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Mr. Aldrich:
Please read the earlier posts on this topic. One would hope that you are a reasonable enough individual that if someone came to you and said that “Eating peanuts next to me could make me really sick – please don’t do that” that you would not choose to ‘resist’ this person.
This is a matter of life and death to some people, so I would hope that, if faced with a situation, you would show others that you can be a considerate person (despite your message above).
Thank you.
I am the father of a 5-year old with a severe peanut allergy as well as a physician and a medical epidemiologist. While I have been fortunate enough to not experience an anaphylactic reaction in my son, I have seen patients with anaphylactic reactions. They are terrifying for everyone involved, even in situations where you are surrounded by trained staff, abundant medications and crash carts.
The way I see this issue is that it is balancing the risks and benefits of peanuts on planes. The risks are pretty obvious and encompass death and less severe reactions that, at a minimum, are likely to result in an emergency landing.
The benefits of serving peanuts on planes are limited to the fact that most people like peanuts and they are fairly inexpensive.
I have seen on this discussion board arguments that people have the right to eat peanuts, that people with allergies should wear masks or other personal protective equipment (extending to full body suits), that people with allergies should not fly, etc… These arguments seem somewhat petty, impractical, and outdated, respectively. Petty because it is not a major sacrifice to go without a bag of peanuts. Impractical because trying to keep an N95 (particulate) mask on a young child for up to 6 hours just cannot happen. Outdated because in modern US society with families spread across the nation travel is often the norm.
For people who say ‘Just don’t travel on planes’, I assert that they are missing the point. It is not as if dealing with a severe allergy is not already lifestyle altering. I will never be able to take my son to a major league baseball park; we will never be able to go down the street for ice cream on a hot summer day; we cannot go to a Chinese restaurant. This is all OK because these are luxuries. Furthermore, if we somehow do find ourselves in a hazardous situation, we can just get up and leave. On an airplane, that is not an option. There is no getting up and leaving (and just the act of changing your seat is a challenge).
So, the way I see it is that the risks associated with serving peanuts in a closed environment where the ability to provide medical care is limited clearly outweigh the benefits of serving peanuts both on a societal and cultural level (because the very real risk faced by children and adults with severe peanut allergies far exceeds the benefit of airlines serving peanuts).
There is nothing that I am aware of that has not been recently publicized.
These include:
1) Sicherer SH et al. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010; 125(6):1322-6.
This article showed increasing prevalence peanut allergy in children but is limited by the lack of a gold standard for diagnosis.
2) Ben-Shoshan M et al. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. J Allergy Clin Immunol. 2010;125(6):1327-35.
This article is similar in the effect size and is notable because the rates of peanut allergy are 2-4 times higher in children than in adults (with varying the definitions to include only confirmed as well as confirmed and probable allergy).
3) Venter C et al. Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK. Allergy. 2010 Jan;65(1):103-8.
Shows similar prevalence rates as the US and Canadian studies above of ~1.2-1.4% in children born on the Isle of Wight, UK.
4) Branum and Lukacs. Food allergy among children in the United States. Pediatrics. 2009; 124(6):1549-55.
This is an analysis of data gathered by the CDC program (NHANES 2005-2006), designed to be a nationally representative population. In this study, serum immunoglobulin E (IgE) antibodies to peanut were detectable for an estimated 9% of US children. This tells us a few things: 1) Peanut allergies are likely common; and 2) Serum IgE testing likely overestimates the number of people with clinically significant peanut allergies. Still, this high rate of elevate IgE could presage trends to come.
The major problem is that some cases of peanut allergy are obvious while others are of uncertain significance. But, it appears that the prevalence of children with clinically significant peanut allergy is increasing (which means in a few years that the prevalence will also increase in adults). Why the prevalence is increasing remains a mystery.
As the parent of a young child with a severe peanut allergy, I would be thrilled with the following:
1) Airlines do not serve peanuts on-board
2) All airlines have a well-documented, easily accessible, and ingrained among all flight staff policy regarding food allergies and procedures for dealing with food allergies, including:
a) Early boarding for passengers with allergies to inspect their assigned seats and either clean them or request a seat change if necessary (Southwest allows early boarding as long as you do not take an exit row)
2) Following declaration of an allergy, education of nearby passengers regarding peanut products (particularly those which may release dust that can go airborne); this could be done with a single-sided piece of paper.
