Flying With a Peanut Allergy

Man waiting to board airplane, for flying with a peanut allergy

Flying with a peanut allergy can be quite a scary thought, but there are certain steps you can take to make it safer, easier, and less stressful. Being stuck inside an enclosed cabin 30,000 feet in the air means you need to be extra careful about avoiding your allergen, even more so than usual. To be as prepared as possible, do your research, plan ahead, and know which accommodations are available to you for traveling and flying with a peanut allergy.

Note that I refer to peanut allergies throughout this article, but the same general advice applies to all nut allergies.

No airline can guarantee you a peanut free plane. But, there are certain things that you can do to minimize your risk of exposure to nuts inside the cabin.

Do not assume an allergen free environment when flying with a peanut allergy. Even with precautions, you need to have a well thought out emergency care plan. You have to know that going into it. Every airline will have a different policy, and it’s important to familiarize yourself with your options, and to then pick the airline that makes you feel the most acknowledged and cared for.

At the time this article is being published, Southwest, Jet Blue, and Delta have different approaches to accommodating peanut-allergic passengers:

Southwest, Jet Blue, and Delta are just three options. And please note their policies could change over time. You should always call an airline to confirm your options. If you’re considering flying an airline, see what they are willing to provide, even past their documented policy. The more the community makes their voices heard, the more the airlines will adapt and create policy reform.

Day of Travel Tip: It doesn’t hurt to print out a copy of your airline’s policy and allergen statement for quick reference regarding your available accommodations for the day you’re flying, should any employee have any sort of question or confusion while flying with a peanut allergy.

Whatever airline you’re choosing to fly, here are 10 tips on how to make the most of your flying experience.

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    1. If This Is Your First Time Flying With a Peanut Allergy, Consult Your Allergist

    Make sure you always check with your allergist or the allergist of your child before confirming your travel plans with others. Or, before purchasing tickets for flying with a peanut allergy. This is especially important when you’re planning a trip outside the country. Your allergist may have important tips that only they can offer to you. As your allergist will be the most prepped on your special situation, they’ll also be able to create a customized emergency care plan that will be suitable to you, specific to traveling, and unique to the area you’ll be visiting.

    When you do meet with your allergist, you’ll want to ask for an allergen confirmation note for flying with a peanut allergy. Essentially, it’s a written confirmation or a doctor’s note confirming your child’s allergen and the potential risks associated to allergen contaminationmeaning, your doctor must put into writing that you or your child have a confirmed food allergy diagnosis, and that anaphylaxis would be a concern should their patient come into contact with an offending allergen—in this case peanuts or tree nuts.

    It’s imperative for your doctor to state that their patient must be allowed to carry auto-injectors of epinephrine, as well as antihistamines at all times, and must be allowed to carry auto-injectors in carry-on luggage while flying with a peanut allergy. This requirement will be important when addressing accommodations with your chosen airline, as well as when addressing any other requested accommodation for your trip (just in case for some reason it would be handy to have in writing, it’s always better to have it than to not have it).

    Planes are supposed to have required epinephrine on board. But, it’s not considered essential. Reliance on it might not be wise, as its reliability is sometimes foggy.

    According to the article At 30,000 Feet, Why We Can’t Count on Epinephrine Vials on an Airplane by Allergic Living, Airlines for America issued an exemption of epinephrine for when there are shortages. You can read the details of this exemption document, Exemption 10690E, through a digital copy uploaded to the internet by the Federal Aviation Administration.

    But, in a hypothetical situation, let’s say your plane does carry epinephrine. Chances are it will be in the form of a vial of epinephrine, and not in the form of an auto-injector. In this scenario, a flight attendant might ask if a doctor or allergist is on board to administer the vial. But, when time is of critical importance, it’s best to have access to your own auto-injector. Get your doctor’s note and keep it easily accessible while preparing for your flight. Keep it handy while going through pre-boarding. It’s crucial that you’re able to bring your auto-injector medication with you.

    In a 2014 webinar offered by Kids With Food Allergies, Dr. Greenhawt spoke of his 2008 study of 150 self reported airline allergic reactions through the Food Allergy & Anaphylaxis Network. This report is old but there have been updates. The report found that only 10% of allergic reactions were treated with epinephrine. 33% of those reactions were considered as severe as anaphylaxis. So, what this study showed was that in the case of allergic reactions that occurred during traveling, ephedrine was underused. In a 2013 followup study entitled International Study of Risk-Mitigating Factors and In-Flight Allergic Reactions to Peanut and Tree Nut, led again by Dr. Greenhawt and the University of Michigan, epinephrine usage was at 13.3% for the reported allergic reactions that occurred during travel. Between 2008 and 2013, ephedrine use only went up an increment of 3.3%.

