Peanut Allergy, Air Travel and Public Policy

A friend of mine was recently on a flight. Her son has a peanut allergy. Once she took her seat, she heard an announcement that flight attendants would not be serving peanuts or any other nuts because of a passenger with a food allergy on the flight. All passengers were asked to refrain from eating these products. Afterward, my friend noticed the person next to her opening a bag of trail mix full of nuts. Thankfully, her son wasn’t flying with her that day.

Would a federal law banning peanuts on all flights prevent incidents like these and keep passengers with food allergies safe? Peanut bans and peanut-free buffer zones have been suggested before, dating back to at least 1998, but none of the proposed accommodations for passengers with food allergies have been passed into law. As such, airlines lack consistent policies when it comes to flying with food allergies.

Congress has actually prohibited the US Department of Transportation (DOT) from making rules restricting the distribution of peanuts, unless a peer-reviewed scientific study finds that airborne peanut dust can cause a severe allergic reaction. To date, studies have been conducted, but none have found this link. Therefore, DOT currently has no authority to establish rules with regard to peanuts and airlines (see the infographic I prepared below; you can click on the image for an interactive version with links to the relevant federal laws and notices).

2015 Peanut Allergy and Air Travel

Allergic Living recently interviewed Dr. Matthew Greenhawt about flying with food allergies, after two high-profile cases in which airline passengers experienced severe allergic reactions while in-flight. According to this expert, five studies in the last 10 years have looked at airborne peanut dust. However, none of these studies seem to have found the evidence necessary to fulfill the Congressional mandate in Public Law 106-69.

“…it is highly unlikely for a passenger to inhale nut protein from someone consuming nuts a few rows in front of him/her. There is no evidence that has been able to show that such dust circulates.” —Dr. M. Greenhawt, Research Director, Food Allergy Center and Assistant Professor, Division of Allergy and Immunology, University of Michigan

While this current research should bring some comfort to people with peanut allergy, an open bag of peanuts or trail mix on a plane can be a scary thing, even though the risk may be very low. Also, the Congressional mandate for a peer-reviewed study only focuses on airborne peanut dust, but what about allergens that might linger and accumulate on surfaces within a plane, like tray tables or arm rests, an issue Dr. Greenhawt raised in his interview with Allergic Living. (That’s why Food Allergy Research & Education and others recommend passengers with food allergies wipe down their seat area on the plane.)

Weighing both the evidence and the concerns, why not ban peanuts from all flights? At the same time, we know that even in peanut-free classrooms, people still make mistakes and bring in unsafe foods. Would a peanut ban or peanut-free buffer zones provide a false sense of security? And, how should airlines handle other food allergies?

In my opinion, more consistent policies for all airlines on how to accommodate passengers with peanut or other severe allergies would be an improvement. What do you think? Please share your thoughts in a comment below.

Additional resources:

For a detailed comparison of the various allergy policies of 11 major airlines, Allergic Living has compiled a 4-page chart to help people understand what accommodations they can request and receive.

Finally, there are at least two online petitions related to food allergies and air travel. One of these petitions was started by Elizabeth Goldenberg who authors the Onespot Allergy Blog. Her petition supports a total ban on peanuts. It’s earned over 15,000 signatures. Lianne Mandelbaum authored the second petition I came across last week, and it requires airlines to institute an allergen-free buffer zone for passengers with food allergies. To date, this second petition has earned over 30,000 signatures.

Update: I made revisions to the inforgraphic above on January 19, 2015 to include a key policy action from 2003 that came to my attention after reading The Not-So-Friendly Skies – Allergic Passenger Rights by the Allergy Law Project (ALP). For a more detailed analysis of your rights as an airline passenger with food allergies, I highly recommend you check out ALP’s post.

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Traveling to Dublin: Food Allergy Conference

I’m in the final stages of packing for our family trip to Dublin, in part so I can attend the third annual Food Allergy and Anaphylaxis Meeting (FAAM) 2014 presented by the European Academy of Allergy and Clinical Immunology (EAACI). For every trip we take—no matter where we’re going and especially if we’re flying—I prepare a “food bag” for my son with allergy-friendly treats and back-up meal options. Today, I made madeleines in the morning, and a batch of saffron buns just came out of the oven.

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Allergy-friendly food for my son, sans dairy and (raw/undercooked) eggs

FAAM 2014 will be a great opportunity for me to hear from allergists working throughout Europe. To give you some background info on this conference, according to the EAACI website:

“The FAAM 2014 scientific programme has three integrated and complimentary plenaries, presenting the basic, translational and clinical science of food allergy and anaphylaxis. The final plenary weaves these themes together addressing how we hope to help patients move from merely controlling their food allergy – which is difficult for them – to a cure – which is proving difficult for us.”

For those on Twitter, I’ll take a stab at live-tweeting from the event, providing highlights of what’s being presented and by whom. I look forward to sharing with you what I learn in Dublin in the coming days and weeks.

