Allergic reactions during air travel are 10 to 100 times less common than on the ground, according to a recent review.
Researchers critically examined the risks and prevention strategies for food-allergic passengers during air travel. The review analyzed literature from 1980 to 2022, with a focus on whether peanut and tree nut allergens pose significant risks through airborne transmission in aircraft cabins.
The review, published in Archives of Disease in Childhood, highlighted that allergic reactions during flights are 10 to 100 times less common than on the ground, a finding linked to the controlled conditions of air travel, including precautions taken by passengers and the high-efficiency filtration systems used in aircraft. The reduced incidence is partially attributed to the precautions food-allergic passengers often take, such as avoiding airline-provided meals and bringing their own food, though the review acknowledges that differences in exposure settings may also contribute to the lower risk. Simulated studies of airborne allergen exposure demonstrated minimal risk; for instance, when peanut allergens were aerosolized during deshelling, they were detectable only at close range and briefly during the process. Airborne allergen levels dropped quickly due to the efficiency of modern aircraft’s high-efficiency particulate air filtration systems, which remove 99.97% of particles as small as 0.3 μm. Real-world studies confirmed that peanut allergens were undetectable in cabin air samples, even during active peanut consumption.
Surface contamination was identified as a more significant risk than airborne exposure. Sampling studies revealed the presence of peanut protein on tray tables, seats, and other surfaces in amounts sufficient to cause allergic reactions through contact. Cleaning these surfaces with wet wipes or detergent was shown to effectively reduce allergen residues.
Significant inconsistencies in airline policies related to food allergies were highlighted, emphasizing the need for clear, standardized guidelines to ensure consistent and effective allergy management across carriers, according to the researchers. While the researchers discouraged announcements requesting “nut bans,” they emphasized practical measures such as pre-boarding for food-allergic passengers and consistent cleaning protocols. Additionally, they recommended that airlines include general-use epinephrine autoinjectors in onboard medical kits to enhance preparedness for anaphylactic emergencies.
Researchers highlight the need for evidence-based interventions, emphasizing surface cleaning and passenger self-preparation as critical strategies to reduce the risk of allergic reactions during air travel.
Full disclosures can be found in the published review.
