My Journey with Airborne Nut Allergies

Summer 2015 –

Five years ago, I boarded a flight from Chicago with my husband and two daughters, one of whom has asthma and life-threatening nut allergies, to attend a family member’s wedding in California.  Twenty minutes after take-off we began smelling nuts—within seconds my daughter started to react.

I grabbed the epinephrine, nebulizer, and Benadryl and started medicating my then 5 year old.  After several terrorizing minutes of not knowing whether she’d go into full anaphylactic shock, her medicine kicked in, and her symptoms slowly subsided.

There are no words to adequately describe my fear of being in the sky at 35,000 feet and watching my daughter react to one of her deadliest allergens.  That day…we got lucky.   What caused my daughter’s reaction—a couple sitting several rows in front of us opened a can of mixed nuts.

We are not alone on this journey of navigating air travel and life-threatening allergies to the inhalation of nut proteins.  There are others who have had similar, even worse, reactions on board flights.

Nearly three years ago, Alisa Gleason of Sacramento went into anaphylactic shock on board a flight when a woman sitting several rows away from her opened a bag of peanuts.  According to published reports, Gleason said as soon as she inhaled the airborne peanut proteins, it felt as though her lungs collapsed.  “Every time you breathe, it closes in and doesn’t open,” she said.  The plane diverted and made an emergency landing in St. Louis where Gleason spent two days in ICU.

Last August, a 4-year-old girl went into anaphylactic shock. On this flight, the flight attendants made repeated announcements about a passenger with life-threatening allergies to peanuts and requested that such products not be opened.  Sadly, a passenger, sitting several rows away from the girl, opened a bag of nuts.  The girl stopped breathing and luckily survived after being revived by epinephrine.

The plane was diverted to make an emergency landing.

While we don’t know exactly how many passengers have had airborne reactions to nuts on airplanes since there are no reporting requirements, there are steps airlines can take to safeguard passengers who have life-threatening allergies to nuts.

  • First, allow affected travelers time to pre-board flights for wiping down seats, seat belts, tray tables, and surrounding areas.  Residue from previous flights can trigger a reaction.
  • Second, make pre-flight announcements requesting passengers to refrain from eating nut products due to passengers with life-threatening nut allergies.  Passengers should be made aware that if nuts are opened and eaten on the aircraft there is a possibility that the plane may need to be diverted from its existing schedule and route to make an emergency landing.
  • Third, establish a nut free section or buffer zone around allergic passengers. (How large that zone needs to be should be determined by nut allergic passenger and flight crew).
  • Finally, carry epinephrine auto-injectors and train flight personnel — Case in point, there’ve been two situations within recent months where medical personnel had difficulty using epinephrine supplied in airline medical kits on individuals who were in anaphylaxis.

While scientific evidence is not where it should be when it comes to proving that airborne reactions to nuts can occur and can have detrimental results, there is some data that reinforces the health impacts of airborne nut allergies.

Leading food allergy researcher Dr. Kari Nadeau of Stanford, says one has to be careful of saying there is “absolutely no risk” of airborne anaphylaxis given the information we have already.  Nadeau points out that data exists from aerochamber studies that may be helpful in determining the risk of airborne reactions.  During these aerochamber studies, people with allergies breathe in certain particles and wait to see when they get symptoms.  According to Nadeau, one can infer some degree of an allergic reaction in the average food allergy patient on an airplane. (Please see information below for specific data)

In November’s Journal of Allergy & Clinical Immunology,  Dr. Hugh Sampson, one of the lead authors of “Food allergy:  A practice parameter update – 2014” states “the primary exposure to a food allergen for most patients is through ingestion, although some patients can exhibit symptoms after skin contact or inhalation of aerosolized protein.”

During a taped interview several years ago, Ann Munoz Furlong, the founder of the Food Allergy and Anaphylaxis Network (now FARE), discusses the dangers of airborne reactions.  Furlong said individuals have died after inhaling their allergen.  She spoke specifically of one man who died after inhaling shrimp and another girl who died as a result of inhaling chick peas. Munoz said, “if you’ve got people opening nuts on a plane, for some individuals it will cause a reaction.”

Think about the risk of physical exposure to passengers with severe allergies when a passenger is sitting in such close quarters with other passengers.   Case in point, college junior Zac Chelini was sitting at the airport waiting to board his flight when a woman sitting next to him opened a package of trail mix which included nuts.  Chelini says the mix spilled everywhere, including on himself.  He immediately went into anaphylaxis, and had to be rushed to the hospital where he received multiple shots of epinephrine.  One wonders what would have been the outcome of this exposure had he been on a plane at 35,000 feet.  No doubt, he would have been protected from this type of exposure had he been sitting in a buffer zone on an airplane.

One thing we know for certain is that no two allergies are alike, and no two reactions are alike.  We also know that when airlines take the proper precautions, onboard emergencies can be avoided and lives are protected.  Please take action now to create a safer flying environment for all passengers, because even one life lost to anaphylaxis is too many.

By: Amy Wicker