These included:
•  making any accommodation request of the airline;
•  getting flight crew to make an announcement asking fellow passengers not to consume peanuts or nuts;
•  requesting a peanut- and tree nut-free buffer zone;
•  asking for a peanut- or nut-free meal;
•  wiping off the seat’s tray table;
•  eating only food brought from home;
•  avoiding using the airline’s pillow or blankets;
•  and requesting a certain section of the cabin (not as significant).

Greenhawt and his colleagues found that of the 3,273 participants from 11 countries who took part in the survey study, 349 reported having an in-flight reaction.

“Looking at those who reported a reaction, there were clear differences in what was asked (of the airline) and what wasn’t asked,” he says. So the allergist sees a definite benefit of informing the airline of a serious food allergy.

The study, published in the Journal of Allergy and Clinical Immunology in Practice, involved participants in the United States, Canada, Australia, New Zealand and several countries in Europe and Asia.

Greenhawt acknowledges that many airlines will not offer accommodations such as a PA announcement asking fellow passengers to refrain from eating allergenic snacks.

However, “I do think pre-notification is important, regardless of whether it’s rebuked by the airline or not,” he told Allergic Living. “If you don’t ask and don’t make an effort, you will never receive anything. And certain airlines will be more receptive than others.”

He believes there are lessons from the mitigating behaviors for passengers, for doctors to communicate to patients, and for airlines. While beyond the scope of his study, he agrees that airline allergy policies designed to protect a minority of people, no matter if reasonable, can cause controversy.

“But choices will have to be made at some point,” he says. “Every business wants customers to have a positive experience, and I do believe airlines are concerned about this [allergy risks], but it’s more a matter of not knowing what to do. Hopefully, an airline might also look at a study like this and see some solutions.”

One thing that might grab their attention in this international study is that, among American respondents, an astounding 61 percent reported not flying again after receiving a diagnosis (usually for a child) of a peanut- or tree nut allergy.

Next: Key Recommendations to Allergic Travelers

“Extreme Adventures” appeared at the top of the page, followed by a list of activities on the tour. I held my breath as I read the descriptions, to the effect of: “Travel through river canyons at 100 kilometers per hour in a jet boat!” “Bring your courage along as we bungee jump over Queenstown!” “Fall out of a plane from 14,000 feet over magnificent scenery.”

I stopped there. “Are you crazy?” I e-mailed back. “I hope these activities cost extra, and you can’t afford them.”

“Everything is included except for skydiving,” she replied, inserting a smiley emoticon.

Not only did I think she was nuts for considering jumping off a mountaintop attached to a rubber band or parachuting from a plane, but also for sharing this information with me. Having grown up watching me deal with her severe milk allergy, she knew I was wired to worry.

When dining out, I’d interrupt while she was ordering, urging the waiter to check the dish’s ingredients before she had a chance to ask herself. Once the meal arrived, I’d lean over her plate to inspect the food for any trace of butter or cheese.

But that anxiety was nothing compared to what I felt after Arielle, at age 16, had an anaphylactic reaction requiring three doses of epinephrine and hours of monitoring in the emergency room.

From that day on, whenever she was headed out to meet friends, I’d stop her at the door and ask where she’d be eating and if she had her medications with her.

She’d glare back at me. “You can’t keep me in a bubble for the rest of my life.”

***

She was right. Ultimately, I wanted what she wanted – for her to enjoy the same activities and freedoms as any teen. I worked on backing off, and reminded myself that she had always been careful: checking labels, alerting servers and managers to her allergy and passing up a food when she couldn’t be certain whether it contained dairy.

With planning and proper precautions, she spent two weeks without incident in Provence through a high school exchange program. (Full disclosure: my husband and I followed her to France. We stayed approximately 30 miles from her home base and never saw her, but felt reassured that we were only a car ride away in case of an emergency.)