    This is why it’s really important to make sure you have access to auto-injectors while traveling. When you do bring a few on the plane, make sure you don’t place your epinephrine in the overhead bin! Keep it inside your carryon and store that carryon underneath the seat in front of you. Don’t store it in the fold out compartment sewn into the chair in front of you as those compartments might contain peanut particles.

    What Is the Role of a Doctor's Note for Food Allergies?

    The note your doctor gives you will provide insurance for carrying epinephrine auto-injectors as needed while flying with a peanut allergy. Actual use of this letter might not be required. But, if you do end up in a situation where it will be, you will be so glad you have it. A doctor’s note will always be nice to have while flying with a peanut allergy.

    Unfortunately, a doctors note probably won’t help you claim disability rights once you are actually onboard your plane while flying with a peanut allergy. If your particular pilot decides flying you would be too high of a risk, you could potentially be escorted off the plane. Certain airlines react better than others, and that’s always growing and evolving. Don’t be afraid to speak up if you have a bad experience. And if you do have a bad experience, please, share it within this community too.

    How Is That Possible?

    The reason pilots can sometimes turn nut allergic customers away is that airlines play by a different set of rules than schools do. Section 504 of the Rehabilitation Act will protect nut allergic children in schools that receive federal funding. But, it’s the Air Carrier Access Act that protects against the discrimination of disabilities in regards to passengers of air travel. The discriminatory practices that are prohibited (U.S. Department of Transportation) prevent any refusal of transportation due to disability.

    And according to the Allergy Law Project, the Air Carrier Access Act (ACAA) does define the term disability in a similar way to the Rehabilitation Act, stating, “a physical or mental impairment that, on a permanent or temporary basis, substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment”. 14 CFR § 382.5. DOT. But, protection of the airline and pilot are also in place. You should also know that in the case of an allergic reaction, flight attendants will not be required to help you with your auto-injector. If they choose to help you, that’s great! But, just know that they are not legally required to do so.

    2. Pick an Airline That Wants to Work With You While Flying With a Peanut Allergy

    Because every airline will have their own policy on how they provide support to customers with a severe food allergy, I suggest calling a few airlines to shop around and see what accommodations are available to you before making any purchases. 

    Call your airline of preference and ask for the accommodations you’d like to have, even if their online statement doesn’t mention pre-boarding as a part of their policy, etc. Talk to them and ask.

    We’ll talk more about a list of specific accommodations later in this article, but make sure that whatever airline you do end up flying with, your reservations are made in advance.

    Some airlines commit to no longer serving peanuts on flights, and others that don’t serve peanuts may stop selling peanut snacks if they’ve been informed of a passenger having a severe allergy.

    Make the reservations early and check in closer to the date about the accommodations you’re requesting.

    a. Ask for an Announcement

    When asking for accommodations, request for an announcement to be made by attendants at the beginning of your flight. In this announcement, simply ask for the flight attendants to inform the cabin that there is a nut allergic passenger onboard with a severe life-threatening food allergy to peanuts and tree nuts. Then, have the flight attendant make a request for all nut products to be abstained from until after the flight.

    b. Ask for Pre-Boarding

    Pre-boarding while flying with a peanut allergy gives you an opportunity to wipe down your tray, your seat, surrounding seats, etc., so you can safely organize yourself before the rest of the cabin boards. I’d try to stay away from the pockets on the back of the seat in front of you as they might not be cleaned well and could be potentially dangerous if they are harboring nut particles inside. Bring disposable gloves if you plan on cleaning the areas surrounding your seat yourself. If you’re going to travel with a friend or partner, ask them to wipe down the areas surrounding your seat for you.

    Bring wipes. Hand sanitizer doesn’t remove peanut particles. Wipes do.

    c. Ask for a Buffer

    Sometimes the airline will honor your request for a nut free flight while flying with a peanut allergy. Sometimes, they won’t. To be fair, they can’t guarantee a nut free flight and no airline can. Additionally, it’s hard for attendants to keep track of, or to monitor. A good in between is asking for a buffer. In the earlier mentioned webinar offered by Kids With Food Allergies, Dr. Greenhawt said that there wasn’t enough evidence supporting the push for a nut free plane over a nut free buffer zone. There wasn’t conclusive evidence presenting or supporting the efficacy of asking for a nut free plane. Similarly, nut free schools are also safer in concept than in practice. To learn more about the controversy surrounding nut free schools vs nut aware schools, please read our article What’s the Difference Between a Nut Free School and a Nut Aware School?

