Flying Safely with Food Allergies

By Kelley Lindberg


This week, I’m a guest blogger for Living Without magazine, a magazine about gluten-free and allergy-free living that’s been a great resource for several years. So click on over to their blog to read my new article called “10 Tips for Flying Safely with Food Allergies,” where I share survival tips for airline travel.

While you’re clicking, you might want to read an excellent opinion piece that was published on the New York Time’s website this week, called “EpiPens for All.” Curtis Sittenfeld writes about the need for the national School Access to Emergency Epinephrine Act, which will allow schools to stock ephiphrine autoinjectors that can be used for anyone in an emergency, whether or not they have a prescription. Not sure why that's so important? Sittenfeld explains it well.

See you back here next Monday!

Food Allergy Emergencies on Planes are Rare

By Kelley Lindberg


Flying somewhere this summer? Great! A new study, just published in the New England Journal of Medicine, says the odds of having an in-flight medical emergency are rare. (“Outcomes of Medical Emergencies on Commercial Airline Flights,” New England Journal of Medicine, May 30, 3013.)

According to the study, 2.75 billion passengers fly worldwide every year. The authors of the study analyzed records from all calls to a medical communications center from five large domestic and international airlines, which together represent about 10% of global flight passengers. After analyzing the data from more than 7 million flights, they categorized the number and the type of medical emergencies as well as their outcomes (whether or not the passenger had to go to the hospital after landing, whether they were admitted, etc.).

The study shows good news. Medical emergencies are rare, occurring on only 1 out of every 604 flights, affecting only 16 out of every 1 million passengers. According to the authors, “the most common medical problems were syncope [fainting] or presyncope (37.4%), respiratory symptoms (12.1%), and nausea or vomiting (9.5%).”

Allergic reactions were about half-way down the list, lower than cardiac symptoms and seizures. Allergic reactions accounted for only 2.2% of the medical emergencies – that’s just 2.2% of the 16 out of a million passengers. So out of the estimated 744 million airline passengers analyzed during the study period, there were a total of 11,920 medical emergencies reported, and only 265 of them were an allergic reaction. (It doesn’t break down “allergic reactions” into causes, so we don’t know how many were caused by food allergies, environmental allergies, or other.)

And of those 265 allergic reactions, only 12 required the aircraft to be diverted, 40 required transport to a hospital, and only 8 were actually admitted to the hospital. Here’s the best part: there were zero (0) deaths caused by an allergic reaction on the plane.

Remember, that’s out of 744 MILLION total passengers studied during that time frame.

So… airplanes are scary. Peanuts on airplanes are even scarier. But if you consider how many people with food allergies fly every year (and we’re one of those families), these numbers were actually really surprising to me – I thought they would be a lot higher. I actually have an adult friend who had a food allergy reaction on a plane once, so I know it happens. But I’m surprised at how seldom it happens, according to this study. (And my friend knew nuts didn’t agree with her, but had never had a serious reaction before the airplane incident, so she wasn’t as prepared as she might have been had she known.)

What I would love to see now is a study that is more specific to food allergic passengers. I'd like to see how many food-allergic people have flown on airplanes during a particular time period, and then see the percentage of THOSE people who had reactions on airplanes. That would really show us some concrete information. So if there are any researchers out there looking for a good topic... have I got an idea for you!

Please understand, I’m not trivializing the risks of food allergies on airplanes. The risk is DEFINITELY still there. Here is a story of a woman who is severely allergic to peanut allergy who reacts to airborne particles (which may be more severe than some allergic individuals), and her bad reaction on a recent United flight: "Peanut Allergy Causes Emergency Landing, Airline Sued," USAToday.com. As we plan our vacations, we need to remember to be vigilant – take HandiWipes to wipe down the seat tray, seat belt, and arm rests; notify the flight attendant of your allergies (especially if you are traveling alone); keep your antihistamine and epinephrine auto-injectors handy; and pack your own food or snacks for the flight if at all possible.

By staying vigilant and being careful, we can reduce those numbers of medical emergencies even more.