3) Flexibility with seating assignments to accommodate changes if a problem is apparent.
Essentially, the key with this, as with everything in life, is to minimize risk while maximizing feasibility. An absolute ban on peanut products is not currently possible, but it is possible to increase the protection of passengers with life threatening allergies with minimal inconvenience to other passengers.
Please everyone on this site, be reasonable, accommodating and, if possible, kind to others.
There is a question of practicality here. Peanut allergies (and other food allergies) at the current time are becoming increasingly common in children. For a hypothetical cross-country flight with a young child, how can you keep an N95 mask on them for 6 hours (the masks for particulates are not the thin surgical masks but the far thicker versions)? Seriously??
While I appreciate that a person may require peanuts to be ‘comfortable’ as asserted by csleep2, I would ask this individual to consider this proposition more fully, as I suspect that 6 hours of screaming from said toddler while the distraught parent struggles valiantly to keep the surgical mask in place will result in far greater discomfort than the loss of the 2 ounce bag of airplane peanuts. But I could be wrong – airplane passengers embracing the concept of N95 masks on children may actually rejoice at the idea of 6 hours with a screaming child because, well, peanuts are just that important to their quality of life and a brief peanut deprivation would quite simply be too devastating to even fathom.
I am actually focusing on feasibility and weighing risks against benefits (and apologize for the sarcasm). But, yes, I do reject the concept that having a toddler suit and mask up for 6 hours is feasible. Just curious, but have you ever worn a surgical mask for 6 hours? I actually have, and I found it quite uncomfortable. Critically, I have the willpower and the motivation to keep it in place (because I am an adult and have the ability to modify my behavior when faced with logical demands). Toddlers do not have this ability. So now balance this against the idea of airlines needing to serve peanuts at 35,000 feet. It seems fairly straightforward to me. Personally, if you want to bring your Snickers bar on-board and eat it, that is fine. But, I do not want to be sitting anywhere near you with my child when this occurs.
My suggestions:
1) Airlines do not serve peanuts on-board
2) All airlines have a well-documented, easily accessible, and ingrained among all flight staff policy regarding food allergies and procedures for dealing with food allergies, including:
a) Early boarding for passengers with allergies to inspect their assigned seats and either clean them or request a seat change if necessary (Southwest allows early boarding as long as you do not take an exit row)
b) Following declaration of an allergy, education of nearby passengers regarding peanut products (particularly those which may release dust that can go airborne); this could be done with a single-sided piece of paper.
c) Flexibility with seating assignments to accommodate changes if a problem is apparent.
This is not a ‘take it or leave it’ approach, but rather a balanced approach that weighs risks versus inconvenience for peanut consumers. Individual masks are not a practical solution for the most vulnerable passengers.
I agree with Steyermark’s comments in many ways – a full ban on peanut products is unenforceable and not practical. In my family, we read labels, understand where the labels may not give all of the information, etc… This is not something that will be done by the majority of people. Also, foods like PBJ sandwiches are really easy to fly with – no refrigeration required.
So, what I think needs to happen:
1) The airlines themselves do not serve peanut products
2) The airlines have clearly documented/posted allergy policies with education of staff (and encouragement of passenger awareness of these policies) to increase awareness that there may need to be some seat flexibility for people intending to eat peanut products from home during the flight if seated near peanut-allergic individuals. A key reason for this is that people deal with change better when it is expected, so if there is education in advance regarding these policies and issues, then seat changes or similar interventions are more likely to go smoothly. Overall, I can foresee that this may be a bit inconvenient and people affected may find this to be an annoyance, but, in the grand scheme of things, this is not that big of a deal. A policy could consist of identifying those in close proximity to the peanut-allergic individual and giving them a handout that asks if they have peanut products that they are going to be eating. If so, they should notify the flight attendant and some sort of seating rearrangement will occur in a way to maximize safety and minimize inconvenience. This will require flexibility and generosity of spirit on the part of all people involved (and I do recognize is likely to be annoying) but, in truth, is not that big of a deal when compared to a significant safety issue. The other factor here is that I am, in truth, less worried about a nearby PBJ sandwich or a Snickers bar than I am about a bag of raw peanuts as these foods are less likely to have particles that go airborne. It does not mean that I am unconcerned but just that they pose less risk.