    However, Dr. Greenhawt did say he saw sufficient evidence to encourage the use of buffers while flying with a peanut allergy. According to his study, his research indicated that buffers did create a safer environment for nut-allergic passengers.

    What Is a Buffer?

    A buffer is a stricter request to the passengers in the seats surrounding you. It’s easier for airline attendants to monitor and enforce. Some airlines will only strongly suggest this restriction, and won’t gartunee to enforce it if a customer protests. Which, again, is why picking an airline that will work with you is so important. It can get difficult if people decide they want to protest. And unfortunately, I don’t think there’s an easy way around this one. I think if you can, it’s a good idea to introduce yourself at the beginning of the flight to the passengers in the surrounding seats. Simply inform them that you have a severe allergy and would really appreciate it if they could refrain from any nut snacks that they were planning to eat while on the shared flight.

    It’s nice for the flight attendant to have this conversation for you, but if you sense it might be a problem, confronting it straight on might be your next best option. I think when people put a face to the nut allergic passenger they were told about, it’s harder for them to roll their eyes. You could bring a bag of nut free snacks to offer your buffer zone, as a sort of ice breaker to alleviate any tension. They might take you up on it, or they might not. But, I think the gesture is nice and will help. You can offer the snacks to nearby passengers when you introduce yourself. If this just seems like your absolute worst nightmare, then maybe try to form a relationship with the airline attendant so that they can, in the worst case scenario, do more than just inform someone of your allergy if they are in your buffer zone, but to then be your advocate should any tensions arise.

    d. Ask for Nuts to Not Be Sold While Onboard the Airplane

    Although most airplanes will tell you that they can only make a strong suggestion to passengers to abstain from nut products, some airlines are willing to work with you in regards to no longer selling nut products. As talked about in the intro of this article, Delta Airlines currently has a policy to stop selling their nut products should they be informed of a nut-allergic passenger flying their services. So, make sure you speak up and see what options are available.

    3. Carry an Extra Epipen—With Its Original Prescription Label

    Consider bringing double the amount you might think you’ll need while flying with a peanut allergy. It’s better to over-pack than under-pack. So bring an extra auto-injector with you. Keep the original prescription labels.

    According to this Airline Travel article by FARE, “Since 2003, the FAA has required all airlines to carry epinephrine in their on-board medical kits. But most airlines today only stock vials of the drug and not the easy-to-use autoinjectors.”

    Make sure it’s in your carry-on, printed label to identify what the medication is, the prescription label by your pharmacy or hospital, and have a doctor’s note. 

    Declare your prescription drugs and over the counter medicines, gel packs, etc, with a TSA officer at the security screening.

    Last update on 2021-09-26 // Source: Amazon

    Also Consider Bringing an Insulated Case for Your Auto-Injectors

    It’s nice to have an insulated case for your medications, because it helps keep your medication at the proper storage temperatures. This EPI-TEMP case (Amazon) stores up to three EpiPens and regulates the temperature inside the case within recommended range (59° – 86° F or 15° – 30° C). It’s also rechargeable. Perfect for flying with a peanut allergy.

    4. Introduce Yourself to the Cabin Crew While Flying With a Peanut Allergy

    I think it’s a good idea to introduce yourself to the cabin crew when entering an airplane to let them know that you’re the passenger with the life-threatening food allergy. Simply open a dialogue. Let them know that if they have any questions regarding accommodations, that you’d be happy to talk openly. Flight attendants typically ask if a doctor is flying their airline if there is a need to administer medication or ephedrine from a plane’s emergency kit vial. But should there not be a doctor that steps forward, airplane staff is actually not legally required to administer aid in an emergency situation. Oftentimes they do, but forming a relationship will be helpful and potentially help them feel more comfortable to administer aid should it become necessary while flying with a peanut allergy.

    5. Bring Your Own Food While Flying With a Peanut Allergy

    You can call ahead and ask if your aircraft will offer any peanut free products, but, truthfully  it’s just better for you to bring your own meals. It’s not worth the risk and airline food usually isn’t that great anyway. It’s expensive, too. Instead, stock up on some of your favorite nut free snacks, keep them handy, and plan ahead for your meals.

