Hot Topics

FOR IMMEDIATE RELEASE   RSS Icon Subscribe | Receive hot topics by e-mail

FAAN Responds to Department of Transportation Proposal

Department of Transportation

Docket: DOT-OST-2010-0140

Public Comment from The Food Allergy & Anaphylaxis Network (FAAN)

Dear DOT,

Please note the Department of Transportation issued a clarification of the proposed rulemaking and removed the issue of peanuts and peanut allergies on airplanes from the proposal.

For close to two decades, we have been advising peanut-allergic individuals on how best to prepare for air travel; have offered our assistance to the airline industry on this important issue; and have supported published research on allergic reactions due to peanuts and tree nuts that have occurred on commercial flights. We hope that DOT pays considerable attention to our comment, and will utilize our expertise on this issue to the best extent possible.

As you can imagine, this is an anxiety-laden issue for families affected by peanut allergy, who worry about a severe allergic reaction occurring 30,000 feet in the air. Some of these families, in fact, choose not to fly at all rather than risk an in-flight medical emergency.

There have been three published studies looking specifically at self-reported reactions caused by peanuts/tree nuts during commercial flights2,3,4. These studies confirm that allergic reactions caused by accidental ingestion, skin contact, or inhalation have been reported to occur on commercial flights, and that some of these reactions have been severe, requiring medications such as epinephrine. In the most recent of these studies, in fact, one-third of the reported allergic reactions met the criteria for anaphylaxis, highlighting the potential severity of these in-flight events.

Beyond the published studies, we have received over the past decade or so, through e-mail, letter, and telephone correspondence, anecdotal reports of allergic reactions to peanuts/tree nuts during commercial flights, some of which warranted an emergency landing of the aircraft in order to procure proper emergency medical treatment. Such a landing surely poses a heavy financial burden on any airline.

We have also received numerous reports of passengers being denied air transportation due to their food allergy. Many of these reports have also taken the form of formal, written complaints filed with the Aviation Consumer Protection Division. This denial of air transportation has involved passengers being removed from aircraft prior to takeoff, or being prevented from boarding the aircraft at all. This has caused not only significant embarrassment to families affected by food allergy, but has also created a major inconvenience, sometimes impacting entire travel/vacation plans.

Clearly, then, there is both published and anecdotal evidence that allergic reactions to peanuts/tree nuts take place on airlines, along with evidence that passengers are being denied transportation due to their food allergy. As a result, something must be done to limit or prevent such occurrences in the future. We believe that by eliciting comments from the medical community, the airline industry, and the food allergy community, DOT is initiating the dialogue necessary to finding solutions for all involved. Again, we laud DOT for their current efforts, and offer our assistance as DOT moves forward in its quest for solutions.

We would like to address some of the specific points raised by DOT in this proposed rulemaking, along with other points we feel are crucial as DOT moves forward.

First, the scientific literature at this time does not really have answers to the likelihood that a passenger with peanut allergy will have severe adverse health reactions by being exposed to airborne peanut particles in an aircraft cabin. Based on the published studies, we know that airborne reactions have been reported to have occurred; however, the magnitude and potential severity are still unclear. The published cases involve self-reporting, so there is a chance that all of the facts were not collected. We are more than willing, however, to work with DOT on conducting an in-depth study on this very issue. Our Medical Advisory Board comprises the world’s leading experts on food allergy and anaphylaxis, and has been at the forefront of published research in the field. As this issue is one of major importance to the food allergy community, we feel that scientific research is sorely needed. DOT, then, could play an instrumental role in helping to fund necessary research, especially concerning the risk posed by airborne peanut particles in aircraft cabins. We would be happy to work with DOT on designing a research project to address the issue.

Second, FAAN believes that the most practical solution to reduce the risk of an allergic reaction to peanuts would be to simply discontinue serving packaged peanut snacks on all flights covered by DOT. This is already the approach taken by many airlines, both domestic and international; is clearly the method that will be most easily understood by the food allergy community, and reduces the attention airlines would need to give to cleaning the aircraft. What is more, this approach will certainly be favored by the members of the food allergy community who respond to this proposed rulemaking.

Should the discontinuance of serving packaged peanut snacks not be a viable option to DOT, then we would ask DOT to rule that airlines should, at a minimum, serve a non-peanut snack on each flight where a passenger with peanut allergy has requested such an accommodation in advance. However, we would caution DOT that this approach does introduce the possibility of miscommunication and confusion between airline personnel and passengers affected by peanut allergy; suggests that airlines might have to pay added attention to cleaning; and also raises the issue of enforcement (i.e., what happens if an airline does not follow through with the request).

It is unlikely that the food allergy community will advocate for the “buffer zone” approach. Not only is there no data showing that this approach represents a valid risk-reduction strategy, but complaints we have received regarding this approach have been numerous. Many claim that the buffer zone creates a false sense of security, while others claim that airline personnel are often lax in their enforcement of a true buffer zone. What is more, for a buffer zone to be effective, it would have to be a designated, static zone of seats for all flights on a particular aircraft, as opposed to being a mobile zone, which would need to be cleaned, depending on where the peanut-allergic passenger happens to be seated. As a result, the creation of a true buffer zone seems like an unwieldy prospect from the airline’s perspective.