Next page: The trip of a lifetime

Robert Palmer, WestJet’s manager of public relations, spoke with Allergic Living’s Gwen Smith this week about the details of his airline’s new forward-thinking food allergy policy.

Allergic Living: I have to start by asking: Why did WestJet make these few policy changes that are quite groundbreaking in terms of food allergy accommodation?

Robert Palmer: “I think the Allergic Living write-in campaign [to WestJet and Air Canada] made us aware that this was perhaps a more serious issue within the allergy community than we may have thought. And that’s the role of allergy advocacy.

“As an airline, we try always to strike a balance based on the information we have, to make the best decisions we can at the time. But that’s not to say that we ever have all of the information that we need, and so it was helpful to have brought this to our attention.

“[That] caused us to take a serious look at whether our policy was the best that it could be, given that we have so many constituencies to serve within our guest community. That’s always the challenge.”

AL: It’s pleasantly surprising to hear that the voices of the community made a difference.

RP: “Well, policies are living, breathing documents and we need to look at them when new information arises that suggests perhaps a change is in order. With respect to the work Allergic Living did, that’s what raised the profile of the issue. The letters [from the allergy community] made a big difference. I still have them at my desk. They’re a constant reminder that this is an extremely important issue.”

AL mentions that people won’t be aware, but WestJet’s talks with the allergy community – including allergy groups and well-known allergists and organized by Anaphylaxis Canada – about potential policy changes have gone on intermittently since last March. WestJet discussed in the talks that it was complicated both with internal communcations and in a highly regulated industry to make sure something as simple as a one-minute p.a. announcement could be done.

RP: “They (Transport Canada) don’t care if we say: ‘And happy birthday to Ted in Row 6C’, but if we’re going to institutionalize a formal announcement as part of our ‘suite of announcements’, it has to be approved and then translated (English and French). And then it has to go into the Flight Attendants’ Manual or FAM.”

Booking with Allergy Accommodations

AL: Let’s talk about some of the specifics of flying under your new policy. With booking, you need to go through the Reservations centre?

RP: “Yes. They can identify themselves as having the nut or peanut allergy, and then a special coding will be put on their file that identifies them as having that allergy.

AL: But should you still tell Reservations every time if it’s on your file?

RP: “I would, just to be on the safe side.”

AL: So Reservations is aware of the allergy accommodations request. Now the person is boarding. When do you approach the flight attendant about the p.a. announcement?

RP: “I would do it as quickly as possible either while boarding or while people are getting settled but before the doors close. The flight attendants have got a few minutes because they’re walking up and down the aisles, helping people stow their bags. That’s the time.”

AL: Do you need to alert the crew at the gate before boarding.

RP: “I’m not sure there’s much point as those people are not going to be on the flight.”

Next: Buffer Zones and EpiPens

See also: Q&A with Robert Palmer, WestJet spokesman.

• It is now posted on WestJet’s site that flight attendants will make one public address announcement about food allergies when a passenger self-identifies as being allergic to peanuts or nuts and requests that an announcement be made.

An update in the Flight Attendants’ Manual gives the flight crew this script (in English and French): “We have a guest traveling with us today who has a severe allergy to peanuts/nuts. We ask that you do not open or consume any peanuts, nuts or nut products during this flight. Thanks for your help.”

• WestJet notes in its policy that it can’t guarantee an allergen-free environment, but also says it understands the serious medical issues involved with nut and peanut allergies. Its flight crew will now ask a passenger who identifies as having a nut or peanut allergy whether they have an epinephrine auto-injector with them in case of emergency.

• As a backup precaution in case of anaphylaxis, WestJet has inked a deal with the makers of EpiPen to buy EpiPen auto-injectors (child and adult size) for its fleet of 91 planes. (Aircraft medical kits otherwise only contain vials and syringes for a medical professional’s use.)

• The airline’s flight attendants will also create a buffer zone around a person with a food allergy. Those seated within three rows of a passenger with these allergies (the row the person is seated in, plus two rows ahead and two behind) will be asked to refrain from eating products that contain nuts or peanuts. (This practice was available before the updated policy.)

