COL Glenn alerted me to a blog post where a child on a plane had a severe peanut allergy, and anaphylaxed (stopped breathing) when a passenger 4 rows away had opened a bag of peanuts. He wanted my medical opinion on this case. I find her anaphylaxis from 4 rows away by smelling peanuts dubious, but I’m not an allergist, I’m an ER doc, so I asked my allergist friend (who wished to remain nameless, but works at a top 10 nationally ranked hospital). He said this would be virtually impossible unless the peanuts were ground finely and aerosolized. Here’s the medscape article on inhalation of peanuts.

I read one study where found researchers failed to detect peanut in air filters at the level of the neck after volunteers danced on peanuts on the floor of a poorly ventilated room (Perry TT, Conover-Walker MK, Pomes A, Chapman MD, Wood RA. Distribution of peanut allergen in the environment. J Allergy Clin Immunol. 2004;113:973-976). There was also a study where people with severe peanut allergies smelled a jar of peanut butter from very close range but experienced no allergic side effects (Simonte SJ, Ma S, Mofidi S, Sicherer SH. Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunol. 2003;112:180-182). There is still persistent belief that just smelling peanuts can cause anaphylaxis; however the medical literature does not support this, as there have only been anecdotal cases.

From my perspective, if you’ve got such a severe allergy that you anaphylax from smelling peanuts, you need an epi-pen on you at all times, and you need to immediately see an allergist for desensitization therapy, because you’re constantly at risk of death.

 

Posted by glenn | 5 Comments

5 responses to “Peanut allergies and planes”

  1. charles says:

    I was flying jetBlue with my autistic son when the cabin Crew announced that due to an allergic passenger the flight would be peanut free. I allerted the crew to the fact that my son was eating a peanut candy and it was on his clothing. There was a supposed phone consultation with some medical experts and the crew insisted we wipe down my son with alcohol wipes and remove his clothing.
    At the end of the flight I suggested the allergic passenger remain on board till we deplane rather than pass us but now the allergy was not a real concern.
    I asked JetBlue to sapologize for the treatment of my son, never answered.

  2. ChoochMom says:

    I hate to be critical post of your well meaning post, but as you state you are not an allergist. My son has a severe peanut allergy and though he is not sensitive to airborne peanut dust, the suggestion that those with peanut allergies can just go through “desensitizing therapy” is patently false. It is not an allergy like grass or pollen with shots available. I would take my son in a heartbeat if they offered it. There have been several clinical studies which have shown some promising results finally (after many years of setbacks). But they are not open to the general public and are many years away from being offered as a general treatment.

    Every year when we see this allergist we ask about the progress of the trials but it still is not ready for prime time.The first tries as I understand had too high a ratio of patients going into shock, so they have changed protocol with better results, but the consequence is that allergists presently refuse any conditioning therapy for those with the most severe reactions ( and even others). It is just considered too risky.

    So for us right now, there is nothing to do but be vigilant. So your post seems to put an unfair twist on the subject as if the patient has a choice about staying allergic. It is simply not true. Believe me, I would stand line for a month or longer to get such a treatment or pay any amount of money not to have to have the day to day worry about accidental exposure. But for now I do, and your posting just reinforces the idea to the general public that there is something we are “not doing”.

  3. Andy says:

    @ChoochMom – You’ll have to forgive my ignorance on the desensitization subject. I work partly at Children’s Hospital of Philly, where they are doing it, but it must be experimental. I was not aware that it had not gone mainstream yet. My apologies.

  4. Segments says:

    Great blog. Very informative. Appreciate the study links and references.

    It seems many parents go the extreme demanding peanut free flights. They try to intimidate other pax into complying with their over the top demands when a nut free row would be sufficient.

  5. Kevin says:

    Seems to me the prudent option would be for someone terrified of coming into contact with a peanut on a flight would be to drive instead.

    Airlines can’t and shouldn’t be responsible for the hypoallergenic fitness of their planes, nor should they be responsible if a hungry passenger tears open a Payday candy bar because they might be hungry…

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