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Travel and Allergies

Flying Allergic

Published in Allergic Living Winter 2009.

Flying AllergicIt was a flight that Paige Humphreys and her family looked forward to every winter: from chilly Edmonton to Vancouver, Vancouver to sunny Maui. Along with the sunscreen and bathing suits, Humphreys, who has a severe allergy to tree nuts, diligently packed her own snacks as well as two Twinjects, and silently prayed that her fellow passengers didn’t pick up packets of trail mix on their way through the airport.

In her experience, airlines had stopped serving nuts years ago – pretzels were the norm now – so she didn’t think to contact Air Canada in advance.

But 10 minutes after takeoff, Humphreys’ tropical vacation became an allergy nightmare: Thousands of feet in the air and locked in the thin metal tube with nothing but hours of ocean ahead, the flight attendants began handing out packages of cashews – by far Humphreys’ worst allergy.

The 43-year-old knew she had to speak up, so she tapped one of the flight attendants on the elbow and explained that she was extremely concerned about the possibility of a serious reaction.

“The flight attendant was nasty. She said, ‘Well, we just can’t take care of everybody,’” recounts Humphreys. The crew continued to dole out the nuts. “So I had to bide my time and hope that nothing happened.”

Luckily, nothing did. But Humphreys and her husband spent much of their vacation trying to figure out how to get Paige home safely. Air Canada told them, as they do all allergic travelers, that it would be “unfair to other passengers” to withhold nuts, and that it was the couple’s responsibility to “bring the proper medication and to have the proper protection.”

Problem was, the “proper protection” included not being surrounded by people eating cashews. Humphreys began looking into other options. “But the other airlines serve nuts, too,” she says. So I thought, ‘I’m no better there – and I would be alone, too.’”

When it comes to nerve-wracking and sometimes dangerous experiences of flying with food or environmental allergies, Humphreys is definitely not alone. In the past decade, allergies themselves have taken off: roughly one million Canadians and 12 million Americans now have food allergies, and approximately 23 million North Americans have asthma.

Still, airlines have not adapted to this new reality. Few have clearly defined policies and procedures in place for allergic passengers, and they continue to serve some of the most highly allergenic foods, including nuts, sesame, fish and shellfish. Some even still hand out peanuts, the most prevalent trigger of serious reactions.

But many allergy sufferers and parents of allergic kids think it’s high time airlines made the skies safer for the millions of travelers with allergies. Dozens have filed formal complaints with airline regulators such as the U.S. Department of Transportation (DOT) and the Canadian Transportation Agency.

In one DOT complaint, a woman who had informed an airline of her severe peanut allergy ended up having breathing difficulties when the flight attendants refused to stop serving peanuts throughout the plane.

In another, a 3-year-old girl became covered in hives, her face swelled and her breathing grew labored on a flight where peanuts were handed out – even though her parents were promised they wouldn’t be. Again, the crew would not stop.

“The airlines are usually reactive and not so much proactive,” says Dr. Donald Stark, the Vancouver allergist who, in 1996, was the first to show that peanut dust can be circulated through airplanes’ ventilation systems, and can pose a problem for allergic passengers. “It’s only when the issues get brought to their attention, and particular reactions have occurred, that they are more likely to do something.”

Until recently, there has been little information about just how common on-board reactions really are. But a 2008 study, “Allergic reactions to peanuts, tree nuts, and seeds aboard commercial airlines,” out of the University of California at Davis’s School of Medicine, shows that high-flying allergic reactions are not unusual.

The study surveyed 471 people known to have severe peanut, nut or seed allergies. Forty-five reported reactions in the skies – that’s nearly 10 per cent – and three-quarters of those involved symptoms such as vomiting, wheezing, hoarseness, hives, diarrhea and lightheadedness.

More than half attributed their reactions either to inhaling the allergen as dozens of passengers opened packages of peanuts or tree nuts – which tend to be associated with more serious reactions – or to coming into direct contact with the potent allergens on the seats and elsewhere on the plane. (Because peanuts and nuts are oily, their proteins tend to literally stick around.)

Two allergic passengers who inadvertently ate food that contained allergens went into anaphylactic shock. Six ended up in emergency departments after landing.

“In hindsight, it’s not surprising that people are having reactions on airplanes, especially people with very severe allergies,” says Sarah Comstock, a PhD graduate in nutritional biology and the lead author on the study, which also involved high-profile professor of allergy and immunology Dr. Suzanne Teuber.

“You have an enclosed environment where the airline serves food you’re allergic to, and people eat it with their hands – and they don’t wash their hands afterwards. Food gets stuck in seats and seat-back pockets.

“You have individuals coming onto the airplane who are exquisitely sensitized to the food, and they’re in turn touching the seats, they’re touching the handles, they’re in the cabin when the peanuts are being opened. So they have a high likelihood of being exposed to one of the proteins that they are sensitized to.”

But while the University of California study, and others before it, demonstrate the risks to allergic passengers, the airline industry has done little in response. Some airlines have phased out peanuts, which has made an enormous difference in the lives of peanut-allergic passengers.

Others refuse, insisting that the highly allergenic legumes are part of the in-flight experience. Most of those that did remove peanuts, including Air Canada and American Airlines, introduced tree nuts such as almonds or cashews.

Nearly all airlines say, “We cannot guarantee an allergen-free flight” – even though that’s not what allergic passengers are seeking. Many who are speaking out about this issue hope that eventually, airlines will stop serving highly allergenic foods such as nuts and peanuts altogether.

For now, most who are seeking change say they would like airlines to develop clear allergy policies, and to avoid serving the highly allergenic foods on flights where there is an allergic person on board. (This would not include items that “may contain traces” of an allergen products, as that would be nearly impossible.)

They would also like the flight crews to make an announcement politely asking fellow passengers to avoid eating foods that contain the allergen in question.

Some flight crews on airlines such as Air Canada already provide such courtesies, but some don’t – and because they’re not part of a formal policy, passengers don’t know what they’ll face until they get to the gate. Other carriers are miles away from such practices.

Next: What airlines are and aren’t doing

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