• Animal allergies: While it won’t satisfy asthma advocates who have been lobbying to keep all pets out of the cabin, WestJet has reduced the number animals allowed in the cabin from four to two. Pets must remain in their carriers. People are supposed to book with pets in advance and most flights are pet-free. Check if yours will be at: 1-888-937-8538.

What they serve: No snacks that contain peanuts, nuts or sesame. The policy advises that some products may have warnings that they “may contain” traces of such allergens. For this reason, WestJet recommends allergic passengers bring their own food.

Flight Booking: Must be done through the Reservations desk rather than online to receive the food allergy accommodations. Call: 1-888-937-8538.

Reaction to the Policy: “It looks like such a small thing, but it’s a hugely important accommodation,” Gwen Smith, Editor of Allergic Living magazine, said of WestJet’s revised allergy policy that provides p.a. allergy announcements for those with serious peanut and nut allergies. “I am delighted to see it and I hope other airlines will follow suit.”

Air Canada’s New Allergy Policy

As of Dec. 2, Air Canada has posted its first formal allergy policy on its website.

• The airline will accommodate passengers with peanut or nut allergies with a small buffer zone if certain steps are followed in advance:

- The booking requesting the buffer zone is made at least 48 hours in advance with Air Canada Reservations.
- The allergic traveler has had a physician complete a “Fitness for Travel” medical form to confirm the nut or peanut allergy. The form needs to be faxed to Air Canada’s medical assistance desk for approval. (Air Canada hasn’t yet confirmed how frequently a new form must be completed, though a spokesperson suggested a form might be good for more than a year.) The passenger keeps the form, which has to be faxed to the desk before every trip requiring buffer zone accommodation.

• Buffer zone size: The policy says that, in economy class, a buffer zone will include the row of seats the allergic person is sitting in, as well as the row in front and behind. In business class, the buffer zone is the bank of seats (often two) that the person is sitting in.

• Air Canada makes clear that on international flights, even within a 3-row buffer zone, it can’t be certain that meals served are nut- or peanut-free. The same is true in executive class in all flights. (The issue is international catering services with multiple suppliers, some of whom use nut products, and the risks of cross-contamination in prepared meals.)

• The airline says it can’t be responsible for other passengers who bring peanuts or allergenic foods onboard.

Next: Booking, Policy Reactions

• Flying Allergic: The risks, the facts about airplane reactions, and the push for safer skies. [Read more]
• The Airlines on Allergies: Our mega-chart of airlines’ allergy policies. [Read more] Extra: Flying Tips. [Read more]
• Natural Asthma Strategies: Some wellness approaches prove successful at reducing symptoms.
• Winter Baking Special: Great cookies, squares, pies and more. Plus, gluten-free favourites.
• Healthy Home: Stephen Collette’s winter tune-up for your indoor air.
• Celiac Disease: The scientist behind the celiac pill.
• Allergic to the Cold: Living with cold-induced urticaria. [Read more]
• Allergy news: Surge in reaction hospital admissions [Read more]; the common cold and asthma [Read more]; new allergy tests; Q&A with peanut-allergic ski champion Steve Omischl. [Read more]
• Ask the Allergists: with Drs. Susan Waserman and Wade Watson. [See Columns]
• Breathing Space: The Lung Association on babies and headache pills. [Read more]
• Surprising Allergy Facts: Winter trivia. [Read more]
• Parting Shots: The girl who’s allergic to it all. [Read more]

BUY THIS ISSUE

We’re the people you may have heard about in the news. On February 15, we got tossed off a Mexicana Airlines flight simply because I’d asked that the attendants not serve peanuts. I’m at risk of anaphylaxis to both peanuts and tree nuts, and distributing peanuts throughout an airplane could be dangerous to me. When I finally got home to Calgary, I complained to the media about the poor treatment that my children and I received while waiting for Mexicana to decide –over several hours – what to do with us. CBC-TV ran a news item, then posted my story online. The fallout has come as a complete shock.

