine they used and how they prepared for flights after this incident.

A total of 3,273 people from 11 different countries filled out the survey. Most of the respondents – 79.7 percent – were parents of children with food allergies.

The age of food-allergic people represented in the survey results ranged from 3 months to over 50 years old.

Of the participants, 60.7 percent reported an allergy to both peanut and at least one tree nut, 28.9 percent to only peanuts and 10.3 percent to tree nuts alone.

While 60.4 percent of Americans reported not flying again after being diagnosed with a peanut or tree nut allergy, only 39.5 percent of non-Americans stopped flying.           

An in-flight peanut or tree nut reaction was reported by 349 (10.7 percent) of the total respondents.

Of the participants who reported these reactions, 314 (90 percent) knew about their allergy before their in-flight incident.

Peanuts were responsible for 69.5 percent of the reported reactions.

In 24 of the reactions, medical assistance was given by a doctor who happened to be a passenger on the same flight. In 11 of the cases, the flight had to be diverted.

Only 27 of the 349 reported reactions went untreated, according to the participants’ responses.

Of those who did seek treatment, epinephrine was used to treat 46 (13.3 percent) of the reported reactions. Of these cases, 41 recipients used epinephrine that they had brought on board themselves.

The responses showed that the flight crew was notified of the reaction in only 50.1 percent of cases.

“Despite that 98 percent of passengers had a personal source of epinephrine available, epinephrine was underused to treat a reaction,” said Dr. Greenhawt.

“Flight crews were not always readily alerted to reactions when they occurred, but interestingly, when they were notified, it was associated with a higher odds that epinephrine was used to treat the reaction,” he said.

Despite underuse of epinephrine and low reporting to flight crews, the authors still encouraged those with nut allergies to continue flying.

“We still think the risk of an in-flight reaction is small, but it’s hard to imagine a more helpless situation than having a reaction while you’re at 35,000 feet in an airplane,” Dr. Greenhawt said.

“This study identifies some things passengers can do to reduce their anxiety. We want them to fly. It can help improve their quality of life,” he said.

As a result of their findings, the authors recommend eight precautions people with nut allergies should take before flying:

  1. Request any accommodation necessary from the airline.
  2. Request a peanut/tree nut-free meal.
  3. Wipe your tray table with a commercial wipe.
  4. Avoid airline pillows.
  5. Avoid airline blankets.
  6. Request a peanut/tree nut-free buffer zone.
  7. Request other passengers not eat peanut/tree nut-containing products.
  8. Don’t eat airline-provided food.

Given the fact that most airlines serve peanuts and tree nuts in snacks and meals, Dr. Greenhawt advised allergic passengers to take their safety into their own hands with these recommendations.

“These behaviors are simple, practical measures which may offer some protection and reduce anxiety until formal policies are implemented,” said Dr. Greenhawt.

The authors concluded that more research is needed to ensure that passenger allergy safety measures can effectively prevent in-flight reactions and to better understand how allergy sufferers make decisions about epinephrine use.

The study was published in the March issue of the Journal of Allergy and Clinical Immunology - In Practice.

The research was funded by the National Center for Research Resources.

Lead author Dr. Greenhawt received assistance from the International Food Allergy and Anaphylaxis Network, has received consultancy and lecture fees from pharmaceutical companies Nutricia and Sunovion and is employed by and given research funding from the University of Michigan.

The other authors declared no potential conflicts of interest.

Reviewed by: 
Review Date: 
March 20, 2013
Last Updated:
August 16, 2013