Can you imagine flying home from a family vacation and having a first-time anaphylactic reaction in the air? Did you know that airlines are not required to stock their planes with easy-to-use auto-injectors that any adult or child could operate?

Francine’s family was flying back home from vacation on American Airlines. Her 10-year-old son, who had no history of food allergy, ate the warm mixed nuts they served and immediately had stomach pain, chest pain, and stridor when breathing. Francine told me that, “If not for the nurse who administered the Epi-Pen and cared for him the entire trip and passengers who gave us their Epi-Pens this would have been fatal.”

Travel by air is a unique situation for those with food allergies because passengers are in an enclosed space that is far away from immediate medical care. This testimonial, and others like it, serves as a painful reminder that food allergies can strike at any age to any person and be triggered by any food.

A new study shows over 50 percent of people with potentially harmful food allergies have actually developed them as adults. This is truly frightening considering many airlines still serve potential trigger foods among them nuts and shellfish.

As we have defibrillators on the wall in many public entities, wouldn’t it behoove us to have life-saving epinephrine auto-injectors in all schools and airplanes? Many states have passed epinephrine stocking laws for schools, allowing staff to administer epinephrine auto-injectors to any person who warrants treatment, not just those with a prescription.

Steps like these may mean the difference between life and death for a food allergic person, as well as a person who does not yet know they have developed an allergy. I would be remiss not to point out that data shows that approximately 20-25% of stock epinephrine in schools was administered to children whose allergy was unknown at the time.

There is research that asserts delayed administration of epinephrine can lead to fatal consequences. Time is of the essence when treating a severe allergic reaction, which is why it was a shame that legislation introduced in the Senate seeking to replace the unlabeled epinephrine ampules currently on planes with easy to use auto-injectors was not adapted.

I have encountered many naysayers who don’t think a food allergy in the air is their problem. But please remember, food allergies do not discriminate, and one day, it may be you, your spouse or your loved one who has an undiagnosed food allergy and experiences anaphylaxis at 35,000 feet.

It is time for the airline industry to share responsibility for the safety of food allergic passengers and develop a clear and consistent approach. It is also necessary to educate all airline staff on the severity of food allergies and to be prepared in the event of an emergency by labeling emergency medications and having easy to use auto-injectors onboard.

Fifteen million Americans have food allergies, and since so many more people like Francine’s son are unaware that they have an allergy until that first bite, we need to take steps to make sure that the first bite is not a fatal one.

Lianne Mandelbaum is a leading advocate for airline safety measures to protect food-allergic passengers. As president of No Nut Traveler and airline correspondent for Allergic Living, she drives policy change by collecting testimonials from food-allergic families to share with lawmakers, media, and advocacy groups. She can be reached on X @nonuttraveler, Facebook, and LinkedIn.

A sought-after speaker and media source, Lianne participated in a Medscape panel on emergency medical kits on planes and contributed global data on airline travel and food allergies at the GA²LEN Anacare Anaphylaxis & Food Allergy Forum. Her travel tips were also featured by Stanford’s Sean N. Parker Center for Allergy Research. She also appeared on Bloomberg to discuss the challenges faced by food-allergic travelers and advocate for policy changes.

Her advocacy led to a Department of Transportation ruling recognizing food allergy as a disability. She co-designed a global air travel and food allergy survey with Northwestern University’s CFAAR, which was presented at AAAAI and published in The Journal of Allergy & Clinical Immunology. She is the co-author of “Understanding Experiences, Barriers, and Facilitators of Safe Airline Travel—A Global Survey of Food Allergy Patients and Caregivers” (The Journal of Allergy & Clinical Immunology). She also contributed to “10 Practical Priorities to Prevent and Manage Serious Allergic Reactions: GA²LEN ANACare and EFA Anaphylaxis Manifesto” (Clinical and Translational Allergy) and “Ever Treat a Patient on a Plane? Why Med Kits Need an Update” (Medscape). Additionally, she collaborated with stakeholders to include anaphylaxis and necessary medications in the FAA Reauthorization Act of 2024.

Image credit: Lianne Mandelbaum