And, if the unthinkable happens and you DO suffer an allergic reaction on the plane, there’s more good news. The FAA mandates that every commercial airline keep an emergency medical kit onboard, and epinephrine is a required medication in that kit. In addition, the study also showed that when the flight attendants asked for medical help over the PA system, physicians were on board 48% of the time, and professional nurses or emergency medical technicians (EMTs) were on board another 25% of the time. So chances are very good that there will be professional medical help on your flight should you need it.

So if travel is in your future, plan ahead and stay vigilant, but rest a little easier knowing that the odds appear to be good that you’ll have a great time.

 

Food Allergy Snapshots

Sometimes I’m amazed at the places I go and things I do that make me think about life with food allergies. Here are a few snapshots of things that brought food allergies to mind in the last couple of weeks:

• On the Metro in Washington D.C., as well as on TRAX here in Salt Lake, you’re not allowed to eat or drink anything. That’s a blessing for food-allergy sufferers – one less place to worry about getting spilled on or sitting in crumbs.
• At a birthday party, the mom served Italian Ice from a new place in Layton called Zeppo’s – it’s milk-free, egg-free, and nut-free, and quite yummy!
• Another friend called twice to check on ingredients for a birthday cake to make sure the two allergic boys there would be okay at that party. Don’t you love friends who care?
• In the ultra-cheesy movie “The Game Plan” starring Dwayne “The Rock” Johnson (not my usual movie fare, but it was late and I was too lazy to find the remote), the big climax is when his newly discovered daughter suffers an anaphylactic reaction to nuts in a dessert that he fed her without remembering that she’d mentioned her nut allergy earlier in the movie.
• At the Utah Arts Festival, a vendor was hawking free samples of those roasted almonds – and my son was nervous about standing at the art booths next to the vendor’s stand because the smell made him worry he might have a reaction. (He didn’t.)
• Southwest Airline’s peanut policy makes me nuts. (Ha.) They hand them out to every passenger without even asking. I had to be quick to tell them not to give us any before they plopped them down on my tray. On a longer flight, they also offered other snacks as an additional treat, but nearly every one had a nut warning.
• Hershey’s Dark Bark recipe makes great chocolate for making S’mores:
  1 (8-oz.) package of Hershey’s Unsweetened Baking Chocolate, broken into pieces (if you can’t find Hershey’s baking chocolate, substitute 3 T Hershey’s cocoa melted and blended with 1 T shortening or oil for every ounce of baking chocolate); 1/4 cup plus 1 tsp. shortening; 1/8 tsp. vanilla extract; 2 cups confectioners sugar.
  Grease 9x9-inch pan. Set aside. In medium bowl, microwave chocolate and shortening on high for 1 1/2 to 2 minutes, until mixture is melted and smooth when stirred. Add vanilla extract. Gradually stir in sugar. If mixture becomes too thick, knead with clean hands. Spread out in prepared pan. Cover tightly. Refrigerate until firm. Break into pieces. Store, well covered, in refrigerator.

What are some of the places and events that have made you think of food allergies this week?

Caribbean Dreams

Re-entry is hard.

I love vacations, and I hate coming home. Coming home means piles of laundry, stacks of mail, a to-do list a mile long, looming work deadlines, and cold weather.

Sure, it’s nice to sleep in my own bed. I guess. Oh, who am I kidding? I much preferred sleeping on the 43-foot catamaran we just spent a week on while sailing through St. Lucia and the Grenadines in the Caribbean. Endless miles of turquoise water. Coral reefs teeming with fish in every color of the rainbow. Millions of stars in an unspoiled sky. Steel drum music wafting over the water from the nearby beach bar. Flippers and masks piled in the corner, ready for the next snorkeling foray. Rum punches. Conch fritters. Fish on the grill, freshly pulled from the water off the back of our boat.

I traded all this for gloomy skies, a messy house, and Christmas sale commercials?

Blech.

I’m a traveler at heart, and there’s no way around it. Right now, I’m sitting here with a handful of exotic coins in my pocket – they have scalloped edges and an old-fashion sailing ship on them. A giant conch shell, its inside pink and pearly, sits drying on my kitchen counter. My passport is lying open in front of me, its latest stamp a testament to my wanderlust.