There are now over 800 mostly vitriolic replies. Some people have wished I would choke on a peanut and die; I am getting hate mail at my home. I have been saddened and disturbed by the response of fellow citizens. They clearly don’t comprehend the seriousness of anaphylaxis. From the airline to online, I’ve been treated like a troublemaker. I’m actually anything but. I just happen to have a medical condition that requires the consideration of others.

I also feel my “real” story isn’t out there. So here, for the record is my recent travel experience as an allergic individual:

I BOOKED A FLIGHT to Mexico for myself and my two kids, aged 8 and 3 years old. I informed the booking agents that I have life-threatening allergies to peanuts and requested, in advance as I always have, that no peanuts be served on my flight. I was then told that to have this happen I should speak directly to the Mexicana flight staff upon boarding. As it was explained, there isn’t a real communication process that’s used to let the booking agents inform the flight attendants of this issue. And even if there was, I was told, it could get lost and besides, ultimately, it’s the flight attendants who are in charge of serving – and not serving – peanuts on a flight.

So my family and I board in Calgary to fly down to Puerto Vallarta on February 4. I ask the flight attendants as soon as we got on to please not serve peanuts. I’ve successfully made such a request many times on previous flights. These attendants did look a little confused by my request, but then said: “No problem, we can understand your situation.” We all get down to Puerto Vallarta safely and comfortably.

My family has a great two weeks in Mexico. On February 15, we get to the airport to leave to go home. We have a short flight from Puerto Vallarta to Mexico City and then are to continue on from there to Calgary. My children and I board the plane, get to our seats. I tell a flight attendant right away that I am deathly allergic to peanuts and ask that for this 11/2-hour flight that they please not serve them. Mexicana crew all begin to tell me that it is their “right” to serve peanuts. I tell them that there is a possibility of me not being able to breathe.

More staff come by to tell me that they “have to” serve the peanuts. They offer me a seat at the back of the plane. I don’t think they realize that the entire plane will eat the peanuts – so it’s not a solution for me to be stuffed in the back, behind all the peanut-eating. This situation has now delayed the plane about 15-20 minutes. So a Mexican lady stands up in the middle of the plane and explains in Spanish my situation to the rest of the passengers. Then the flight attendant explains in English what my situation is. Passengers start saying to just not serve them the peanuts! One man yells out: “I can live without peanuts for an hour!”

So the flight staff all nod their heads and everyone is ready to go. Then the pilot makes the decision to ask my son, daughter and me to leave the plane. A lady behind me starts yelling that I am not listening to the staff about going to the back of the plane.

“I am waiting for them to tell me what
I have to do when a staff member yells
at me to get away from the plane.”

At this point, my children start to cry because there is a lady yelling at us and we are very rudely asked to get off the flight. So I pack up and we walk out of the plane. I am waiting for them to tell me what I have to do when a staff member yells at me to get away from the plane. We walk into the terminal and sit down on the floor in a lump, crying. The plane sits there for another 15 to 20 minutes while they rummage through the baggage hold for our bags. I’m sure people are missing connecting flights.

A staff member finally instructs us to go back to the check-in counter to see if there is another flight. We stand at the counter for an hour as agents are supposed to be trying to get us on a flight. Not one person from the airline speaks to us.

I finally demand to speak to the supervisor. Another 30 minutes later, an agent says Mexicana has booked us on a flight the next day – but they are not sure if the airline will fly us home because they “have to” serve the peanuts. We go to a hotel and an airline representative calls the room. They’ve switched us to another airline, but I’m told I have to get a letter from the doctor in Mexico by the morning explaining that I have a peanut allergy. How am I going to go to a doctor in Mexico in the next 10 hours, and how will he even know that I have an allergy? I told the representative this was a ridiculous request. She said she just wanted me to know I might have issues again without a medical note.

