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Flying Allergic

Published in Allergic Living Winter 2009.

Flying Allergic [1]It 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

Asked whether British Airways would consider making an announcement requesting that passengers refrain from eating nuts or peanuts if there was an allergic passenger on board, the airline’s media relations manager Cathy West said it simply wouldn’t be practical. “We take steps, but I don’t think you can make an announcement across the whole aircraft about everyone’s medical needs.”

West also said the airline does not serve peanuts but it does serve other nuts, as well as fish and shellfish, and the menu will not change for an allergic passenger. Still, she adds, “you’re not going to be suddenly thrust a prawn or anything.”

Air Canada has taken a few steps to accommodate it’s allergic passengers – the airline stopped serving peanuts back in 1998, it doesn’t serve shellfish and it no longer allows pets in the cabin. Still, the carrier’s slogan, “The freedom to fly your own way,” doesn’t ring as true for passengers who are highly allergic to tree nuts and sesame, top allergens which the airline serves regularly, and to fish, which is still offered as a meal on international flights.

“We have to develop policies which balance the needs and desires of our very differing customers, and still be fair to the vast majority of those customers,” says Angela Mah, a spokesperson for Air Canada based in Vancouver.

But while the flight crews “will do everything they can to make sure that everyone on board is safe and comfortable,” the company does not have a policy that says it will refrain from serving particular foods for an allergic passenger.

“If they’re selling things like nuts, then they are actively placing a barrier to transportation for allergic people,” says Cathy Reader, a Victoria mother whose 4-year-old daughter experienced her first serious reaction to nuts just minutes after exiting an Air Canada flight, where the little girl had found an empty cashew wrapper while pulling her toys out of the seat-back pocket.

By the time the family arrived at the baggage area, her face and eyes had grown red and swollen, she had hives down her neck, and was sobbing. “When you have a nut allergy, you have to be prepared for nuts to be anywhere,” says Reader. “But it seems to me that on an airplane, you would want the risks to be lower than average, not higher.”

Reader approached Air Canada about the incident but was dissatisfied with the response, so she lodged a complaint with the Canadian Transportation Agency, the regulatory body that oversees the airlines, and expressed concern about Canadian airlines selling nuts.

In 2002, the agency had ruled that an allergy is not a disability under Part V of the Canadian Transportation Act, but that, on a case-by-case basis, people with allergies can be considered to have a disability. (In other words, if allergies give you the sniffles, chances are you won’t be deemed disabled; if those allergies could put you into anaphylactic shock, it may be a different story.)

If the agency decides that a particular airline’s allergy policy poses an “undue obstacle to mobility,” they can order changes, and those decisions are binding.

Instead of going through the formal process, Reader opted for mediation, which brings the various parties together to talk about their concerns. Canadian carrier WestJet came to the table for the meeting.

Using the feedback from Reader and passengers with allergies, the airline overhauled its allergy policy, making it one of the most progressive in North America when it comes to allergenic foods. (The airline does still allow pets in the cabin, however, which can be problematic for those with allergies to pets.)

WestJet had stopped serving peanuts years ago, but in 2007 it decided to also remove tree nuts and sesame from its “Buy On Board” menu, and it does not serve fish or shellfish. Some flight crews will make announcements asking other travelers to refrain from eating items such as peanuts or nuts on the plane.

However, that practice is not currently included in the airline’s official policy, so allergic passengers still won’t know in advance if that accommodation will be made. But flight attendants will speak to passengers three rows in front and three rows behind the allergic traveler, asking them to avoid the problem food.

If a pet-allergic passenger finds himself seated near a passenger with a dog or a cat, one or the other will be moved to a different seat; if the allergic traveler can’t be on the same plane as a pet, one or the other will be moved to a different flight free of charge.

“We do the best we can to provide a safe and secure environment for all of our guests, regardless of whether they have allergies or a disability or are in a wheelchair – whatever the case may be,” says Robert Palmer, a spokesperson for WestJet, who reminds people that the airline cannot promise an allergen-free flight.

“There are some particular challenges … but by no means does that suggest to us that people with allergies should simply be told not to fly. That’s just ludicrous. It’s limiting, it’s restrictive, and it’s just not fair,” he said.

As a result of those changes, WestJet won Reader’s business – and the business of an increasing number of allergic travelers and their families. “I haven’t even looked at other airlines lately,” says Reader. “I don’t want to sound like a commercial, but this whole experience has engendered some consumer loyalty in me.”

When flying most airlines, however, it’s still buyer beware – but it’s especially difficult for allergic travelers to protect themselves when the information they’re given is inconsistent or just plain wrong.