Finally, if necessary, I am more than prepared to either 1) give an affected passenger food that we brought on the plane that is peanut safe if they are really hungry (we always bring plenty of extra ‘safe’ food) or will gladly fork over the additional $5-$50 to buy them/their family whatever in-flight food they want if it means that they will not expose my family to peanut allergens in close proximity.
I would love to see a full ban – for those with allergies, it is clearly optimal. I do not think it is possible at this time though. Where is the line drawn? What about ‘possible contamination’ or ‘shares equipment’ labels, etc…
I know that I will never feel secure when flying on a plane with my son (who has a severe allergy), just as I am never secure in a restaurant and just as we always make sure to have his epi-pens with us.
The above would be a huge advance for people with food allergies, and, maybe in the future, it will be able to go further. But, for now, I do not see how it is practical.
On a plane 2 years ago, when my son was 3, he came into contact the carpeting below the seat and developed hives. We looked and saw an old peanut under the seat in front of us. He has a documented peanut allergy. I suspect that there was residual peanut in the carpet that he came into contact with.
I am fairly certain that this 3 year-old boy he did not get hives because he was ‘stressed out’. Fortunately all he got was hives, but as best we could tell he did not have a serious ingestion (and our leg of the flight was peanut-free after we had notified the airline of his allergy at booking and check-in).
Please also see posts above citing the peer reviewed medical literature regarding the prevalence of food allergies, and specifically peanut allergies, in children.
So, while it is possible to have an IgE-mediated reaction solely from emotional stress, this was not the case here.
Mr. Aldrich:
Please read the earlier posts on this topic. One would hope that you are a reasonable enough individual that if someone came to you and said that “Eating peanuts next to me could make me really sick – please don’t do that” that you would not choose to ‘resist’ this person.
This is a matter of life and death to some people, so I would hope that, if faced with a situation, you would show others that you can be a considerate person (despite your message above).
Thank you.
I am the father of a 5-year old with a severe peanut allergy as well as a physician and a medical epidemiologist. While I have been fortunate enough to not experience an anaphylactic reaction in my son, I have seen patients with anaphylactic reactions. They are terrifying for everyone involved, even in situations where you are surrounded by trained staff, abundant medications and crash carts.
The way I see this issue is that it is balancing the risks and benefits of peanuts on planes. The risks are pretty obvious and encompass death and less severe reactions that, at a minimum, are likely to result in an emergency landing.
The benefits of serving peanuts on planes are limited to the fact that most people like peanuts and they are fairly inexpensive.
I have seen on this discussion board arguments that people have the right to eat peanuts, that people with allergies should wear masks or other personal protective equipment (extending to full body suits), that people with allergies should not fly, etc… These arguments seem somewhat petty, impractical, and outdated, respectively. Petty because it is not a major sacrifice to go without a bag of peanuts. Impractical because trying to keep an N95 (particulate) mask on a young child for up to 6 hours just cannot happen. Outdated because in modern US society with families spread across the nation travel is often the norm.
For people who say ‘Just don’t travel on planes’, I assert that they are missing the point. It is not as if dealing with a severe allergy is not already lifestyle altering. I will never be able to take my son to a major league baseball park; we will never be able to go down the street for ice cream on a hot summer day; we cannot go to a Chinese restaurant. This is all OK because these are luxuries. Furthermore, if we somehow do find ourselves in a hazardous situation, we can just get up and leave. On an airplane, that is not an option. There is no getting up and leaving (and just the act of changing your seat is a challenge).
