Passengers engaged in eight mitigating factors less likely to report allergic reaction, researchers find

Published on March 16, 2013 at 12:43 AM · No Comments

Few situations can provoke more anxiety for people with peanut or tree-nut allergies than having an allergic reaction while flying on an airplane and being unable to get help.

But in a new study, published in the Journal of Allergy and Clinical Immunology-In Practice, researchers found passengers who engaged in eight mitigating factors were less likely to report an allergic reaction.

This is the first study to show that in-flight peanut and tree nut allergy is an international problem, says lead author and pediatrician Matthew Greenhawt, M.D., M.B.A., M.Sc., of the University of Michigan's Food Allergy Center and C.S. Mott Children's Hospital. Past research has focused on the U.S. and only on those who had reactions, instead of including those who did not.

Greenhawt, and his co-authors from Allergy & Anaphylaxis Australia and the International Food Allergy & Anaphylaxis Alliance, asked passengers to answer an online survey about their in-flight experiences. More than 3,200 people from 11 countries completed the survey. Of those, 349 reported having an allergic reaction during an airline flight.

Passengers with peanut/tree nut allergies who reported taking these actions had significantly lower odds of reporting a reaction:

(1) requesting any accommodation
(2) requesting a peanut/tree nut-free meal
(3) wiping their tray table with a commercial wipe
(4) avoiding use of airline pillows
(5) avoiding use of airline blankets
(6) requesting a peanut/tree nut-free buffer zone
(7) requesting other passengers not consume peanut/tree nut-containing products (8) not consuming airline-provided food

"Flying with a peanut/tree nut allergy is equal parts frustrating and frightening for allergic passengers. These eight passenger-initiated risk-mitigating behaviors may help clinicians wishing to advise concerned patients planning to fly commercially," says Greenhawt, of U-M's Food Allergy Center.

Greenhawt says most airlines still serve peanuts and tree nuts or snacks and meals with peanuts or tree nuts included. Canada is the only country with any formal policy in place, which requires a 3-row buffer zone with advance notification only on Air Canada flights, he says.

"So these behaviors are simple, practical measures which may offer some protection and reduce anxiety until formal policies are implemented."

The study also found that epinephrine, a common and effective treatment, was drastically underused in-flight. Only 13.3 percent of passengers reporting a reaction received epinephrine as treatment. Flight crews were notified regarding 50.1 percent of reactions. In a similar study of US passengers five years ago, Greenhawt noted a similarly low rate of epinephrine use.

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