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The nut problem

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ISSUE Allergic to peanuts and tree nuts? Here’s some wisdom from flyers with nut allergies

Be preparedHave a battle plan ready to mitigate the risk of allergy to nuts
Be preparedHave a battle plan ready to mitigate the risk of allergy to nuts

When Roxanne Palin of Manhattan travels by plane with her family, some of whom are allergic to tree nuts or peanuts, she has a standing battle plan. She books flights in advance so that the three with allergies can sit together, and makes sure they bring their own food and beverages. She swabs their seats and table trays with alcohol pads or baby wipes. She packs eight doses of self-injectable epinephrine, including back-ups, in case any of them has an allergic reaction.

Once onboard, she begins her polite campaign of explanation and entreaty. To flight personnel. To nearby passengers. “If I see them being offered nuts,” said Palin, “I say, ‘Would you mind? I have children with life-threatening food allergies and it makes them nervous to be on a plane where there are nuts. Would it be possible for you to elect to eat something else?”’ Many people comply without a murmur. “And some people say, ‘OK’ and they eat the nuts anyway.”

In-flight allergy reactions to tree nuts and peanuts have been reported by only small numbers of passengers, and scientists are uncertain whether dust from the nuts poses serious airborne risks to travellers with allergies. But Palin is far from alone in taking a pro-active stance, as a new study of 3,273 air travellers with these types of allergies affirms.

“Even though it’s a rare event, we wanted to determine what would influence that rare event from happening,” said Dr. Matthew Greenhawt, a clinician and researcher at the University of Michigan Food Allergy Centre, and the lead author of the study, which was published in the latest issue of The Journal of Allergy and Clinical Immunology: In Practice .

He and his colleagues asked peanut and tree nut allergy sufferers from 11 countries, only some of whom had in-flight reactions, what precautions they routinely took when they flew. The most common strategies cited included requesting a buffer zone around the allergy-affected passengers, in which peanuts or tree nuts would not be served; requesting a general announcement that passengers not eat peanut or tree nut-containing food; and ordering a peanut or tree nut-free meal. Other common safety measures included wiping their tray tables, bringing their own food and avoiding use of airline pillows and blankets.

In addition, travellers reported bringing their own epinephrine (even though American carriers must include them in their emergency medical kits); asking to preboard the plane (presumably to clean); wiping seat backs, seat belts and other surfaces like bathroom door handles; and requesting to sit in a particular seat or area that they believed would mitigate their risk.

Just over 1 in 10 passengers who responded to the questionnaire reported having had an allergic reaction on an airplane within the previous five years. Some who had reactions reported taking precautions, while others who made no such efforts reported being fine.When a reaction occurred, epinephrine was sparsely used. Dust may have other ways of spreading besides being airborne: Palin’s husband once had an in-flight reaction, the family believes, because he touched a bathroom door handle with peanut residue from another passenger.

“The looming issue is: Should peanuts be taken off airplanes?” said Greenhawt. “There are protective measures that passengers can consider taking themselves that might make their flying experience safer.”

NYT NEWS SERVICE

If you’re as careful as you can be, the chances of having a reaction are less

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