So, the way I see it is that the risks associated with serving peanuts in a closed environment where the ability to provide medical care is limited clearly outweigh the benefits of serving peanuts both on a societal and cultural level (because the very real risk faced by children and adults with severe peanut allergies far exceeds the benefit of airlines serving peanuts).
This is a clear choice.
There is nothing that I am aware of that has not been recently publicized.
These include:
1) Sicherer SH et al. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010; 125(6):1322-6.
This article showed increasing prevalence peanut allergy in children but is limited by the lack of a gold standard for diagnosis.
2) Ben-Shoshan M et al. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. J Allergy Clin Immunol. 2010;125(6):1327-35.
This article is similar in the effect size and is notable because the rates of peanut allergy are 2-4 times higher in children than in adults (with varying the definitions to include only confirmed as well as confirmed and probable allergy).
3) Venter C et al. Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK. Allergy. 2010 Jan;65(1):103-8.
Shows similar prevalence rates as the US and Canadian studies above of ~1.2-1.4% in children born on the Isle of Wight, UK.
4) Branum and Lukacs. Food allergy among children in the United States. Pediatrics. 2009; 124(6):1549-55.
This is an analysis of data gathered by the CDC program (NHANES 2005-2006), designed to be a nationally representative population. In this study, serum immunoglobulin E (IgE) antibodies to peanut were detectable for an estimated 9% of US children. This tells us a few things: 1) Peanut allergies are likely common; and 2) Serum IgE testing likely overestimates the number of people with clinically significant peanut allergies. Still, this high rate of elevate IgE could presage trends to come.
The major problem is that some cases of peanut allergy are obvious while others are of uncertain significance. But, it appears that the prevalence of children with clinically significant peanut allergy is increasing (which means in a few years that the prevalence will also increase in adults). Why the prevalence is increasing remains a mystery.
As the parent of a young child with a severe peanut allergy, I would be thrilled with the following:
1) Airlines do not serve peanuts on-board
2) All airlines have a well-documented, easily accessible, and ingrained among all flight staff policy regarding food allergies and procedures for dealing with food allergies, including:
a) Early boarding for passengers with allergies to inspect their assigned seats and either clean them or request a seat change if necessary (Southwest allows early boarding as long as you do not take an exit row)
2) Following declaration of an allergy, education of nearby passengers regarding peanut products (particularly those which may release dust that can go airborne); this could be done with a single-sided piece of paper.
3) Flexibility with seating assignments to accommodate changes if a problem is apparent.
Essentially, the key with this, as with everything in life, is to minimize risk while maximizing feasibility. An absolute ban on peanut products is not currently possible, but it is possible to increase the protection of passengers with life threatening allergies with minimal inconvenience to other passengers.
Please everyone on this site, be reasonable, accommodating and, if possible, kind to others.
Thank you.
There is a question of practicality here. Peanut allergies (and other food allergies) at the current time are becoming increasingly common in children. For a hypothetical cross-country flight with a young child, how can you keep an N95 mask on them for 6 hours (the masks for particulates are not the thin surgical masks but the far thicker versions)? Seriously??
While I appreciate that a person may require peanuts to be ‘comfortable’ as asserted by csleep2, I would ask this individual to consider this proposition more fully, as I suspect that 6 hours of screaming from said toddler while the distraught parent struggles valiantly to keep the surgical mask in place will result in far greater discomfort than the loss of the 2 ounce bag of airplane peanuts. But I could be wrong – airplane passengers embracing the concept of N95 masks on children may actually rejoice at the idea of 6 hours with a screaming child because, well, peanuts are just that important to their quality of life and a brief peanut deprivation would quite simply be too devastating to even fathom.
I am actually focusing on feasibility and weighing risks against benefits (and apologize for the sarcasm). But, yes, I do reject the concept that having a toddler suit and mask up for 6 hours is feasible. Just curious, but have you ever worn a surgical mask for 6 hours? I actually have, and I found it quite uncomfortable. Critically, I have the willpower and the motivation to keep it in place (because I am an adult and have the ability to modify my behavior when faced with logical demands). Toddlers do not have this ability. So now balance this against the idea of airlines needing to serve peanuts at 35,000 feet. It seems fairly straightforward to me. Personally, if you want to bring your Snickers bar on-board and eat it, that is fine. But, I do not want to be sitting anywhere near you with my child when this occurs.