At no time during this entire situation did one person tell me they wanted to help me and my children, or that they were sorry this was happening. It felt like I was a criminal. My kids and I had to spend another night in Puerto Vallarta and the next day Mexicana got us on an American Airlines and we got home.

I’m not sure what is going to happen in regards to peanuts on airplanes. Many airlines that claim not to serve peanuts still offer mixed nuts bags for sale. I am deathly allergic to all peanuts and tree nuts – so this is a huge concern for me as someone who wants to be able to travel.

“I have never realized that I am hated
by a large part of the population”

I have had enough of this peanut issue and people’s “right to have their peanuts.” I am not asking that the plane be fumigated, or that the seats need to be shampooed. I am just asking that the packages of peanuts that are sitting in a small box are just not served on a particular flight. Here’s a thought: hand the customers their package of peanuts when they leave the plane … so they don’t miss out.

It hurt so much that total strangers were yelling at me and my children. After the abuse I’ve taken on the CBC site, I’m actually scared to tell anyone again that I am allergic to peanuts and nuts. I will now be very careful who I tell and who I don’t tell.

I have never realized that I am hated by a large part of the population – until I read those comments. There were a couple of days that I was waiting for a jar of peanut butter to be thrown through my window at home.

Having a peanut allergy is not a choice! We are born with it. Those of us with allergies don’t deserve to be subjected to hate mail and having people hate us because we are different.

I will fly again on an airplane again that doesn’t serve peanuts. But I will always remember the way that I was treated, the way I was made to feel. I do wish everyone here the best of luck dealing with their food allergies. Keep advocating because, there’s clearly a long way to go.

A recent study finds that one in three people reacting to peanuts and tree nuts aboard an aircraft are experiencing anaphylaxis, the most serious form of allergic reaction.

Of particular concern to researchers from the University of Michigan division of allergy & clinical immunology and the Food Allergy & Anaphylaxis Network was that only 10 per cent of survey participants who had an in-flight reaction used an epinephrine auto-injector to treat symptoms. (Most opted for antihistamines, which allergists don’t consider adequate for anaphylaxis.)

“These symptoms are not just – ‘I’m getting a little itchy, I’m getting hives, my mouth is itchy’. These are people having hives, vomiting, diarrhea, wheezing,” allergist Dr. Matthew Greenhawt, co-author of the study, told Allergic Living. As well, few of these passengers informed the flight crew that there was a reaction in progress.

Of 285 people who expressed interest in this study, 150 were chosen to participate since they (or their children) had experienced one or more allergic reactions aboard a U.S. commercial flight. This group answered the full questionnaire, and 50 of those individuals fit the criteria for having anaphylaxis while a passenger on a plane.

“If you think about the circumstances: you have 50 people who had a fairly severe reaction on airplanes in the middle of nowhere, there’s a lot of risk to be taken if you’re just going to have Benadryl,” said Greenhawt, whose study appeared in the November issue of the Journal of Allergy and Clinical Immunology. As well, six of the 15 allergic passengers who did receive epinephrine required a second dose while still in the air.

Greenhawt says the discrepancy between the severity of symptoms and the passengers’ hesitation to use auto-injectors shows the allergists’ message of what constitutes anaphylaxis, and when to use epinephrine has yet to get through. “Perhaps that’s the next step in education: to explain exactly when we want them to use their epinephrine,” he said.

Another interesting point in the study was that 88 per cent of study participants continued to fly despite a reaction in the skies.

See Also:

• Air Travel & Allergies: 8 Factors That May Reduce Risks.
• Exclusive Chart comparison – 11 airlines and their food, pet allergy policies.
• Air Canada Ordered to Offer Nut-free Zones.
• What the Canadian Transport Agency Said – Highlights of the Ruling
• What about Pet Allergies on the Plane?