Self-reported allergic reactions to peanut on commercial airliners

Background: Allergic reactions to food occurring on commercial airlines hav e not been systematically characterized. Objective: We sought to describe the clinical characteristics of allergic r eactions to peanuts on airplanes. Methods: Participants in the National Registry of Peanut and Tree Nut Aller gy who indicated an allergic reaction while on a commercial airliner were i nterviewed by telephone, Results: Sixty-two of 3704 National Registry of Peanut and Tree Nut Allergy participants indicated a reaction on an airplane; 42 of 48 patients or par ental surrogates contacted confirmed the reaction began on the airplane (me dian age of affected subject, 2 years; range, 6 months to 50 years). Of the se, 35 reacted to peanuts (4 were uncertain of exposure) and 7 to tree nuts , although 3 of these 7 reacted to substances that may have also contained peanut. Exposures occurred by ingestion (20 subjects), skin contact (8 subj ects), and inhalation (14 subjects). Reactions generally occurred within 10 minutes of exposure (32 of 42 subjects), and reaction severity correlated with exposure route (ingestion > inhalation > skin). The causal food was ge nerally served by the airline (37 of 32 subjects). Medications were given i n flight to 19 patients (epinephrine to 5) and to an additional 14 at landi ng/gate return (including epinephrine to 1 and intravenous medication to 2) , totaling 79% treated. Flight crews were notified in 33% of reactions, Dur ing inhalation reactions as a result of peanut allergy, greater than 25 pas sengers were estimated to be eating peanuts at the time of the reaction, In itial symptoms generally involved the upper airway, with progression to the skin or further lower respiratory reactions (no gastrointestinal symptoms) , Conclusions: Allergic reactions to peanuts and tree nuts caused by accident al ingestion, skin contact, or inhalation occur during commercial flights, but airline personnel are usually not notified, Reactions can be severe, re quiring medications, including epinephrine.