Understanding Experiences, Barriers, and Facilitators of Safe Airline Travel: A Global Survey of Food Allergy Patients and Caregivers

Background: The global prevalence of food allergy (FA) has increased markedly across recent decades, with millions of patients engaging in airline travel each year. However, air travel can pose specific challenges to FA management. Objective: To collect global data about patients’ and families’ FA-related airline travel experiences, attitudes, and behaviors. Methods: An electronic survey was developed and refined by global FA stakeholders, which was administered between October 2022 and January 2023 to patients with FA and caregivers recruited via 45 FA patient advocacy organizations and research institutions. Results: Most of the 4704 survey respondents self-reported as female (88.4%), aged between 40 and 59 years (67.7%), and non-Hispanic White race (75.8%), and resided in the United States (79.6%). A history of 1 or more in-flight food-allergic reaction was reported by 8.5% of participants, with peanut (3.9%), tree nuts (2.4%), and milk (0.6%) the most reported triggers. Epinephrine was administered in 15.1% of reactions and was most often self-carried (91.7% of events). Only 57.4% of in-flight reactions were reported to either the flight crew in the air or the airline on landing. Many preventive measures were reportedly taken by respondents to avoid adverse FA outcomes during air travel, including specific requests for accommodation, which were often not provided as assured. Respondents generally reported high levels of anxiety managing FA during air travel and that FA-related policies and other related factors were primary drivers of travel-related decision making. Conclusions: Air travel presents numerous challenges to optimal FA management, many of which can be at least partially mitigated though consistent implementation of appropriate FA-related policies.