I’m addicted to travel, and my addiction is apparently hereditary. My son has it, too. He got his first passport when he was 4 months old, when we went to Holland. At 2, he went to Hawaii and Sint Maarten in the Caribbean. He’s been to Mexico a couple of times, the British Virgin Islands, Belize, and now St. Lucia and the Grenadines. His wish list includes places like Pompeii, Japan, London, and Paris. Not bad for a kid who just turned 10. He’s gone through two passports now, and we’re about to order his third.

With his food allergies, we have to be a little more cautious and a lot more prepared than some when we travel. I carry a ton of food with me whenever we travel – lots of Enjoy Life! Foods granola bars, fruit snacks, and boxes and cans of things he can eat if we get stuck.

But the real life-saver is that since we chartered our own sailboat, we cooked most of our meals ourselves. Chartering a sailboat for a week is like renting a condo for a week – you have your own kitchen, so you can cook all of your own meals. The big difference is that you can’t usually sail your condo to another island when the mood strikes you!

Another good part about this trip was that our airline experience was positive – we discovered a benefit to the airlines’ recent cost-cutting measures! We flew American Airlines this time, and apparently they’ve done away with free snacks. No little packets of peanuts or trail mix! Instead, they have “food for purchase” on some of the flights. You can purchase snacks like chips, a cheese plate, or even a sandwich, but because they’re pretty expensive ($6), few people did. Personally, I felt a lot more relaxed on the flight because there simply weren’t as many wrappers floating around the plane.

Being able to control the food my son comes into contact with means my luggage is heavier, my planning is a little more complicated, and our meals might not be as spontaneous, but it does mean that we can still succumb to that wanderlust in our hearts.

Now if only I could feel as good about my return to reality. Where did all these bills come from, anyway?

Flying Peanuts

I was in Arizona this weekend with a couple of girlfriends. We had a blast – we let “spontaneity” be our theme word, so we let our whims guide us and had a great adventure, somehow cramming a little of everything into our trip.

Then, just to keep that “spontaneous” theme going, the airline decided to help by bumping us off our return flight. So instead of returning Sunday night as planned, we returned yesterday. It meant a few fast phone calls to sort out babysitting, lining up people to get our kids ready and off to school without us, and another phone call for a friend to come pick up my two companions at the airport so that I could drive directly to a Monday morning work meeting that I couldn’t miss.

But it all worked out surprisingly well, and we eventually made it home safe, sound, slightly sunburned, and recharged – and a day off-schedule, which explains why my blog is a day late this week. Oh well. Sometimes life just has its own agenda.

Anyway, the flights to and from Phoenix were short, but still long enough for the attendants to bring out beverages and snacks – your choice of crackers, cookies, or peanuts.

I continue to be surprised that airlines still serve peanuts. How can they do it, knowing that 11 million Americans suffer from food allergies, knowing that peanuts cause the most fatal allergic reactions of any foods, and knowing that they are trapping people in a giant flying can far away from medical help?

Sure, people who fly a lot know that they can call the airlines ahead of time and ask for a peanut-free flight. But that doesn’t help eliminate all the ground-in peanut crumbs in the carpet, on the arm rests, on the trays, in the seats, on the lavatory door handles, and everywhere else. And what about people who don’t fly regularly and don’t know they can call and request a peanut-free flight?

Watching them hand out peanuts made me nervous, even though my son wasn’t on the flight with me. It’s funny how sensitized I am to nuts now.

About three weeks ago, a friend of mine flew across country for work. She’s allergic to a few tree nuts, but she doesn’t usually worry about flights because she’s not allergic to peanuts. But on this particular flight, her colleague, who was sitting next to her, ordered a food tray from the attendant. The food tray contained fruit, pecans, cheese and crackers. He ate the fruit and nuts, but offered my friend the cheese and crackers. Not realizing there had been cross-contamination, she had one.

Quickly, she felt her throat closing up, and knew she was reacting. She grabbed some Benadryl and some water, but it continued to get worse. A few minutes later, she found herself waking up in the back of the plane, a doctor’s face bent over her, with a blood pressure cuff on her arm. Luckily, there was a doctor who responded when the attendants had asked passengers “Is there a doctor on the plane?” There was also someone who had an EpiPen, who offered it to the doctor.

