Tips and Resources

Requesting Accommodation and Limiting Exposure Decreases Risk of In-Flight Allergic Reaction

Worldwide, about 44,000 medical emergencies take place on commercial airline flights each year. Allergic reactions are currently estimated to account for 2 percent to 4 percent of these medical events, or roughly 900 to 1,800 in-flight reactions annually. A brief 2017 review article in the World Allergy Organization Journal (WAOJ) advises that travelers at risk for allergic reactions can prepare in advance to minimize the odds of reacting and respond effectively if a reaction does occur:

The WAOJ review article notes that as air travel becomes more commonplace, the number of allergy-related emergencies that occur in flight– such as asthma exacerbations (AE) and systemic allergic reactions (SAR, such as anaphylaxis) – can be expected to increase.

“Therefore, passengers at risk should be aware of the necessary measures to prevent and manage these emergencies. It is also vitally important that airlines are prepared to deal with these diseases by providing the necessary strategies to decrease the incidence of SAR and AE. They also should have the necessary means to treat these reactions when and if they occur. There is a clear opportunity for airlines to work alongside allergists/immunologists to implement evidence-based recommendations to prevent allergic reactions during flight, especially SAR.”

The review article cites a 2013 Journal of Allergy and Clinical Immunology study of in-flight allergic reactions to peanut and tree nut, which collected survey responses from more than 3200 food allergy patients or parents in 11 countries. This international study found that about 1 in 10 respondents reported a food allergy reaction in flight. Nearly 7 in 10 respondents requested accommodations before the flight, such as a special meal or an announcement asking passengers not to eat peanut or tree nut snacks. Roughly 9 in 10 respondents engaged in actions to limit exposure to allergens, such as bringing allergen-free food or wiping tray tables and armrests. Individuals who requested any accommodation or performed any risk-mitigating behavior were significantly less likely to experience an allergic reaction in flight.

U.S. airlines are required to carry epinephrine in their on-board medical kits. To treat anaphylaxis with the 1:1,000 epinephrine solution typically included in these kits, a hypodermic syringe is used to draw the solution from an ampule and inject it into the thigh muscle. The volume of epinephrine varies based on the patient’s weight. Administering epinephrine this way is much more difficult than using an epinephrine auto-injector, especially for people who don’t have medical training. Requiring airlines to stock epinephrine auto-injectors and train flight personnel on how to use them is one of FARE’s advocacy priorities.

Food allergy patients who have been prescribed epinephrine should keep two auto-injectors accessible during the flight, rather than packed in checked luggage or stored in an overhead bin. On international flights, a prescription label with the patient’s name may help ensure that the auto-injectors can be carried onto the plane.

Airlines vary widely in their pre-boarding and food service policies. To compare how 13 airlines address the needs of customers with allergies, you can refer to a useful March 2016 chart by Allergic Living.

In December 2016, a food allergy family filed a complaint with the Department of Transportation (DOT) against American Airlines, which does not allow pre-boarding for food allergy patients or parents to clean seats and tray tables, but does allow pre-boarding for other disabling medical conditions. FARE filed a similar DOT complaint in January 2017 protesting the American Airlines ban on pre-boarding for food allergies. If you have been affected by the American Airlines food allergy pre-boarding policy, you can submit complaints to DOT through the FARE website.

You can find additional information about traveling with food allergies on the FARE website, Also on foodallergy.org, the International Food Allergy and Anaphylaxis Association (IFAAA) offers tips for traveling to selected destinations.

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