Next: Inconsistent information at ticket-buying stage

In the California study, researchers phoned airlines three times and asked the same series of questions, including: “Does your airline regularly serve peanuts?” and “Would you be willing to remove peanuts or tree nuts from a flight?” Airlines responded consistently only 31 per cent of the time. “As a consumer, you’re stuck between a rock and a hard place, because you can call three times and get three different answers,” says Comstock.

Rather than offering little more than a non-descript statement that protects them from lawsuits, she adds, airlines should formulate detailed allergy policies and post them on their websites so allergic passengers know exactly what they’re getting into.

“It costs an airline an extreme amount of money to divert a flight,” she notes, “so it would seem to be cost effective for them to have accurate information available to consumers about what food is being served on the plane, and whether or not people can bring pets.”

Part of the reason airlines have been so slow to respond to allergic passengers’ needs, however, could lie with passengers themselves, most of whom aren’t communicating their concerns to the crew. In the California study, just 12 of the 41 passengers who reacted on an airplane advised an attendant.

One peanut allergic business traveler in the study regularly doses himself up on antihistamines and inhalers before flying; and despite the fact that he still experiences significant symptoms when peanuts are served, he has never notified an airline.

Comstock found the allergic passengers’ tendency to “deal with it themselves” surprising. “I just couldn’t believe that individuals were willing to take that sort of a risk. Most of the individuals in our study were adults, and they felt like they had a good handle on their normal reaction progression – but you just never know which reaction is going to be the one that becomes even more severe.”

That’s something Steve Rosenbaum does not want to find out the hard way – so he is doing everything in his power to make Canadian airlines more allergy-friendly. The Toronto father of three young boys – one of whom has severe allergies to nuts and another to sesame – Rosenbaum wanted to arrange a family trip to Disney World, and called to find out if Air Canada would be willing to refrain from serving nuts on their flight to minimize the risk to his sons.

He received the standard message that states such a move would be unfair to other passengers and that he should bring the proper protection. He was flabbergasted.

“They don’t understand the whole concept of an EpiPen buying 15 minutes. If you’re at 38,000 feet, even if you use a second EpiPen, that might only buy you half an hour,” he says. (In most instances, reactions are brought fully under control by a single auto-injector; in others they are not.) At 38,000 feet, you’re in such a vulnerable position that they should be taking a more reasonable and responsible approach.”

Rosenbaum has since written letters and spoken with representatives from several major airlines, some of whom helped to accommodate him and his family, but stopped short of agreeing to change their airline’s policies.

Recently, he also launched a formal complaint to the Canadian Transportation Agency, where there are already eight food and environmental allergy complaints in progress. (In the U.S., more than 200 passengers have made allergy-related complaints in the past eight years.)

He recognizes that a “nut-free” aircraft is impossible. But he points out that airlines can significantly reduce the risk of exposure by not serving highly allergenic items such as peanuts and nuts, especially when, prior to boarding, a passenger has alerted the airline about a life-threatening allergy.

Now Rosenbaum hopes that more parents will speak up and ask for change. “We don’t need another child to die and then name a law after them like Sabrina’s Law,” says Rosenbaum, referencing the groundbreaking Ontario law that protects anaphylactic students.

“We need to do what we can to protect and educate. Because in an environment where you are locked in a cabin for two or three hours at 38,000 feet, you need to be protected and have rights. We need a reasonable and collaborative approach by both allergic passengers and the airlines.”

Laurie Harada, the executive director of Anaphylaxis Canada (now Food Allergy Canada), agrees that there needs to be dialogue among all parties – including passengers, allergists, airline management, flight attendants and food providers. In the meantime, Harada suggests allergic passengers and parents of allergic kids need to protect themselves by choosing airlines that will best accommodate their needs, by bringing their own food, and by wiping down armrests and tray tables as needed.

Harada also emphasizes that allergic travelers should not only speak up when they have been treated badly – and they should do it civilly – but also when they have been treated well. When airlines begin to understand that millions of North Americans suffer from allergies and a large percentage of them fly, she adds, they will be more likely to listen.

“Tell them, tell others, tell their bosses. If we give more positive messages about what’s working well, it can work to our benefit. It’s not just about what went wrong.”

Paige Humphreys plans to once again escape to sunny Hawaii this winter, and already, she’s hoping that nothing will go wrong. As usual, she will pack the nut-free snacks and the extra Twinjects for the flight.

She will also call the airline and tell the agents about her allergies, but she knows from experience that they may or may not make any special accommodations for her. “If I came in a wheelchair, they would make room for me. Lord knows I didn’t choose thing, but sometimes, they make it seem like it’s our choice,” says Humphreys.

“If you can get people who are addicted to cigarettes to not smoke for six hours, for goodness’ sake, I’m sure they could munch on potato chips and not eat peanuts or tree nuts for six hours, you know?”

From the Winter 2009 issue of Allergic Living magazine.
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