An anaphylactic reaction includes more than one of the body’s systems, such as the respiratory tract, gastrointestinal tract, the skin and cardiovascular symptom. Symptoms of an allergic reaction include tingling in the mouth, swelling of the tongue and throat, itchy skin or hives, difficulty breathing, abdominal cramping and vomiting. In a severe anaphylactic reaction, a person may experience a drop of blood pressure, loss of consciousness and even cardiac arrest and death.

One of the issues in managing peanut allergy is that symptoms can vary. A person may have had minor symptoms, only to suffer anaphylaxis on a subsequent exposure.

Because peanut allergy reactions can be severe, it is important that a person with this allergy carry an epinephrine auto-injector (EpiPen or Twinject) with them at all times. Peanut allergy is often considered a lifelong allergy, but research has shown up to 20 per cent of children may outgrow it by the time they reach school-age.*

*Source: 2010 FA primer. JACI

Prevalence

In the United States, the rate of peanut allergy in children increased by 3.5 times from 1997 to 2008, to a rate of 1.4 per cent. In Canada, it is estimated that 1.68 per cent of children and 0.71 per cent of adults have peanut allergy.

More on Peanut Allergy Statistics

Next Page: Not a Nut!

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 11 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 and the Canadian Transportation Agency.

Specifically, DOT said it was considering these options: banning peanuts from being served on flights; banning them from being served when there was a peanut-allergic passenger on board; or requiring a peanut-free zone around a person with severe peanut allergy.

DOT did state at the time that Congress had restricted it from using public funds to limit peanuts on aircraft without a scientific study showing passengers can have severe reactions to peanuts from airborne peanut particles, but the department appeared willing to forge ahead anyway.

However, two weeks later the department said it would comply with this requirement. A DOT spokesman told Allergic Living that the agency will still review all comments received. (See you can comment below).

Does a study exist?

Allergic Living has previously reported on studies showing that allergic individuals are at risk of serious reactions while aboard aircraft. A July 2008 study from the University of California’s Davis School of Medicine looked at allergic reactions aboard airliners among 471 people with severe peanut, nut or seed allergies. Forty-five of these passengers – almost 10 per cent – reported having reactions while in the air, with symptoms such as vomiting, wheezing, hoarseness, hives, diarrhea and light-headedness.

Six people went to an emergency department after landing, including one following a flight diversion for medical attention. Most study participants treated themselves, and in only three cases of severe reactions were the airline crew even made aware of the medical situation in progress.

Then in 2009, a study from the University of Michigan and the Food Allergy & Anaphylaxis Network (FAAN) found that one in three people who had an allergic reaction to peanuts or tree nuts aboard an airplane suffered anaphylaxis, the most severe form of a reaction.

Despite the findings to date, a spokesperson for DOT told Allergic Living that it has not received a study that would meet the requirements of Congress. However, he also acknowledged that such a study would likely have to be commissioned by DOT and, at this point, the agency has no plans to do so.

Still, the agency wants to hear the public’s views about peanuts being eaten in airplane cabins. The deadline to comment with DOT has been extended to September 23 (see below).

A ray of optimism

Many members of the allergy community have expressed disappointment in the delay of action by the transportation department on the issue of peanuts served on planes. But the allergist who led the University of Michigan study remains optimistic that change is coming.

Dr. Matthew Greenhawt told Allergic Living: “There have now been three studies about this issue over the past 10 years, countless reports from peanut allergic passengers or their families detailing adverse events, and just simply too much circumstantial evidence of a problem for this issue to be ignored further.”

He says it’s critical the scientific community understand that the government must have “further scientific evidence of the scope and nature of the problem before federal funds can be used to implement policy.”

The University of California at Davis, his own research and earlier findings on the issue from the Mount Sinai School of Medicine have laid the groundwork that a problem exists. But Greenhawt says the evidence has to evolve beyond self-reported allergy incidents, a common feature of the work on this issue to date.

“I am confident that one or more investigative groups will step up and deliver further scientific evidence that will hopefully result in a policy that can protect the vulnerable peanut allergic passenger at 35,000 feet,” he says.

And while stipulating the need for greater scientific evidence, DOT does seem genuinely aware of the issues involved for those flying with allergies.

“We asked for public comments because of the significant number of children diagnosed with peanut allergies, some of whom do not fly because of concerns over the serving of peanuts on aircraft,” the DOT spokesman said.

You Can Comment

• Visit DOT’s Enhancing Passenger Protection document (see point 12), and click “Submit a Comment.”
• Join Allergic Living’s discussion on the Talking Allergies Forum.