Third, we would like to point out that one of the most common complaints we receive against the airline industry concerns a lack of awareness and education on the part of airline employees, including flight crews, gate agents, telephone customer service representatives, fellow passengers, and even pilots. We have anecdotal evidence of passengers with food allergy being treated rudely, being given inconsistent and inaccurate information, having their concerns brushed aside or downplayed, and even being intentionally embarrassed in front of other passengers, even after providing the airline with advance notice of their food allergy. Because we assume that the airline industry is highly concerned with polite and helpful treatment of its current and potential customers, we feel it is crucial that DOT work with us in order to help the airline industry educate its employees on the issue of food allergy, and provide them with a necessary level of awareness and education so as to treat food-allergic passengers in an appropriate manner.

Fourth, the primary responsibility of managing one’s food allergy rests with the passenger or the passenger’s family. When flying, it is crucial that a passenger affected by food allergy assure that their epinephrine is kept close at hand (on their person, as opposed to in the overhead bin). However, we would recommend that airline flight crews understand the importance of epinephrine in treating a potentially severe allergic reaction, and be aware that should there be an allergic emergency on board, all efforts should be made to assure that epinephrine is administered in a timely manner. Epinephrine training, not unlike AED training, could certainly benefit flight crews should an allergic emergency arise on the aircraft.  

Fifth, DOT needs to be aware that there may be circumstances where other allergens are problematic and should be addressed. Tree nuts (almonds, cashews, etc.) are often part of snack offerings on commercial aircraft and, together with peanuts, cause a significant percentage of severe, and even fatal, food allergy reactions.

Sixth, we would suggest that “peanut products” should not include items prepared in peanut oil. It is reasonably well documented that highly refined peanut oil is safe. Cold pressed peanut oil is a minor product with very limited use, and is likely only a risk if directly ingested in appreciable amounts. If peanut oil were included in the definition of peanut products, airlines would certainly end up facing difficulties with all fried snack foods, many of which may be fried in peanut oil. The risk from these products is essentially nil.

Finally, there appears to be considerable misinformation on the part of the food allergy community itself pertaining to certain “requirements” imposed upon the airline industry. To illustrate, we understand that airlines cannot be expected to monitor or control food and snack items brought on board by other passengers; however, some members of the food allergy community are under the impression that airlines are somehow required to do this. Again, we offer our assistance to DOT to help educate the food allergy community, along with the public at large, as to any or all requirements DOT wishes to convey upon commercial airlines.

In closing, we again thank DOT for addressing an issue of great importance to millions of Americans, and continue to offer our assistance and expertise to help find workable solutions.

Sincerely,

The Food Allergy & Anaphylaxis Network 

Julia Bradsher
CEO                    

Christopher Weiss     
Vice President, Advocacy and Government Relations

FAAN Medical Advisory Board
Hugh A. Sampson, MD
S. Allan Bock, MD
A. Wesley Burks, MD
John M. James, MD
Stacie M. Jones, MD
Todd A. Mahr, MD
Scott H. Sicherer, MD
F. Estelle R. Simons, MD
Steve Taylor, Ph.D.
Robert A. Wood, MD
Robert S. Zeiger, MD, Ph.D.

1 Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010;125(6):1332-6. Epub 2010 May 11.

2 Sicherer SH, Furlong TJ, DeSimone J, Sampson HA. Self-reported allergic reactions to peanut on commercial airliners. J Allergy Clin Immunol 1999;103:186-9.

3 Comstock SS, DeMera R, Vega LC, Boren EJ, Deane S, Haapanen LAD, Teuber SS. Allergic reactions to peanuts, tree nuts, and seeds aboard commercial airliners. Ann Allergy Asthma Immunol 2008;101:51-56.

4 Greenhawt MJ, McMorris MS, Furlong TJ. Self-reported allergic reactions to peanut and tree nuts occurring on commercial airlines (Letter to the Editor). J Allergy Clin Immonol 2009;124(3):598-9.

About FAAN

Founded in 1991, The Food Allergy & Anaphylaxis Network (FAAN) is the world leader in information, resources, and programs for food allergy, a potentially life-threatening medical condition that afflicts as many as 15 million Americans including almost 6 million children. A nonprofit organization based in Fairfax, Va., FAAN has approximately 22,000 members in the U.S., Canada, and 58 other countries. It is dedicated to increasing public awareness of food allergy and its consequences, to educating people about the condition, and to advancing research on behalf of all those affected by it. FAAN provides information and educational resources about food allergy to patients, their families, schools, health professionals, pharmaceutical companies, the food industry, and government officials. To become a member or for more information, please visit FAAN at www.foodallergy.org.

Media Contact

Jennifer Roeder
Director, Marketing and Media Communications
Direct: (703) 563-3061
Cell: (301) 639-4811
E-mail: jroeder@foodallergy.org
Twitter: @JenRoeder