They didn’t have to use the EpiPens – the Benadryl began to work, and the doctor was monitoring her blood pressure to make sure she didn’t go anaphylactic.

It’s our worse nightmare – to have an allergic reaction when you’re that far from a hospital. In her case, she was incredibly lucky and just happened to be flying on a flight with both a doctor and another allergic passenger armed with EpiPens. (The fact that there WAS another allergic passenger on the plane with EpiPens shows how prevalent food allergies really are.)

But it made me wonder how often reactions on airplanes happen, and why the attendants who have to deal with it put up with nuts on their flights (the edible kind, not the psycho passenger kind). If I were a flight attendant, I’d speak up and ask that my employer discontinue nuts, just so I’d eliminate a few more chances for things to go wrong on my flights. You can’t eliminate all possibilities of problems, of course, but why not eliminate the obvious and easy ones? In business, that’s called “picking the low-hanging fruit” – taking the obvious steps to increase chances for success.

My friend’s experience may not have taught the airlines anything, but it did remind her that she can’t let her guard down, even for a single snack. And it reminded me that even adults forget to be vigilante, let alone kids, so I have to continue to remind my son to be aware of his environment, not to take anything for granted, and to be responsible for his own life, no matter where we are.

Travel Tips #1: Surviving the Flight

Ah, Mexico. Sunshine, margaritas, white sand, turquoise-colored ocean waves, rainbow-colored fish, Mayan ruins, dolphins, iguanas… Cancun was fabulous, and our trip was smooth, easy, and a lot of fun.

We travel a lot, and we’ve had some minor challenges with my son’s food allergies over the years, so I’ve learned a lot about how to plan ahead and stay safe so that the trip is a blast and not a bust. Since traveling with food allergies can be scary, especially if you’re new to the whole experience, I’ll spend this week and next explaining how I do it. It may or may not work for anyone else, but it’s how I cope.

This week I’ll talk about the first challenge, which is, of course, the airplane ride. To survive the flight without problems, I always carry two things: HandiWipes, and my own meals and snacks. With the HandiWipes, I can clean off the tray tables and arm rests before my son starts handling them. He doesn’t react to peanut dust in the air, fortunately, so we can be on planes that serve peanuts if I’m just careful about cleaning his area.

You can call ahead and request a no-peanut flight. I’ve had varying degrees of success doing this. It depends on the airline, the flight, the person you talk to, the flight attendants assigned to the flight, the alignment of the stars and moon, the political instability in Outer Splatvakia, and the mating rituals of sea porcupines. I’ve been chewed out by flight attendants because I didn’t call ahead, and I’ve been chewed out by flight attendants because I did. And most of the time, I just forget to call ahead or decide I don’t have hours to spend on hold. So I take my Handiwipes and my own snacks. Call it a cop-out.

As for in-flight meals, here’s what I do: I have a collapsible insulated lunch sack. In that, I tuck a couple of empty quart-sized Ziploc freezer bags (depending on how many flights are involved – 1 per flight). Then I put another Ziploc bag of ice in the lunch sack to keep the lunches cold until we get to the airport. Finally, I put in sandwiches that I’ve made, or lunch meat and crackers, cookies, etc. If we’re staying in the U.S., I can pack fruit. If we’re going to another country, you can’t take fruit across the border, so I’ll pack fruit leathers.

At the airport, before I go through the security line, I throw away the baggie with the ice in it (don’t want security getting concerned about a bag of ice), then go through the security gate. On the other side of the gate, I find a fast-food restaurant and ask them to put ice in one of the empty bags (sometimes the soda fountains are out in the public area, so I can fill my own bag with ice). Then I put that bag back into the lunch sack. Voila!

That’s how we make it through the flight. I still have to fend off flight attendants trying to give me peanuts (I am shocked at how many airlines still serve them). But at least I feel like I’ve got my little part of the plane under control.

Next week, I’ll explain how I handle food while we’re on vacation.

Meanwhile, now that we’re back in Utah, I’m trying to remember to put on socks instead of flip-flops in the morning. I’m never quite ready for a vacation to be over!