- To give greater urgency to the growing problem of anaphylaxis and asthma on board planes due to airborne and contact exposure to peanuts and tree nuts, I want to share with you anecdotal and scientific evidence that this issue deserves more attention. This article also outlines ways to prevent anaphylactic reactions by taking some common sense precautionary measures.
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 United flight when a woman sitting several rows in front of 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.
This past 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.
We don’t know exactly how many passengers have had airborne reactions to nuts on airplanes. The FAA does not require airlines to track and report such data. Airlines can however implement several simple measures to safeguard passengers who have life-threatening allergies to nuts. Many of these measures have already been discussed.
- First, allow affected travelers time to pre-board flights for wiping down seats, seat belts, tray tables, and surrounding areas.
- Second, flight attendants should 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, require airlines to carry epinephrine auto-injectors — 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.
Albeit simple, the trick is how to get the airlines to implement and comply with these measures to protect the millions of people with food allergies. This is easier said than done especially when our community itself cannot agree on these measures.
During numerous discussions with several top food allergy organizations and advocates, it has become clear that the biggest stumbling block is the request for buffer zones. Medical advisory boards of these food allergy organizations are hesitant to support buffer zones due to the lack of scientific evidence to prove that airborne reactions can occur. Herein lies the problem—anecdotal data is all that we have because scientific studies haven’t been performed to determine the health impacts of airborne nut allergies. Think about it, would you let your child participate in a study where death is a possible outcome?
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 by 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.”
Even if you find it difficult to support buffer zones, think about the risk of physical exposure 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.
The solution to addressing food allergies on airlines is to take a proactive stance and unite as a community. I would encourage each and every one of you who sits on a medical advisory board of a food allergy organization to support these measures, and to allow these organizations to support an initiative in which we all have a stake. By working together we can ensure that messaging is clear and united. As long as we have even one voice from this community casting doubt on these measures, we will not move forward. We need to take action now because even one life lost to anaphylaxis is too many.
*Additional Information on Aerochamber Studies
According to Dr. Kari Nadeau of Stanford University, the following information is hypothetical but one can infer some degree of an allergic reaction in the average food allergy patient on an airplane:
- The average 747 is about 60,000 cubic feet, so that is 1699 cubic meters.
- There is data to show that in aero chambers, an allergic person could react with respiratory tract symptoms at between 40-200 nanograms per cubic meter. That would be 67,960ng in 1699 cubic meters or 40ng per cubic meter in an airplane.
- There are about 420 seats on a 747, so that means each seat probably takes up about 4 cubic meters (give or take) so that is 160 nanograms in the air around a seat that could possibly induce an allergic reaction.
The following links were used to gather airplane data:
Internal Airplane Dimensions
Cabin Air Systems
*Dr. Kari Nadeau has reviewed this article and has approved its contents.
*Anecdotal evidence has been gathered through personal interviews and/or public records
Dr. Robert Jacobs, an allergist/immunologist, has been studying environmental antigens for 40 years. Much of his work, in recent years, has involved the use of aerochambers. I reached out to him to find out what he could tell us about airborne allergies.
Want to take Action? Here’s how you can help.
If you share my concern, I urge you to make your voice heard. Call on your representatives in Washington to support legislation that will protect families with food allergies. Together, we can be the catalyst for change.
1. Send the attached letter to your congressman and senator on Capitol Hill.
2. Become a member of one of the following organizations, call them, encourage them to get involved:
3. Share This Video: More Than An Inconvenience
4. Sign and Share This Petition: NoNutTraveler
About Amy Wicker:
Amy Wicker is a journalist and the founder and president of AllergySafeTravel, a not-for-profit travel resource for individuals with food allergies. She is also an award winning producer. Her short film “More Than An Inconvenience” that looks at the issue of flying with nut allergies won best short documentary at the LA Film & Script Festival in 2013. The inspiration for Wicker’s work stems from her experiences with her 10-year-old daughter’s life threatening food allergies.
Wicker has also worked for the U.S. Department of Justice and the John F. Kennedy Center for the Performing Arts. She received her master’s degree in journalism from The American University, Washington, DC, and her undergraduate degree from Butler University, Indiananpolis, IN.