By the way, if you have any recommendations for allergy-friendly restaurants or products in Dublin (or Belfast), please leave a comment below! Thanks in advance for your help.

Whirlwind Trip to New England

Our jet lag has nearly worn off after a whirlwind trip to New England. Two weeks just wasn’t enough to see and do everything we wanted, but we had a wonderful visit nonetheless.

To our friends and family, I want to say a big thank you for helping to accommodate our son’s food allergies during our trip. Wherever we went, I was allowed to take over the kitchen and make nearly every meal so I knew it was free of his allergens.

I’m also grateful to those of you who thoughtfully prepared allergy-friendly meals and snacks—some of which appear in the photos below. You even had ingredient lists ready to show me, so I could double-check to make sure the food was safe. Even though I love cooking, to have a break from it was such a gift.

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So Many Allergy-Friendly Products

After visiting a couple mainstream grocery stores in New England, I was amazed by all the allergy-friendly products. I never make frozen pizza in Switzerland. Our grocery stores just don’t carry dairy-free pizza. Nor do they have coconut milk yogurt or ice cream, all the various milk alternatives or dairy-free macaroni and cheese. I would need to visit multiple organic markets and websites here to try and find the same selection of products.

So, we bought a few frozen pizzas one night and had them for dinner at my sister’s place. Of the three pizzas we made, one contained dairy-free cheese. Those of us who tried it weren’t big fans, but my food-allergic son ate three pieces. In the photo below, can you tell which slice doesn’t contain milk? It felt like a small victory being able to all eat pizza together that I didn’t have to make myself!

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While grocery stores in Switzerland have a much smaller selection of allergy-friendly products in comparison to those I visited in New England, I’m curious to learn about and share more allergy-friendly Swiss companies and products. In the meantime, I need to try making coconut milk ice cream this month. I’ll share the recipe if it turns out!


Vegan Blueberry Pancakes

Another culinary highlight from our trip involved foraging for wild blueberries in New Hampshire. Our little guy enjoyed sitting among the low bushes and eating the berries as he picked them, à la Blueberries for Sal. I added these delicious little berries to a vegan pancake recipe I use when we’re traveling or short on time and ingredients. Up at the lake cabin, wild blueberry pancakes are traditional breakfast fare for my husband’s family. I took great pleasure in sharing a safe version with our son.

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Dairy-Free Switzerland has quietly joined the ranks using Twitter. If you’re looking for more food allergy info and recipes, please follow me. Thanks so much!

Airplane Food and Refried Beans

We’ve arrived in Switzerland! Currently, my family and I are living in a temporary apartment until we find a permanent home. For the next few days, we’re enjoying some time playing tourist in our new city before having to focus more on our moving logistics.

Successfully Avoiding Airplane Food

For our two flights to Zurich, my husband called the airline and found out they could not accommodate our son’s milk and egg allergies, as well as his likely peanut allergy (a blood test indicates a positive results, but we still need a skin test). While we probably overreacted, we were concerned about how to keep our 1-year old son away from the airplane food. The best the airline could do was a non-dairy, vegetarian meal (no guarantee on eggs or peanuts not being ingredients or non-exposure to these ingredients).

To prepare for the flight, we avoided the plane food, and I bagged up some allergy-friendly grapes, crackers, dried-fruit cookies, homemade biscuits and a sunflower nut butter sandwich. It ended up being heavy on the starches, but we somehow managed to keep our little guy fed and happy. We also carried two EpiPens with us, as well as some children’s Benadryl (an antihistamine) in case of a milder reaction. FARE has info about airline travel that’s helpful, but I would have been even more nervous for our flights (although maybe more prepared), had I read it in advance.

Rediscovering Refried Pinto Beans

Yesterday, I was excited to find refried beans at the grocery store. Canned black beans were a staple at our house in the U.S. because my son loves them, and they’re quick to prepare. I usually don’t buy refried pinto beans, but we had them for dinner last night. I used leftover rice to make a quick side dish with chicken and steamed veggies. Then, I mixed it all together, and my son ate three servings. Yahoo! I enjoy cooking for both my kids, but I get a deep satisfaction when I make something my food-allergic son absolutely loves.

During our stroll downtown in our new city today, we saw lots of delicious bakeries, cheese shops and chocolateries, but we avoided them all. We ended up with dried mango from the grocery store, which the whole family could enjoy. I’ll have to make time with my oldest son and check out some of these other shops. For now, we’ll just have to leave his baby brother at home. I don’t want to put him unnecessarily at risk of a reaction. Hopefully we can find at least one local shop or restaurant that can provide him with some allergy-friendly options. To be determined…

My son is nearly 14 months old, and I know many of you have been living with food allergies for years. If you have any advice or suggestions for traveling with food allergies, please leave a comment below.

Updated December 8, 2013.