Air Travel Anxiety Amplified for Families Dealing with Food Allergies

The skies aren't always so friendly for patients and families affected by food allergies, who may often experience worry and anxiety regarding airline travel, according to a new study from the Center for Food Allergy and Asthma Research at Northwestern University (CFAAR).

The study will be published the morning of Dec. 5 in The Journal of Allergy and Clinical Immunology -; IN PRACTICE.

The findings, which reflect survey responses from more than 4,700 individual patients and families across the world, show that airline travel is a significant source of worry and anxiety for individuals managing food allergy for many reasons. 

Specific sources of worry for those traveling with food allergy include:

• Uncertainty regarding whether specific accommodations arranged during the flight-booking process will be honored when individuals arrive at the airport. For example, many respondents reported being told by airlines that food allergy-related cabin announcements would be made (20%), allergen-free "buffer" zones would be established (17%), or allergen-free food options would be available on board (23%), yet these promised accommodations were not granted in-flight. 
• Reportedly having to sign special waivers absolving the airline of liability (5%) or provide a signed doctor's note that they are "fit to fly" (12%) prior to boarding the plane.
• Potentially having epinephrine or allergy-safe foods confiscated or contaminated by airport security/customs agents. 

Food allergies are on the rise and affect more than 33 million people in the U.S., according to data previously published by lead author Christopher Warren, director of population health research at Northwestern's CFAAR, and current study senior author Dr. Ruchi Gupta, who directs CFAAR.

These data clearly show that air travel is a major stressor for those affected by food allergy -; to the point that food allergy-related airline policies were the single-most important consideration respondents identified when making air-travel decisions -; taking priority over factors like the proximity of the airport to their home, flight duration and price."

Christopher Warren, director of population health research at Northwestern's CFAAR

"We are not asking for the moon and stars, we just want reasonable accommodations that are promised in advance of travel to be honored at 30,000 feet," said study co-author Lianne Mandelbaum, a leading advocate for the implementation of airline safety measures to protect food-allergic passengers and founder of the non-profit No Nut Traveler.

"On every flight it is uncertain if and how crew members will accommodate nut allergies, and this adds tremendous unnecessary stress," Mandelbaum said. "Flying with food allergies is akin to a game of roulette, each flight a random spin around the wheel."

Mandelbaum has collected testimonials on No Nut Traveler that include people with food allergies being kicked off flights for asking for an announcement, being mocked by flight attendants and being ridiculed by other passengers. 

Passengers simply want the precautions they requested during the booking process and were told would be provided, Mandelbaum said. These include being allowed to pre-board the flight and wipe down their space to remove allergens and establishing a buffer zone around them where allergens won't be served. 

"When you get to the gate and everyone acts like you're crazy for bringing this up, that's a terrible experience," she said.

But not everyone flying with a food allergy feels similarly empowered to advocate for their medical needs during air travel.

"We also found that a disturbingly high proportion of surveyed travelers reported deliberately not disclosing their food allergy when travelling, with many expressing concern that such efforts would lead to undesired consequences," said Warren, who also is an assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. 

"Most travelers we surveyed expressed confidence that their anxiety could be substantially reduced if airlines systematically implemented appropriate policies, and around one in three respondents could recall a specific experience where an airline or flight crew member went 'above and beyond' to accommodate their food allergy, accommodations that were often related to the crew member's own personal experiences with food allergy," Warren said. 

"On the occasions when I have been called upon to treat in-flight health emergencies and have personally cracked open the in-flight medical bag, I have been pleasantly surprised each time I found unexpired epinephrine auto-injectors ready for immediate use," said senior author Gupta, who has personal experience effectively managing food allergy during air travel. "However, I know that this is not always the case. Every traveler and family at risk of anaphylaxis deserves the peace of mind that their potentially life-saving medication is unexpired and ready for use in every emergency kit."

This study engaged more than 40 global research institutions and patient advocacy organizations to better understand the experiences, barriers and desired facilitators of safe airline travel.

The title of the article is "Understanding experiences, barriers, and facilitators of safe airline travel: A global survey of food allergy patients and caregivers."