Inconsistent allergy policies are leaving travelers stressed and angry. What can be done?
Dr. Brett Greenberger vividly recalls the dream vacation that imploded. Four years ago, the Baltimore psychiatrist and his wife Emily, a social worker, planned a Caribbean getaway for the family – including their three kids and his parents. Since their daughter Lily, then 5, has serious allergies to peanuts and nuts, the couple researched staying in a condo on the Leeward Island of St. Kitts, figuring they could do their own cooking and ensure the food was safe.
They looked into flights. The times worked well with American Airlines, which doesn’t serve peanuts, so the next step was to inquire whether nuts would be served on these particular routes. “We were assured they would not be,” says Greenberger. So they booked the seats and prepaid the condo. On their travel day, the flight from Baltimore to Miami went well. The family checked in at the ticket counter in Miami – just to confirm that nuts wouldn’t be served on the flight to St. Kitts.
The first hint of trouble came when a supervisor responded that this was up to the crew. When the Greenbergers headed to the entranceway of the plane and began to speak to a flight attendant about Lily’s allergies and previous assurances, she told them that nuts were being baked, as they spoke, in the front ovens to be served in first class. The couple immediately noticed the strong aroma.
Next, the pilot and gate supervisor were there, telling them that the snack service could not be changed and further, the pilot felt their child and her serious allergies presented a flight risk to the whole plane. With Lily now sobbing, the Greenbergers say they were not allowed to board.
So could they get another flight? Not to the Caribbean. The airline’s representatives said they could fly them elsewhere but heated nuts would be served in first class on all St. Kitts flights. “Multiple people from the airline said there would be no issue with nuts, then one individual and the pilot made the decision not to accommodate or problem-solve in any way. It was just not fair,” says Greenberger.
These are turbulent times for North Americans traveling with peanut or nut allergies. On the upward bounce, some airlines are taking positive steps forward. JetBlue and Southwest Airlines often receive positive reviews for allergy awareness, and Canadian airline WestJet has become the shining star of food accommodations. (WestJet  doesn’t serve peanut or nut snacks and, to reduce the risk of residue, its crews will make an announcement asking fellow passengers to refrain from eating nut or peanut snacks.)
But on the stomach-flipping downward bounce, the negative stories and tales of inconsistent promises about allergy accommodations abound. In Allergic Living’s view, they are becoming more frequent.
One of the big problems is that some airlines’ own staff members seem unaware of their employer’s exact policy on food allergies.
In a 2008 study from the University of California at Davis, researchers phoned several airlines three times and asked the same questions, including: “Would you be willing to remove peanuts or tree nuts from a flight?” Airlines responded consistently only 31 per cent of the time. Anecdotally, this situation persists with many carriers.
Next: Anaphylaxis in the Air
On board, it’s the same story: some cabin crews will serve alternative snacks and make a P.A. announcement that there is someone on board with a nut or peanut allergy and ask passengers not eat those foods. But customers often don’t realize that, at most airlines, these are the sympathetic actions of an individual crew, not a policy you can rely on.
During the recent years of a tough economy, large carriers like United and American Airlines also became attached to the prestige value of tree nuts (usually almonds and cashews) to attract the high-paying customers in the first-class section.
“The warm nuts are something we can offer the premium passenger to make the travel experience better and to help differentiate our product,” said American’s spokesman Ed Martelle.
While food allergy consumers need airlines to be overt about their practices regarding peanuts and nuts especially – since they are common snacks and potent allergens – some airline websites offer only a terse allergy policy. Offering consumers adequate online information is helpful – and cost-effective. Case in point, the Greenbergers ended up with a full refund on their seven flights.
The idea of reducing the risk of reaction at 35,000 feet often seems like a no-brainer to those living with food allergies. But there are those who strongly object, and not just those who like their nut snacks. From the peanut grower to the big confectioner, there are lobby groups that say there’s no proof that peanuts or nuts in an airline cabin cause severe reactions.
This came up in late 2010, when the U.S. Department of Transportation (DOT) proposed banning the serving of peanuts on planes. DOT backed away from such a ruling because of a law, passed in 1999, that demands a peer-reviewed study that shows “severe reactions by passengers to peanuts as a result of contact with very small airborne peanut particles” before any peanut-restricting edict can be issued. But on a smaller scale, there is, in fact, evidence of risk.
Three studies have examined air travel and found that, based on passengers’ reports, there have been peanut and tree nut reactions. In the University of California study of 471 people known to have severe peanut, nut or seed allergies, almost 10 percent reported experiencing a reaction.
Of significant concern in a 2009 study  from the University of Michigan was that one-third of the reactions were consistent with anaphylaxis. Dr. Matthew Greenhawt, an allergist and author of the Michigan research, says that a more rigorous study “would require diligent in-flight assessment of how peanut or tree nut particles may distribute within a pressurized cabin, how different cabin configurations may alter this, and how these dynamics may be affected by different aircraft models.”
