Busting Airline Nut Allergy Myths – or Upping Allergy Backlash?

The topic of flying with food allergies is once again in the news. This time, it’s not the umpteenth passenger being deplaned for requesting a food allergy accommodation. This time, it’s a scientific paper published in a U.K. medical journal that promises to bust myths about flying with peanut and nut allergies in particular.

While the authors include some conclusions that will prove helpful to food allergy passengers, they spend an inordinate amount of time on published data that show why it’s unlikely peanut particles are circulated by airplane ventilation systems.

The trouble with this emphasis is that it sounds like a big reveal – and has led to clickbait headlines. From Newsweek to the BBC to England’s The Sun and more, the headlines and the media articles are cherry-picking this single point from the airlines paper.

The overarching takeaway of the coverage? That those managing food allergies need no extra accommodation or consideration on flights. But the fact is, even the authors say we do have needs. Yet this message is being lost.

The internet is now awash in headlines like: “Peanut Panic on Planes is Overblown,” “Nuts on Planes are Safe for Those with Allergies,” “Scientists Debunk Common Airplane Nut Allergy Myth,” or “Nut Bans No Help to Allergic Air Passengers”.

As the one of the leading advocates in safer airline travel with allergies, I know that such clickbait titles will inspire more ire toward passengers with food allergies. This stands to make asking for reasonable accommodations even harder.

What the Report Itself Says

Let’s consider the paper behind the headlines. In it, Dr. Paul Turner and Dr. Nigel Dowdall actually include other points that I support as the founder of the No Nut Traveler nonprofit.

A key example would be the risks they highlight about airplane tray tables and seating areas. The authors note that some common allergenic foods are “sticky,” and can adhere to surfaces. This has the potential to transfer allergenic food residue onto hands or safe foods, and can lead to accidental ingestion.

These experts encourage pre-boarding the airplane for food-allergic passengers, so an individual or family can clean the seat area. Allergic Living and I have long supported pre-boarding as a key precaution to reduce in-flight reaction risks.

However, I am genuinely concerned about a few of the authors’ conclusions in the airlines paper, published in the journal Archives of Disease in Childhood.

Airlines & Allergies Paper: What’s Concerning

On their emphasized point, the two authors say it’s “a common misperception” that peanut particles are recirculated in-flight. Then they discuss at length the capabilities of airlines’ HEPA-filtered ventilation systems.

What’s mystifying, however, is their leap to conclude from such findings that airline PA announcements asking people to “refrain from eating peanuts or nuts” are therefore unnecessary.

They make this assumption despite their own reporting on studies of the abundance of peanut and other food residue on tray tables. They acknowledge that the concern goes beyond tray tables. Yet, where is evidence here that a PA announcement would not curtail, say, sticky fingers and residue on common spaces like restrooms and seatbacks?

Let’s face it: people can be messy when they eat. Consider the common reports on my website of peanuts being shelled, of peanut skins dusted off into aisles, of children with sticky fingers touching common surfaces, etc. A crew request asking those around us for consideration is a reasonable health and safety precaution. How would they otherwise know to be cautious?

The authors further opine, without providing evidence, that offering such PA announcements “may install a false sense of security.” This is at odds with the high levels of anxiety experienced by 98% of food allergy travelers, according to the global air travel survey conducted by Northwestern University’s Center for Food Allergy & Asthma Research (CFAAR). (It’s a study that Turner and Dowdall also cite.)

But where is the proof of that false security? This instead comes off as a slight to the intelligence of individuals living with food allergies. These passengers do understand that no environment is entirely ‘safe’, despite assurances. The request for an in-flight announcement is to reduce the chance of allergen exposures, not to eliminate it.

How Complete is In-Flight Reaction Data?

The airlines paper raises the question of whether allergic reactions are less common in the air than on the ground. I have never heard assertations that they are.

What is different about encountering your allergen at 35,000 feet in the air is that you can’t simply move to a different venue. Also, for those with tree nut and peanut allergies, many airlines still promote nut consumption and make them part of the business-class experience.

The airlines paper also says reactions on flights have not increased over time. But does this match up with the increase in food allergies globally and air travel experiences?

