I was at a party recently and someone asked me a really good question:
“How is it that someone sitting in the back of an airplane can open a bag of peanuts, and trigger an allergic reaction in someone dozens of seats away, when neither of them has moved and no one has walked by or touched one and then the other?”
I pointed out my obvious lack of credentials and standing, but said I had a secret weapon. I volunteer with the Asthma & Allergy Foundation of America, aafa.org, a truly wonderful organization and source of information. They have a great allergist and I asked him.
Hi Debbie. This question was addressed in a recent medical publication which you may not have access to (https://www.annallergy.org/article/S1081-1206(17)31162-6/fulltext)
Dr. Eagan and Dr. Greenhawt reviewed the evidence on the question regarding risk of reaction for a patient allergic to peanut during air travel. I have often thought of this as well, given my own daughter has severe peanut allergy.
In summary, there are reports of reactions on airlines which are thought to be due to inhalation peanut dust in the cabin. The risk of anaphylaxis with this type of exposure is rare. And it is felt that it would be more likely that there is accidental transfer of protein and ingestion.
I have provided some quotes from their discussion in the article above:
“Although allergic reactions on commercial airlines have been reported, current literature is based on self-report of symptoms, which is subject to bias, so true prevalence is unknown.34–36 Sicherer et al34 surveyed patients in the National Registry of Peanut and Tree Nut allergy and found that 62 of 3,704 individuals reported a reaction on an airplane, with reported ingestion exposures being associated with the most severe symptoms. Among the 14 patients who reported symptoms from inhalational exposure, the timing and exposure history was not convincing in 3, and in the remaining 11 participants, more than 25 passengers were eating peanuts at the time of the reaction in question.34
“Greenhawt et al35 reported similar findings with a more recent survey of participants in the Food Allergy & Anaphylaxis Network. Of the 150 participants who reported having an inflight reaction, 15.7% reported reactions attributable to ingestion, with inhalational, skin, and unknown exposure accounting for 48.6%, 27.9%, and 7.8% of reactions, respectively. Surprisingly, although 33% of participants reported symptoms consistent with anaphylaxis, epinephrine was only used in 10%, highlighting the under treatment of reactions.35 “
“Although there is a report of peanut protein being recovered from airline air filters, representing a cumulative exposure,38 studies on inhalational and contact exposures to allergens do not support the notion of systemic reactions with casual contact. As well, it is unclear what particle denoted in an air filter represents because these particles could be pulled from circulation without passage through the cabin (Fig 1).39 Therefore, it remains somewhat likely that the reported inhalational reactions were caused by unnoticed ingestion (peanut inadvertently consumed through casual hand to mouth contact of uncleaned residual levels on surfaces) or another source, such as anxiety-induced symptoms. 35 Overall, inflight medical emergencies are rare, with allergic reactions contributing to a small portion of all events, and it appears that most peanut allergic passengers fly without event. Therefore, there appears to be no evidence to support that commercial air travel is dangerous or should be contraindicated for the peanut allergic patient.”
“Although the risk of reaction is low, all patients with a food allergy who fly should have emergency medications with them, including 2 epinephrine autoinjectors, and should ensure that epinephrine is used for treating severe symptoms.8 The decision to travel on a commercial airline that serves a culprit allergen is individual, but again the available evidence demonstrates that the presence of an allergen is of low risk, likely not to cause any problem as long as the allergen is not directly ingested. We believe that peanut or tree nut allergy should not serve as contraindication for travel in most circumstances, given a low likelihood of an event occurring and multiple risk-reducing behaviors that passengers can implement.”
Douglas T. Johnston D.O. FAAAAI, FACAAI
Medical Scientific Councilmember, Asthma and Allergy Foundation of America
Assistant Professor of Internal Medicine / Allergy & Immunology
Edward Via College of Osteopathic Medicine – Carolina Campus
Adjunct Professor, Department of Public Health Sciences
College of Health and Human Services
University of North Carolina at Charlotte
We encourage you to register for AAFA’s online community for additional information and support: https://community.aafa.org/join.
Travel asthma emergency kit
I found this reassuring. In all the traveling I’ve done, I’ve seen medical emergencies, including asthma, and a couple of allergy issues, but never requiring more than Benedryl. I’ve never seen an obvious need for Epi-pen on a plane. I’ve had a few bad times on airplanes, but again, never to the level of needing help beyond moving me to a different seat (and those were triggered by perfume in one case and a cat smuggled into the cabin in another).
What always amazes me, though, is just how often parents of highly allergic children, who have witnessed their children almost dying from anaphylaxis, will fail to have a fully equipped emergency asthma/allergy kit with emergency instructions (called an Asthma Action Plan – AAP) printed out and easy for others to find. As in ON THE CHILD or immediately next to the seat.
Having it in your carry-on, crammed above seats several rows behind you, and not obviously known as yours, will do you no good in an emergency. Same for your child. It should ALWAYS be physically on you/him or her in a fanny pack or obvious medical bag. (Get one with a big cross or asthma & allergy or KFA* printed on it.) I carry a large brightly colored tote on board, with all kinds of things medically necessary in an emergency in it, medical kit front-and-center.
PS – People frequently ask me what precautions I take when I travel, and the meds I take along. So here’s the emergency asthma & allergy part of that:
-
- Two Epi-pens, unexpired;
- Benedryl capsules and Benedryl liquid;
- Benedryl ointment for skin contact;
- Zyrtec;
- Flyp portable nebulizer (an incredible tiny, battery-powered nebulizer not much larger than a deck of cards – what an improvement!) and nebulizer solutions;
- Prednisone (10 mg.) tablets;
- Rescue inhaler (levalbuterol), azelastine nasal spray and eye drops;
- Disposable masks and gloves, medical grade;
- Individually wrapped alcohol pads (make sure they are still “juicy”); and
- Alcohol-based hand sanitizer.
Be sure and ask your doctor the maximum number of Benedryl capsules and Zyrtec (or other antihistamine) you can take in an emergency and write it down on your plan. Ideally ask your pharmacist put it on a label for the package, and put that into your emergency kit.
Sometimes a few sips of liquid Benedryl can help ease any throat swelling and allow me to swallow capsules, but too much will cause me to choke and vomit. Discuss what to do in that situation with your doctor and put that in your emergency plan.
I board planes early because of my disability. Using alcohol pads, I wipe off the light and call buttons, armrest, belt buckle, tray table, even the parts of the seats I might touch. (I have trouble reaching above my head to the luggage bins, so those usually get a pass. I also regularly wipe off the handles and outside of my luggage, walker and purse with alcohol.)
*KFA – Kids with Food Allergies – is a wonderful off-shoot of AAFA, with helpful info on food allergies for us adults, too. I only wish this would have been available when we were little. My mom struggled so to keep us safe, and balance that with our normal kid preferences and our desire to be like the other kids! It definitely would have made her life, and ours, so much easier.
