A recently published global study finds flying with food allergies to be a big cause of anxiety. So what’s making 98 percent of airline passengers managing food allergies feel so much stress?
According to the study’s survey of 4,704 participants, it’s largely due to airlines’ lack of consistent allergy policies, and communication. The latter relates especially to accommodation promises made, then not delivered.
Seventy percent of the survey group reported being assured of various allergy accommodations that they didn’t receive. Among those, 20 percent did not get promised food allergy cabin announcements, while 18 percent didn’t get a requested alternative snack. Another 17 percent were told allergen-free buffer zones would be established; they weren’t. And on the list goes.
Staff treatment was also an issue. Thirty-six percent reported airline staff being insensitive about food allergies. Shockingly, over 12 percent of participants spoke of being ordered off a flight for revealing a food allergy, or being denied boarding.
Northwestern University’s Center for Food Allergy & Asthma Research (CFAAR) led this global airlines and food allergies study. Those surveyed were parents of allergic children and adult patients (plus a few of their partners).
“We just want reasonable accommodations promised in advance of travel to be honored at 30,000 feet,” says Lianne Mandelbaum of the nonprofit No Nut Traveler, a co-author of this study.
“These data clearly show that air travel is a major stressor for those affected by food allergy,” notes Christopher Warren, PhD, director of population health research for CFAAR. He’s the lead author on the airlines and allergies study, published in the journal JACI: In Practice.
Yet, the study does point to a big opportunity for airlines to mend fences and even win over these customers. Mandelbaum, a leading advocate for airline accommodations, calls food allergy travelers “an untapped economic opportunity.”
Airline Allergy Policies and Loyalty
It’s a compelling point, since 33 million people in the U.S. alone have food allergies.
“An astounding 78 percent participants said airlines’ food allergy policies are a crucial factor in ticket-buying decisions,” Mandelbaum tells Allergic Living. Previous in-flight experiences also influenced 77 percent of bookings. The allergy factors were far bigger drivers of travel choices than cost or airport proximity.
“Food allergy-related airline policies were the single-most important consideration respondents identified when making air travel decisions,” Warren says.
“Now, there is data to confirm that airlines that prioritize and respect food allergy customers stand to gain loyal, repeat customers,” Mandelbaum says. “Such customer loyalty is a great potential asset for the airline industry.”
Remember the 98 percent of participants who felt anxiety with air travel? In the survey, they were also asked if their anxiety would decrease if airlines implemented better food allergy policies.
Almost the same number – 97.6 percent – said that it would. In fact, 62 percent said the stress would decrease anxiety “a lot”.
Hiding Food Allergies
Warren says the study reveals a “disturbingly high proportion of surveyed travelers reported deliberately not disclosing their food allergy when traveling.” The leading reason for that? Many participants expressed concern “that such efforts would lead to undesired consequences,” he says.
The airlines and allergies study data show:
• 31% of those traveling with food allergies at least sometimes do not disclose a serious food allergy.
• The leading reason for not disclosing an allergy: “concern I would get in trouble” with the airline’s staff.
Mandelbaum, who also writes on airline allergy issues for Allergic Living, finds the idea of passengers “hiding their food allergies” of serious concern.
She notes, for instance, that if a passenger traveling alone accidentally ingests their allergen, that person could become incapacitated. The flight crew might have no idea what’s going on, as “symptoms could mimic another medical issue.”
Her big worry is that confusion could delay epinephrine treatment, which allergists advise to give early in a serious reaction. The flight crew wouldn’t know if the passenger carried an epinephrine auto-injector or where to find it. “With many airlines lacking easy-to-use auto-injectors, this situation could result in an anaphylaxis tragedy in the air,” the advocate says.
In-Flight Reactions, But No Epi
A severe allergic reaction on an airplane can be a scary experience. The patient knows they are 30,000 feet in the air, and distant from hospital care.
Among study participants, 8.5 percent reported 400 in-flight reactions, mainly to peanut or tree nut triggers. Most had skin rashes (87 percent), but over half had respiratory symptoms and 17 percent noted cardiovascular symptoms. The latter or the reactions affecting more than one body system qualify as anaphylaxis.
Yet, in 61 percent of the reported reactions, only antihistamines were taken. Similar to an older airlines study, epinephrine use was alarmingly low. Only 15 percent administered an auto-injector in this survey. In 30 percent of the in-flight allergic reactions, participants said the allergic individual was whisked to a hospital after landing.
In the midst of a food reaction, many quietly treated themselves. Of those with reactions, 57 percent informed the flight crew of what was happening. However, 43 percent did not.
To Mandelbaum, this shows the need for work in educating airline staff about food allergies, and passengers about their rights. Passengers should not be afraid to speak up about allergies, she says.
At Allergic Living, we’ve written on the shortcomings of data collection on food allergy reactions aboard airplanes. Underscoring the issue in this study, only 29 percent informed the airline of a food-allergic reaction.
The study authors write: “Data from this survey suggest that many respondents (>40%) reporting in-flight allergic reactions neither informed the flight crew, nor the airline upon landing, likely resulting in systematic under-documentation of food-allergic in-flight medical emergencies in administrative databases.”
Airlines, Allergies Study: Precautions Taken
The airlines and allergies survey found a majority of participants did take precautions.
• 67% contacted the airline ahead of a flight about the food allergy.
• 82% brought antiseptic wipes to clean the seating area, in case of allergen residue.
• Preboarding was the most commonly provided accommodation.
• 82% attempted to bring their own allergy-safe food onto the flight. (Some reported food being “ruined” by customs inspectors or confiscated.)
To undertake the study, CFAAR partnered with 45 patient advocacy groups and research institutions in the U.S., Canada, the U.K., Australia and New Zealand. (U.S. participants accounted for 79 percent of the study sample.)
The study was published in December 2024. It concludes that for airlines, “these data suggest that simple steps to ensure consistent access to basic food allergy-related supports and accommodations throughout the booking and air travel process can meaningfully improve patient-reported outcomes and reduce unnecessary stress and anxiety.”
Related:
Airline Study Authors on The Findings (Video): recorded after initial survey results presented at 2023 allergists’ meeting.
Anaphylaxis over Ocean with No Epinephrine Vial in Kit
‘Borrowing’ Auto-Injectors on Planes
