Food allergies are a serious, life-threatening medical condition that remains widely misunderstood. For millions of travelers with food allergies, navigating airline policies is an unpredictable challenge, where inconsistent accommodations and societal skepticism create unnecessary risks.

Those living with food allergies must often navigate a world that does not always recognize the severity of their condition. Although we teach those with food allergies how to live in a world with their allergens, safety often relies on the cooperation and assistance of those around us.

Recent highly publicized deaths caused by anaphylaxis have heightened global awareness of the dangers of food allergies. As the parent of a young man with a peanut allergy, these stories are deeply unsettling, serving as a stark reminder of just how precarious life can be for those living with food allergies. The urgency for greater public awareness and understanding of the unpredictable and potentially life-threatening nature of food allergies has never been clearer.

As an advocate for safe travel for food-allergic passengers, I witness firsthand the importance of fostering empathy in shared spaces like airlines, where even small accommodations can help mitigate the risk of an in-flight reaction. Unfortunately, flying with a food allergy is fraught with uncertainty—largely due to the inconsistent responses of airlines to this legitimate medical condition.

Up in the air, far from medical care, individuals with food allergies must navigate a system that is often unprepared to support them. The truth is that food allergy policies differ significantly between carriers, and their enforcement is inconsistent. A recent global study conducted by the Center for Food Allergy and Asthma Research at Northwestern University (CFAAR) found that 70 percent of surveyed passengers were promised accommodations that were not honored.

The inconsistent responses from airlines create a stressful reality for travelers simply seeking a safe journey. Uncertainty fuels anxiety, so it is unsurprising that a Northwestern study published in JACI: In Practice found that over 98 percent of passengers with food allergies experience significant anxiety when flying. Even more concerning, many conceal their condition out of fear of being removed from flights or facing stigma. These findings echo countless testimonials I have gathered through my nonprofit, No Nut Traveler, where I advocate for safer policies to protect food allergy travelers.

Flying with a food allergy brings together multiple unknowns—medical, logistical, and social. Even a minor exposure can trigger severe reactions, making preventive measures such as pre-boarding to clean seating areas and informing fellow passengers essential. Yet, these precautions are often met with dismissiveness or outright hostility from airline staff and other travelers. Some view these measures as unnecessary, self-serving, or attention-seeking.

The perception of food allergies as an inconvenience rather than a legitimate medical condition is pervasive. The skepticism surrounding food allergies, particularly on airlines, is often fueled by misconceptions. Social media is filled with instances where passengers ignore airline requests to refrain from consuming allergens. When no visible reaction occurs, some conclude that food allergies are exaggerated or even fake. However, this reasoning is fundamentally flawed.

What many fail to recognize is that food allergies do not follow a predictable scale. Each reaction is an independent event. A mild reaction once does not guarantee a mild reaction in the future. In reality, a person can be exposed to their allergen and experience fatal anaphylaxis, even if their past exposures only produced mild symptoms.

Sometimes, well-meaning airline staff question food-allergic passengers about the severity of their allergy when deciding whether to provide accommodations—as if it were that simple. Food allergies are inherently unpredictable, and no medical test currently exists that can determine who is at risk of a severe or potentially fatal allergic reaction. When you are 30,000 feet up in the air, it is a unique situation—you are far from medical care, and epinephrine, the only life-saving treatment, may not always be readily available. These circumstances make any severe allergic reaction even more dangerous.

A recent testimonial shared on No Nut Traveler described a family traveling with their 8-year-old son, who has life-threatening allergies, encountering mockery from a flight attendant. Despite notifying the airline of the child’s severe peanut, tree nut, and sunflower allergies and pre-boarding to clean the seating area, the flight crew failed to preemptively inform nearby passengers—going against the airline’s own policy on establishing allergy buffer zones when requested.

When the family alerted a member of the crew that there was a passenger eating peanuts directly behind the child, the flight attendant allegedly dismissed their concerns and laughed off the situation. While making light of food allergies may seem trivial to some, attitudes like these contribute to a broader cultural issue: the failure to take life-threatening allergies seriously. That mindset trickles down—into policies, into customer service, and into untenable situations like this one.

Notably, the airline in question does have a nut allergy policy and has received overwhelmingly positive testimonials on my website. Yet, even among airlines known to be allergy-friendly, uncertainty persists. This underscores the message that a child’s or adult’s safety can depend on the mood and education of a particular flight crew and speaks to the need for standardized food allergy policies and greater awareness.

This incident is not just about one passenger’s experience—it is a microcosm of a larger systemic issue. While some airlines have taken steps to implement allergy-aware policies, the Northwestern data highlights that a lack of standardized procedures and training continues to leave allergic passengers vulnerable.

Food allergies cut across political and personal divides, representing a growing global public health issue that affects people of all backgrounds. Many individuals develop food allergies in adulthood, sometimes to foods they once consumed without issue. Yet, airlines continue to serve some of the most common triggers of in-flight allergic reactions. The conversation must shift beyond personal responsibility and acknowledge that ensuring safety in air travel is a shared societal responsibility.

A startling testimonial on my website exposes just how dangerous the gap is in food allergy education. An allergic passenger and his mother were appallingly told to “stand at the back and use an EpiPen” while the airline continued serving tree nuts—his known life-threatening allergen. An EpiPen is not a shield—it is a last-resort emergency measure meant to counteract anaphylaxis, not prevent it. There is no guarantee of full recovery, and severe reactions can escalate quickly. Airlines and their staff must understand that food allergies require proactive avoidance, not reactive treatment. No passenger should ever be placed in harm’s way due to negligence masked as policy.

While awareness is increasing, it must be accompanied by concrete action. Standardized, globally implemented food allergy policies—including comprehensive crew training and readily accessible, easy-to-use epinephrine—are essential to ensuring passenger safety, both for those with known allergies and for individuals who may not yet be aware of their condition.

Ultimately, the need for education, empathy, and cooperation is critical. Air travel for food-allergic passengers should not be a gamble. The food allergy community deserves more than uncertainty—they deserve the right to fly safely, without fear.

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.