After settling in my seat and patiently waiting for my mid-flight snack, the cabin steward made the announcement that all passengers in rows 14, 15 and 16 will not be served any nuts, as there was a peanut allergic child present. A woman in row 17 then proclaimed that she was also allergic, and the zone was extended to rows 18 and 19. While enjoying my pretzels and empathizing with families of the constant threat of food induced anaphylaxis, I was concerned on the widespread misinformation of the food allergic triggers.
Research has shown that anaphylaxis to foods that are not easily airborne such as peanut almost always occurs through ingestion or contact with the mucous membranes, such as the mouth. The reports of symptoms triggered by smelling peanut butter have been refuted by several well designed studies exposing allergic children via contact to the skin or inhalation. A recent study could not identify airborne peanut allergen taken from different airlines during activities that mimic real life scenarios. Small amounts of airborne peanut protein were detected in the scenario of removing shells from roasted peanuts; however, the concentration of airborne peanut allergen to elicit a clinical reaction is unknown.
To mitigate the concerns of families with food allergies, Children’s Mercy Hospital have been offering a “proximity food challenge test” to determine the degree of sensitivity to airborne or skin exposure. The results supported prior studies that no patient experienced a systemic reaction after 10 minutes of airborne exposure.
Parents and patients need to be constantly on guard for inadvertent ingestion and exposure of the food allergen with the mucosal surfaces like the inside of the mouth. However systemic reactions due to inhalation or contact on the skin are unlikely. Multiple meetings to discuss these concerns, and possibly an in office casual exposure challenge may alleviate the fear and burden of food allergy.
To learn more about food allergy challenges, please contact your Allergy Partner physician or visit allergypartners.com.
Patrick Perin, MD
Allergy Partners of New Jersey