Flying With Food Allergies

Travel with Food Allergy

If you're booking a flight for vacation travel this summer, you may want to be aware of a recent study about food allergies and airplane travel. In a March 2013 article published in the Journal of Allergy and Clinical Immunology, researchers shared their findings when they set out to characterize the experience of persons with peanut and tree nut allergy who report in-flight allergic reactions. They also compared pre-flight and in-flight behavior between persons reporting and not reporting a reaction to determine whether any behaviors may be associated with safer flying.

The results come from a survey that was accessed and completed by 3273 persons- mostly parents of peanut and tree nut allergic children. 

More than 10% of respondents reported experiencing a reaction during a flight.

How's that for a frightening statistic?

It goes on to share:

• 13% of those people who experienced a reaction received epinephrine
• peanut was the attributed cause in 69.5% of the reactions
• the crew was notified of the in-flight reaction in only 50.1% of cases
• Airline policy on handling in-flight reactions to peanut and tree nut allergies has been inconsistent between different carriers and nations.

We have successfully flown many times with food allergies. We've always notified the airline in advance of our food allergy and need for accommodations. This study pointed out that fewer reactions occurred for those people who took "risk-mitigating behaviors". Here are the behaviors found by the study that may help decrease the chances of having an in-flight reaction:

• making any request of the airline (in other words, tell the airline about your allergy and what you need)
• requesting a buffer zone
• requesting an announcement that passengers not eat peanut/tree nut–containing goods
• requesting a peanut/tree nut–free meal
•  wiping the tray table (we also wipe the seat and arm rests)
•  bringing own food from home
•  avoiding use of an airline-provided pillow
• avoiding use of an airline-provided blanket

Of course, always carrying your own epinephrine injector (make that two injectors) is also critical. We have a note from our allergist stating that we need to carry life-saving medicine on-board so we don't have any last minute problems getting through security.

The study did note that "one single US carrier was associated with 63 reported reactions (18.1%)". That airline remained unnamed (hmmm....now I'm very curious!) Canada is the only country where a government agency has directly intervened, recently ordering Air Canada (but not other Canadian carriers) to establish a peanut/nut-free buffer zone, on specific request within 48 hours of departure. To date, the US Department of Transportation,has stated that it would not involve itself in the peanut/airline issue.

That means it's up to us. Carry your own food and medication and use the above listed risk-mitigating behaviors when you fly. You can successfully travel by plane with food allergies by being prepared and preparing in advance.

Wishing you happy and safe travels! Feel free to share your personal experiences in the comments below.

One Doctor's Quest to Help Kids With Food Allergies

March 10, 2013 New York Times Magazine

Did you get a chance to read the NY Times piece, The Allergy Buster, by Melanie Thernstrom (an allergy mom herself)? Honestly, I couldn't put it down and I'm thrilled to see a piece like this on the cover of the NY Times Magazine. 

The article features Dr. Kari Nadeau, a Stanford doc with strong convictions about helping kids with multiple food allergies. Dr. Nadeau wrote 13 Investigational New Drug applications (90 pages each!) for the FDA while she was sick, went without a salary for 3 years, and allows patients to call her when she is away on family vacations. Her trial to desensitize children with multiple food allergies spawned the group, Safar Community Council. They raise money and hold meetings for food allergy research.

Allergies to Milk, Eggs, Nuts

Since the article left me still hungry for more information on this possible treatment, I was happy to discover two other related pieces. The NY Times Blog posted a Behind the Cover Story interview with the author of the article and Dr. Nadeau herself is taking questions to be answered in a future Stanford medical journal. Questions may be sent through Twitter, using the hashtag #AskSUMed, or by posting a comment on Scope, the Stanford journal.

I long for the day, as the author pointed out, when food allergies and fatal anaphylaxis are associated with an earlier age, like dying of polio. Until then, we need more people like Dr. Nadeau willing to do the  research, work closely with patients and families and demanding more from our science and medical communities. We also need brave families and people with food allergies to participate in research and trials. That's a tough, and very personal choice, but it's the research and trials that will eventually lead to a cure.

Fifteen million Americans have food allergies. The number keeps rising and we don't know why. Patients and families deserve better, and more consistent, answers- now and for future generations.

Consider Body Weight When Using an Epinephrine Injector

EpiPen Injector

When a person experiences anaphylaxis, a life threatening reaction to foods, bees, latex or other causes, the best course of action is to administer epinephrine quickly and effectively. Typically, this means using an epinephrine auto-injector (like an EpiPen or Auvi-Q) and injecting into the side of the upper leg.

A recent study conducted in the U.K. found that the injection site may vary depending upon body weight. Using ultrasound to take skin surface to muscle depth measurements, researchers found that higher weight and waist circumference were linked to a skin surface to muscle depth measurement greater than the length of the auto-injector needle. This means the epinephrine was not getting into the muscle where it would be more rapidly absorbed.

The study concluded that it may be beneficial to inject further down the leg where skin surface to muscle depth surpassed the length of the auto-injector needle for a majority of kids. 

Auvi-Q Auto Injector

Talk to your doctor (and share the press release, Injecting Epinephrine into the Lower Rather Than Upper Thigh May Be More Effective in Overweight Children) if you have concerns about weight and the effectiveness of an epinephrine injector. Make sure that the prescribed auto-injector user and all caregivers are aware of the best place to administer the injection to maximize the benefits of the medication.