The researchers used data provided by airlines and ground-to-air medical support. It is, however, inadequate to rely solely on their capture of emergency events. Consider a guidance document issued by the Aerospace Medical Association Air Transport Medicine Committee. It noted: “It is not known with certainty how many in-flight medical events occur each year, since there is no internationally agreed recording and classification system.”

So, the fact needs to be acknowledged: there are known shortcomings in the data-capturing process.

In the U.S., the Federal Aviation Administration (FAA) is responsible for the regulation of the safety of flights. Recently, I inquired if there were FAA regulations for airlines regarding reporting of in-flight medical emergencies. Specifically, I asked whether airlines are required to report instances where passengers treat allergic reactions using their own epinephrine. I asked the same about situations where a medical professional administers epinephrine from the airplane emergency medical kit (EMK).

To my surprise, the answer was, “The FAA does not keep statistics on in-flight medical emergencies.”

As well, data from those supplying the EMK medications and the airlines cannot track incidents where passengers use their own medication to treat allergic reactions.

Passengers’ Reactions: Not Uniformly Reported

When considering airlines and food allergies, the questions are: do passengers report reactions and when reported, are the airlines documenting them? This issue alone calls into question some of the paper’s conclusions.

The CFAAR global survey on airline travel and food allergy involved 4,704 people. It revealed that 8.5% experienced at least one allergic reaction during airline travel, with the majority (92%) relying on personal medication for treatment. Only about 57% reported reactions to the crew. While based on self-reporting, the figures are significant.

In addition, Allergic Living’s journalistic coverage shows reporting shortcomings in the anecdotal experiences of physicians. In 2022, on two separate flights, Dr. Kimberly Blumenthal was called up to treat anaphylaxis. She was surprised that an incident report was generated for one flight, but not the other. I’m sent reports of many such experiences. Recently, a physician wrote me about treating her food-allergic teen with his auto-injector on a transatlantic flight. No report was filed.

It’s crucial to acknowledge that statistics on in-flight reactions do not fully capture the reality of in-flight allergic emergencies. Clearly, better incident reporting would lead to a better understanding of the facts.

Airlines & Allergies Paper: What’s Strong in Report

This said, I was heartened that the U.K. authors call for the right to pre-board an airline to clean the seating area for allergen residue. They note that tray tables and seats are the most likely source for allergen contamination.

It’s challenging to thoroughly clean your seat area while others are trying to pass through. The right to pre-board in the U.S. was hard-fought by advocates, who did not accept the status quo.

It is very good to see the authors’ call for global guidelines or standards to protect food-allergic airline passengers. Airlines are consistently inconsistent in dealing with those flying with food allergies. This makes it difficult to navigate the system and make informed choices.

It is also encouraging that the authors suggest that airlines “should consider” including stock epinephrine devices among in-flight medications. My only disappointment: we’re way past “should consider”. This should be required.

With food allergy growing globally, and increased incidence of adult-onset food allergies, the need for safety and precaution with food allergies is ever greater. First-time reactions happen in the air, as Allergic Living has reported. Our community has the right to expect medications for the best possible outcome on airlines.

Societal Takeaway: More Allergy Derision

As an informed observer of in-flight food allergy experiences, I come away from the U.K. airlines paper concerned. This stems mainly from the authors’ statements that rely on data with shortcomings and, again, with the media takeaways.

The messaging here could cause increased barriers for huge numbers of travelers with food allergies, increasing the difficulty of getting reasonable in-flight accommodations.

Consider the New York’s Post’s headline: “The Surprising Reason You’re Safer from Allergic Reactions In-Flight Than on the Ground.” Societal reactions to the mostly invisible condition of food allergy can already be derisive, mean-spirited and dismissive. I predict this study’s coverage will only make it worse.

Airline travel would be far less stressful for those with food allergies if all airlines were compelled to treat this potentially life-threatening disease with dignity and respect. This is an achievable goal. We must continue to advocate for better.

Lianne Mandelbaum is Allergic Living’s airlines correspondent, and the founder of NoNutTraveler.com.