My suggestions:
1) Airlines do not serve peanuts on-board
2) All airlines have a well-documented, easily accessible, and ingrained among all flight staff policy regarding food allergies and procedures for dealing with food allergies, including:
a) Early boarding for passengers with allergies to inspect their assigned seats and either clean them or request a seat change if necessary (Southwest allows early boarding as long as you do not take an exit row)
b) Following declaration of an allergy, education of nearby passengers regarding peanut products (particularly those which may release dust that can go airborne); this could be done with a single-sided piece of paper.
c) Flexibility with seating assignments to accommodate changes if a problem is apparent.
This is not a ‘take it or leave it’ approach, but rather a balanced approach that weighs risks versus inconvenience for peanut consumers. Individual masks are not a practical solution for the most vulnerable passengers.
I agree with Steyermark’s comments in many ways – a full ban on peanut products is unenforceable and not practical. In my family, we read labels, understand where the labels may not give all of the information, etc… This is not something that will be done by the majority of people. Also, foods like PBJ sandwiches are really easy to fly with – no refrigeration required.
So, what I think needs to happen:
1) The airlines themselves do not serve peanut products
2) The airlines have clearly documented/posted allergy policies with education of staff (and encouragement of passenger awareness of these policies) to increase awareness that there may need to be some seat flexibility for people intending to eat peanut products from home during the flight if seated near peanut-allergic individuals. A key reason for this is that people deal with change better when it is expected, so if there is education in advance regarding these policies and issues, then seat changes or similar interventions are more likely to go smoothly. Overall, I can foresee that this may be a bit inconvenient and people affected may find this to be an annoyance, but, in the grand scheme of things, this is not that big of a deal. A policy could consist of identifying those in close proximity to the peanut-allergic individual and giving them a handout that asks if they have peanut products that they are going to be eating. If so, they should notify the flight attendant and some sort of seating rearrangement will occur in a way to maximize safety and minimize inconvenience. This will require flexibility and generosity of spirit on the part of all people involved (and I do recognize is likely to be annoying) but, in truth, is not that big of a deal when compared to a significant safety issue. The other factor here is that I am, in truth, less worried about a nearby PBJ sandwich or a Snickers bar than I am about a bag of raw peanuts as these foods are less likely to have particles that go airborne. It does not mean that I am unconcerned but just that they pose less risk.
Finally, if necessary, I am more than prepared to either 1) give an affected passenger food that we brought on the plane that is peanut safe if they are really hungry (we always bring plenty of extra ‘safe’ food) or will gladly fork over the additional $5-$50 to buy them/their family whatever in-flight food they want if it means that they will not expose my family to peanut allergens in close proximity.
Thanks.
I would love to see a full ban – for those with allergies, it is clearly optimal. I do not think it is possible at this time though. Where is the line drawn? What about ‘possible contamination’ or ‘shares equipment’ labels, etc…
I know that I will never feel secure when flying on a plane with my son (who has a severe allergy), just as I am never secure in a restaurant and just as we always make sure to have his epi-pens with us.
The above would be a huge advance for people with food allergies, and, maybe in the future, it will be able to go further. But, for now, I do not see how it is practical.
On a plane 2 years ago, when my son was 3, he came into contact the carpeting below the seat and developed hives. We looked and saw an old peanut under the seat in front of us. He has a documented peanut allergy. I suspect that there was residual peanut in the carpet that he came into contact with.
I am fairly certain that this 3 year-old boy he did not get hives because he was ‘stressed out’. Fortunately all he got was hives, but as best we could tell he did not have a serious ingestion (and our leg of the flight was peanut-free after we had notified the airline of his allergy at booking and check-in).
Please also see posts above citing the peer reviewed medical literature regarding the prevalence of food allergies, and specifically peanut allergies, in children.
So, while it is possible to have an IgE-mediated reaction solely from emotional stress, this was not the case here.
Thank you.