Of the 44,000 in-flight medical emergencies on commercial airlines each year, roughly 900 to 1,800 involve food allergy reactions. In-flight reactions are concerning since medical resources are limited, and emergency services if needed, are unavailable. Most food allergic fliers understand this and take precautions when traveling, but what precautionary actions are the most beneficial?
Eight Preventive Actions
A study of in-flight reactions to peanuts and tree nuts, completed in 2013, analyzed survey responses from more than 3,200 food allergic travelers, or their parents, from 11 countries.
From the survey, researchers identified eight actions associated with reduced risk for in-flight food reactions. Those who reported an in-flight allergic response performed these actions significantly less:
- Making any request of the airline related to allergy safety.
- Requesting a buffer zone around the allergic person.
- Requesting an announcement that passengers not eat peanut/tree nut containing foods.
- Requesting a peanut/tree nut free meal.
- Cleaning the allergic person’s tray/table.
- Bringing safe food from home.
- Avoiding the use of an airline-provided pillow.
- Avoiding the use of an airline-provided blanket.
The investigators found it reassuring that nearly all respondents said they carried epinephrine auto-injectors (EAIs). Less reassuring was data showing only 13.3 percent of the 349 reported in-flight reactions employed epinephrine as treatment. The others, 85.6 percent treated with antihistamines—which are ineffective for anaphylaxis.
Why Not Epinephrine?
To understand what influences the use of in-flight epinephrine, the researchers looked at specific factors. They found that:
- Cardiovascular, and gastrointestinal symptoms, and notifying the flight crew about the reaction was associated with greater odds of receiving epinephrine.
- There was slightly less use of epinephrine on planes with “nut-free” policies, maybe because the policy creates a false sense of security.
- Skin symptoms, wheezing, and other respiratory issues were not significantly associated with epinephrine use, though these can be indications of severe reactions, including anaphylaxis.
The investigators concluded that stressing the importance of using epinephrine for allergy reactions should be a patient education goal at clinical practices worldwide.
All food allergic individuals who fly are encouraged to keep two EAIs with them always. However, it does not help to carry the auto-injectors if people are afraid to use them.
Time matters when someone is experiencing a food reaction, and though many people administer antihistamines such as Benadryl, instead of epinephrine, they may be putting their self or their child at risk. Antihistamines can take one to two hours to work, but a peak therapeutic response occurs within ten minutes after receiving epinephrine.
Anyone reluctant to use EAIs might benefit from watching a webinar given by Dr. Scott Russell called Epi First, Epi Fast. Ask Questions Later (link below). Watching it might save the life of someone you love.