That’s tough data to come by, especially since the airlines haven’t been open to that kind of aircraft scrutiny. Greenhawt says that while proof beyond self-reporting is ideal, “the passenger reports continue to pour in and should not be dismissed.” Organizations like FARE (Food Allergy Research & Education) and Allergic Living also receive e-mail accounts of reactions on flights. While most of them are mild, all of them are troubling when at such a distance from a hospital.
Next: Proving “Fitness” to Fly
It’s interesting that while sectors of the food industry raise doubts about the seriousness of allergy risks, Allergic Living actually sees an increase in allergic passengers being questioned about whether they are “fit to fly” – the airline term for being healthy enough for air travel.
In the Greenbergers case, “it was like Lily was the perpetrator of the problem,” says her mother Emily. (It should be noted that Martelle says American’s view is that “there are discrepancies between what the Greenbergers are now saying and what they said during the event.”)
Anne Thompson, co-founder of Illinois’ MOCHA support group, relates that her son Andrew almost lost his seat due to his peanut and nut allergies in 2011. The high school student, an elite rower, was heading to a national regatta. Andrew checked in with United at O’Hare International, just to confirm that no peanuts would be served (that is United’s policy). The agent was concerned, since the airline “couldn’t guarantee” there would be no nuts in the cabin. The teen phoned his mother in a panic – the agent might not let him board. He was allowed on – but by no means was it a given.
Also boarding at O’Hare in the fall of 2011 was Amy Wicker and her family. Wicker told United flight attendants on the Phoenix-bound flight that her daughter has severe tree nut and peanut allergies. She’d done this in past and found crews willing to change snacks or make an announcement that there was a child with nut allergies on board. This time, Wicker was told that warmed nuts were being served in first class, with cashews being baked in the front and almonds in the back.
When she asked if an alternative could be served, the reply was: “Ma’am, if you don’t feel comfortable flying, you’re welcome to get off the plane.” Appalled that a snack seemed to trump a child’s health, Wicker gave her daughter a pre-emptive dose of Benadryl for a tense, three-hour flight.
Air Canada  instituted a policy in late 2010 in which a passenger can request a “buffer zone” of three nut-free rows, but to qualify for it, you need a doctor to complete a medical form. There have been incidences of the airline’s staff telling allergic passengers that they can’t board without such clearance – a misinterpretation. The new policy says you need the medical form if you want the allergy buffer zone, but not if you simply wish to take your seat.
All the gut-wrenching over whether people with allergies will be “allowed” to fly, makes Gina Clowes’ blood boil. After taking a flight where nuts were being heated, Clowes, the founder of the Allergymoms.com  website and a columnist  for this magazine, asked the family allergist whether that environment was safe for her son, who’s highly allergic. While Greenhawt’s view is that such warming poses little risk for airborne reactions, Clowes’ allergist counseled not to chance it in her son’s case.
As the family had already booked flights with American out of Pittsburgh, she phoned the airline’s disability desk to see if it was possible to forego heating the nuts. At first she was told to just ask at the gate. When Clowes pressed for a firmer answer, “he said, ‘I don’t know if your son can fly, I’m going to require a letter from your doctor that says he’s safe to fly.’
I said: ‘I’m going to require you to put that in writing.’” Clowes blogged about the incident, generating 10,000 views. The airline got in touch with a solution: the family was put on an early flight where nuts wouldn’t be served.
Wicker’s experience got her fired up about the rights of allergic travelers. The former TV reporter has now launched Allergysafetravel.com  and has begun speaking to airline executives about the need for accommodations. She and Thompson are both of the view that some airlines simply may not be informed enough about the issues that passengers with serious allergies come up against with the nut-snack culture in our skies. American, for instance, moves about 250,000 passengers every day. With that kind of traffic, it’s hard for food allergies to get on the radar.
“There is such an education opportunity with the airline industry,” says Thompson. Wicker asks: “Has anyone sat down with the airlines to say, ‘this is a big and growing issue’? A complete ban on nuts isn’t necessary, but what can we do to work together? I think the solution is there.” The big airlines need to hear reasoned arguments and more of the demand for change.
“We don’t always advocate for this health condition in a very serious way,” says Clowes. Her blog post generated hundreds of messages about reactions or bad treatment, “but people are not reporting incidents. Write to the airline; file your complaint with DOT online. The form takes five minutes.”
Even the Greenbergers, who salvaged their vacation by driving to Disney World, are hopeful about the outlook for more accommodations in the air. “The generation of people with food allergies is growing up and they’re going to be the business people of the future,” says Brett Greenberger. “Those are the customers who matter to the airlines.”
Had a good or bad experience flying with food allergies? Tell us about it at firstname.lastname@example.org.
• 8 Factors that May Reduce Allergy Risks in the Air 
• Allergic Living’s Comparison Chart  of Airlines and Allergy/Gluten Policies