On March 18, 2026, the U.S. Department of Transportation issued a ruling that could make air travel less safe for millions of Americans with food allergies, by limiting a basic accommodation many rely on to prevent life-threatening exposure. Food allergies are a serious, life-threatening medical condition that remains widely misunderstood. For millions of travelers, navigating airline policies is an unpredictable challenge, where inconsistent accommodations and societal skepticism create unnecessary risk. For those living with food allergies, safety depends not only on personal vigilance but also on the awareness and cooperation of others. Air travel magnifies that reality, placing passengers in an enclosed environment far removed from immediate medical care, where even trace exposure can have severe consequences. Before preboarding was recognized as a right under the Air Carrier Access Act, I often found myself rushing through crowded boarding lines, trying to clean my son’s seat before time ran out. I have picked up stray peanuts, his allergen, as well as crumbs of unknown origin and residue that could only be described as goop, any of which could contain a different allergen entirely. Cleaning effectively is nearly impossible while other passengers are boarding and crowding the aisle, limiting both time and access to the seating area.

For most travelers, a dirty tray table is unpleasant. For someone with a food allergy, it can be life-threatening. Children, especially, are at greater risk, as they are more likely to touch surfaces and put their hands in their mouths. Preventive measures like preboarding are not a convenience; they are a critical safety step. Yet even today, airline policies remain inconsistent, and accommodations are not always honored. A recent global study conducted by Northwestern University’s Center for Food Allergy and Asthma Research, published in JACI: In Practice found that 70 percent of passengers were promised accommodations that were not provided. It is no surprise that more than 98 percent of respondents report significant anxiety when flying. Much of this stems from a fundamental misunderstanding. Food allergies are often dismissed as a matter of simply “not eating the allergen,” when in reality, exposure can occur through trace residue or cross-contact. Even lifesaving treatments like epinephrine are not guaranteed to reverse a reaction, particularly if administration is delayed. There are 32 million Americans living with food allergies, making this not a niche issue but a widespread public health concern.

Through my nonprofit, No Nut Traveler, passengers consistently report being denied preboarding, encountering unclear policies, or even being prevented from flying after disclosing their condition. These are not isolated incidents, but part of a broader systemic failure. That failure is not abstract. On one flight, after preboarding to clean my son’s seat, I found peanuts under the seat in front of him. As I wiped down every surface, racing against time, a nearby passenger was asked to refrain from eating peanuts. His response was immediate: “So this entire plane has to suffer because one jerk child has a nut allergy?” That moment reflects a broader reality: Food allergies are still widely viewed as an inconvenience rather than a legitimate medical condition. In November 2022, advocacy organizations including No Nut Traveler, Allergy & Asthma Network, Asthma and Allergy Foundation of America, and Food Allergy & Anaphylaxis Connection Team filed a complaint with the U.S. Department of Transportation (DOT) after Southwest Airlines denied preboarding to passengers with food allergies. Instead, the airline offered “extra time” boarding after the first group, requiring passengers to clean their seating areas while others were already boarding or seated. In practice, passengers could pay to board earlier, effectively placing access to a safety-related accommodation behind a paywall, an approach that would be unacceptable for any other disability. Although Southwest later reversed its policy and reinstated preboarding for passengers with peanut and tree nut allergies, the underlying issue remained unresolved. The complaint was never limited to nut allergies. It was filed on behalf of all individuals with life-threatening food allergies.

Advocacy organizations continued to press the complaint forward, making clear that protections must be applied consistently and without limitation to all passengers with life-threatening food allergies. On March 18, 2026, DOT Order 2026-3-9, ruling on that complaint, introduced a troubling limitation. While it acknowledges that severe food allergies constitute disabilities, it restricts preboarding protections to passengers with nut allergies. Passengers with food allergies are not asking for new or special treatment, but for the consistent application of protections that disability law already provides, including the ability to safely access their seat. As disability rights attorney Mary Vargas explains, “The law already provides that passengers who, because of a disability, need additional time to be seated safely get that time. It does not and has never placed limits on which disabilities qualify. Once food allergies are recognized as a disability, the type of allergen is irrelevant, the question is whether the passenger needs additional time to be seated safely.” This decision draws an arbitrary line between life-threatening conditions that carry identical risks. Anaphylaxis does not depend on whether the trigger is peanuts, dairy, egg, or sesame, yet the protections afforded to passengers now do. This distinction has no grounding in medical reality.

DOT appears to rely on prior cases that referenced peanut and tree nut allergies, treating those facts as if they define the boundary of protection. They do not. Those decisions reflect the circumstances of individual cases, not a legal limit. If those cases had involved dairy or sesame allergies, the language would have reflected that. Instead, a factual detail is being misapplied as policy, and that is a dangerous interpretation. This inconsistency is further underscored by the Department’s own classification system. As disability rights attorney Laurel Francoeur has noted, the DOT categorizes disability-related complaints under the broader heading of “food allergies,” not nut allergies. In its own data and reporting, the agency makes no distinction between allergens, making its decision to limit protections based on allergen type even more difficult to justify. At its core, this issue is about whether a passenger can safely access their seat. For individuals with life-threatening food allergies, that often requires cleaning the seating area before contact. That need exists regardless of the specific allergen, and the risk is the same.

The contradiction is clear: A condition is recognized as a disability, yet access to the accommodation that mitigates its risk is restricted. From both a medical and equity standpoint, that distinction is indefensible. There is no clinical basis for ranking allergens in terms of severity when multiple food allergies can cause life-threatening anaphylaxis from trace exposure. Creating a system where one passenger qualifies for protection and another does not, despite facing the same risk, raises serious questions about equal access and fair treatment under disability law. The consequences are real. Safety becomes dependent on interpretation, training, or even the discretion of individual airline staff. It sends a message that some life-threatening conditions warrant protection while others do not. Food allergies are a growing public health concern. Air travel should not be a gamble. Airlines must implement standardized policies, provide comprehensive training, and ensure access to emergency medications, including easy-to-use epinephrine auto-injectors or nasal sprays. Most importantly, policies must reflect medical reality. Passengers with food allergies do not need special treatment. They need consistent, evidence-based protections that allow them to travel safely. Anything less leaves their safety to chance.

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.