    It wouldn’t hurt to research the nut free restaurant options at your airport in the case of a layover. But if you can, stick to the restaurant menus you know. Stick to the meals you know, and the dishes you know too. Stick to basics. And still inform your server of your allergen if cross-contamination is a concern for you as all restaurants have different policies and slightly vary in the way they prepare their menus.

    6. Choose a Flight Earlier in the Morning

    The theory is that choosing a flight in the morning will help you avoid exposure to nut contamination, as planes are usually cleaned at night. There’s not necessarily evidence on this, or a study on this that would confirm the theory. But, if it makes you feel better while flying with a peanut allergy, then absolutely do what makes you feel most comfortable.

    7. Avoid Airline Blankets and Pillows

    This one’s pretty straight forward. Avoid the airline blankets and the airline pillows that are stored in the plane as they’ve been used by multiple people, aren’t always washed in between flights, and could be carriers of nut particles. Not so comforting while flying with a peanut allergy!

    8. Bring a Signed Allergy Confirmation Letter From Your Allergist and a Copy of Your Emergency Care Plan

    Carry Your Food Allergy and Anaphylaxis Emergency Care Plan with you while traveling —- In case of an allergic reaction where you cannot administer your own epinephrine, carry written instructions on how to be treated when in a situation where you could have a severe allergic reaction. Have it include all of your emergency care numbers, etc. Be sure to use bolded points to minimize the time required to skim through all of the necessary steps and precautions before action is suggested and mediation can be administered.

    If you are specific on what you want your doctor’s note to include, write a template yourself and have your doctor sign it. Or, maybe it’s the opposite and you aren’t sure what to include. If that’s the case, consider taking a look at these templates of of doctor letters for auto-injectors that create a confirmation of allergy statement.

    9. Understand Legal Aspects

    Because a pilot makes the final decision regarding emergency landings, if the pilot feels that it’s dangerous for you to fly, they may have you escorted off the plane. In the case of a severe allergic reaction happening in the air, the pilot will need to do an emergency landing. If that happens, that means they’ll get reviewed. They’ll have to prove that their emergency landing was needed, and that it was necessary.

    It’s possible that the pilot flying you will have a hesitation on wanting to get reviewed or disciplined. It’s possible for them to be sensitive to nut allergic passengers if this is the case and it could explain why some pilots are hesitant to fly folks with severe food allergies.

    It can make asking for accommodations semi-stressful. Unfortunately, it seems like everything is a delicate balance in this issue. As there’s no formal protocol with nut allergies while flying with a peanut allergy, it’s touch-and-go in your personal situations. Even so, don’t let it stop you from asking for the accommodations that will make you feel safe.

    Last update on 2021-09-26 // Source: Amazon

    If you want to learn more about the legal aspects of flying with a peanut allergy or another severe food allergy, I recommend the ebook Flying With Food Allergies: What You Need to Know, by Laurel Francoeur. Lauren was one of the guest speakers in the educational webinar by Kids With Food Allergies (KFA), mentioned several times during this article. Great Resource!

    10. Thank Everyone Involved in Making Your Trip Safe

    Consider whatever happened as one small step for the allergen community as a whole. Consider writing a thank you note to the airline if they’ve made additional accommodations to help you be safe and feel safe while flying with a peanut allergy.

    If you did not have a great experience while flying with a peanut allergy, let the nut free community know! Share what your airline did for you. And let other nut-allergic folks know which airlines are there for us! We want to make our demographic heard. It’s important to support the airlines that are supporting us.

    Likewise if you had a great experience while flying with a peanut allergy, sing their praises. If it was a bad experience, god forbid a dangerous one, make your voice heard and file a complaint. (If you had a bad experience in America, you can file a complaint with the U.S. Department of Transportation, otherwise known as DOT).

    We are stronger together than we are alone.

    Summary for Flying With a Peanut Allergy

    Really think about your non-negotiables. What is it that you’ll need in order to fly calmly and feel safe? Review the suggestions in this article and see what else you can come up with on your own. Create your own travel plan!

    Definitely try to get a buffer, and definitely bring your doctor’s note with you. Make sure you keep it within reach. YOU ABSOLUTELY MUST BRING AN AUTO-INJECTOR OR TWO. Preferably three, just to have peace of mind.

    It’s possible to fly safely. But, make sure you take advantage of the accommodations available to you. Give yourself the safest experience possible, so you can relax as much as possible. Especially if you’re flying with a peanut allergy for personal travel!

    After all, that’s what a vacation is all about! That’s the entire point! 🙂

    Have fun on your trip!