Dr. Patricia Leonard
On August 5, 2014, allergist Patricia Leonard was traveling with her three children on a United Airlines flight out of Dublin, headed home to Houston via Newark, following a vacation with family in Ireland.
Two hours into the flight, the attendants had cleared away the meal, when she heard the crew’s PA announcement. There was a medical emergency, and any health-care professionals were asked to identify themselves.
Dr. Leonard stepped forward, and within seconds she was up in first class, by the side of a 4-year-old Irish girl who was having an anaphylactic reaction to a cashew. Since the girl had no known food allergies, at first her mother had thought she was choking on the nut. Then her daughter began coughing and throwing up.
“They soon realized she was having an allergic reaction because her lips swelled up, her eyes were swelling shut and she was breaking out in hives all over her body,” says Dr. Leonard.
When the allergist got to the child, she knew immediately that she needed epinephrine – and fast. The crew handed her and an ICU nurse, who also came forward to help, the plane’s big medical bag. It wasn’t the easiest experience.
Fumbling for Epi Vial
“We had to go in the bag; we had to fumble through the drugs,” Dr. Leonard recalls. “It had a lot of medicines and was divided up into different areas. I’ve since learned it’s divided up based on oral medicines and IV medicines, but I didn’t know that. The flight attendants gave me a laminated board of all the drugs that were in there, but I couldn’t even read the laminated form – the writing was so small. We just had to go digging through and luckily found the bottle of epinephrine.”
The doctor doesn’t know exactly how long it took to locate the vial, “but in my mind it took longer than it should have taken. If they’d had an auto-injector, it would have been so much easier to give the girl the epinephrine as quickly as we could,” she says.
“By the time I got her the injection, she was having severe nasal congestion – she couldn’t breathe through her nose – so her symptoms were progressing.” Within minutes of the shot, the girl’s symptoms began to recede.
In the meantime, the crew had contacted the ground medical response center in Phoenix. Given the seriousness of the girl’s reaction, the center and the pilot decided to turn the plane back to Dublin, and received clearance for a high-speed return. (Passengers would later be given hotel and food vouchers, as well airline travel vouchers to compensate for the inconvenience of getting delayed until flights out the next afternoon.)
But the little girl wasn’t out of danger. Despite initially feeling much better from the epinephrine, “about 10 minutes later, her symptoms started recurring again, she started getting congested again, so I had to give her a second dose of epinephrine,” Dr. Leonard says. The flight ended well, with the little girl in stable condition, and being whisked off to the hospital by the EMS. She stayed overnight and was discharged and the family did manage to make their trip to America.
But Dr. Leonard, who works at the Houston ENT & Allergy clinic, tells Allergic Living she was left unsettled by this experience, and concerned that things could have turned out quite differently. She believes it illustrates that airlines need to change their approach to food allergy readiness. To start with, she questions why there are not epinephrine auto-injectors available, noting that the pharmaceutical companies have developed these devices to make it easy for anyone, not just a health professional, to treat someone in an emergency.
“If there was on an auto-injector on-board, it would have been so much easier,” she says. “In this day and age of the availability of these devices, I just don’t understand why they’re not on-board.” [Editor’s note: A few carriers do have them.]
Time for Auto-Injectors on Flights
A concern that’s stayed with Dr. Leonard is: What if there was not a health-care provider on that plane? How would that child have gotten the epinephrine that she needed to halt a progressing allergic reaction? “I don’t know if this little girl would have died without the medicine, but she could have. We were over two hours into our flight and over the Atlantic Ocean.”
Her view is that it would not have been simple in the midst of this medical emergency for a flight attendant to draw up the medicine in the needle, even with guidance from a ground medical center’s physician. She notes that even doctors who don’t work with food-allergic children would not likely know offhand the correct dose of epinephrine to give a 4-year-old. “It was just ironic that there was a board-certified allergist on that plane,” she says.
She points out the fast rise of the prevalence of food allergy, the “tradition” of allergenic foods like peanuts and nuts on planes and the tendency of airlines to speak more about liability issues than accommodations when it comes food allergy management.
“I just think it’s time for change,” says Dr. Leonard. “It’s time to revisit this issue [of food allergy protocols], it’s time to protect the passengers who are traveling.”