Managing food allergy at 30,000 feet - experiences, barriers, and facilitators
Published Online: 12/5/2024
In the United States alone, approximately 3 million passengers travel through US airports each day, with up to 5,500 US commercial aircraft in the sky at any given moment. Globally, the estimated number of scheduled airline passengers in 2022 exceeded 3.5 billion people, suggesting that a tremendous number of FA patients and caregivers are engaging in air travel each day. However, outside of a handful of well-publicized stories and articles written by patient advocates about specific experiences of air travelers managing acute FA reactions during travel, remarkably little is known about the present experiences, barriers, and desired facilitators of safe airline travel among FA patients and their families. Consequently, the aim of the present study was to systematically collect global data about patients’ and families’ FA-related airline travel experiences, attitudes and behaviors, in partnership with a large, international coalition of FA research and patient advocacy organizations.
The present FA and airline travel survey was developed and refined over a multi-year period beginning in 2020, during which input was solicited from an international team of experts in FA, clinical and health psychology, primary care, health behavior research, epidemiology, and survey research. The intent of the survey was to assess participants’ annual frequency and type of airline travel (i.e., international, domestic, business-related, etc.), experiences with airline staff and FA accommodations (e.g., pre-boarding, PA announcement, etc.), experiences with food allergic reactions while on a plane, factors that contribute to airline choices (e.g., price, proximity to home, FA policies, etc.), experiences with airport security/customs agents, and anxiety about airline travel. A total of 45 FA patient advocacy organizations and clinical research institutions from the United States, Canada, United Kingdom, Australia, and New Zealand were engaged throughout the survey development, refinement and dissemination process. Anonymous Research Electronic Data Capture (REDCap) survey links were distributed via email, social media, and QR code by our 45 partners in a coordinated fashion beginning in October 2022 and ending in January 2023. Survey data were recently published in JACI: In Practice in a research article led by Dr. Christopher Warren, Director of Population Health Research at Northwestern University Feinberg School of Medicine’s Center for Food Allergy Research.
The findings, collected via survey from over 4700 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.
Common sources of worry 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—the only first-line treatment for a severe allergic reaction—or allergy-safe foods confiscated or contaminated by airport security/customs agents.
However, most travelers 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.
This global survey also found that many travelers reported deliberately not disclosing their food allergy when travelling, with many expressing concerns that such efforts would lead to undesired consequences. Along these lines, these survey data suggest that many in-flight allergic reactions go un-reported—for example over 40% of in-flight allergic reactions captured by this global survey were neither reported to the flight crew, nor the airline upon landing. Moreover, 95% of allergic reactions were treated either with the traveler’s own epinephrine or an epinephrine auto-injector provided by another passenger. These observations suggest that incidence rates of in-flight allergic reactions calculated using data reported to current administrative databases may systematically underestimate the frequency of in-flight food allergic reactions. As such, further work is clearly needed to improve documentation of in-flight reactions and systematically implement policies that ensure the safety and well-being of all travelers.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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