More flying with PA and airborne reactions

I’ve flown airlines long ago where they handed out little bags of peanuts and I I’ve never gone into anaphylaxis.  I’m grateful my allergy is not that severe.  However, when United Airlines declared themselves to be peanut free about 20 years age they became my preferred airline.  Why? It’s because I am airborne sensitive to peanut protein or peanut ‘dust’ and any allergic reaction makes you feel like crap in one way or another and causes bodily fatigue that can last many hours afterwards.

As I’ve gotten older I’ve become more aware of the how my body responds to allergens and also to the decongestants or anti-histamines that counteract them. It seems like every anti-histamine has SOME negative side effect; some of them immediate, some have effects that show up after days of use and some have potential long lasting implications. For this reason I’m looking into Immunotherapy for my seasonal allergies.

Delta to Detroit

But in addition I have hope to change my life and free myself from the LTFA prison, so one of the things I’m doing is flying on Delta Airlines. Delta serves peanuts on some of their flights but has become very responsive to peanut allergy sufferers. If you inform them of your allergy they won’t serve peanuts on your flight. Normally I would never fly Delta, but the majority of my family lives in the Detroit area and Delta has a hub there, so they are the only airline with direct flights from California. A direct flight saves me 90 minutes and the hassle of a connecting flight every time I visit. Not to mention I can fly a red-eye and get uninterrupted sleep the whole way. What’s not to like about that? But in the end I can’t go on being afraid to fly. I need to find a way to not let this get in the way of living.

I’ve tried to figure out the flying thing, read about airborne in my story. This is why I haven’t intentionally flown airlines that serve peanuts or have potential peanut residue in the ventilation system. It’s also nice to arrive at your destination and not feel like crap from an allergy hangover.

Trial Run

So before flying alone for 5 hours to Detroit I took a trial run to Seattle two weekends ago.  Delta’s customer service was outstanding and my wife was with me to help me manage my anxiety.  Delta tried really hard to take care of me and was very accommodating. It was a 2 hour, mid-day flight on a regional jet. I asked the gate agent if there was any way to find out if the aircraft had had peanuts served on the earlier flights that day. I was told the regional jet service doesn’t serve peanuts AT ALL. Then I boarded the aircraft and asked the flight attendant the same question and she told me that the plane is “loaded with peanuts”, but they won’t serve them on the flight because of me.  Ok Delta, looks like you still have some work to do here… this is the sort of misinformation that can put you at a huge liability. Keep reading to find out why.

I had my my epinephrine with me and at the last minute I decided to take with me a P100 respirator that I had in my workshop. I boarded and wiped down everything around me. Things seemed fine. I thought I felt a twinge of a sinus reaction, but that would be understandable since obviously there was peanut residue present. When they closed the door and sealed the cabin there may have been a change in ventilation and that may have exacerbated the problem, I can’t be certain. Does anyone who is an expert in commercial aircraft design know? Even if I asked Delta I’m not sure I would trust the answer that I get.

The next 2 hours I had some ongoing discomfort and at one point I went to the restroom in the front of the aircraft. As I walked through first class they were eating something and I caught an odor that was unpleasant (allergic). I would have guessed one of three things; either peanuts, tree nuts of sesame. (I’m not allergic to sesame, but it smells nutty.)  In the course of the flight I had three anxiety attacks and my wife was able to talk me down.

Airborne Anaphylaxis is Real?

Two hours later when we arrived I was still suffering from sinus irritation and was uncomfortable for the next couple hours after landing. I saw my allergist in the next week and asked about this; whether it was seasonal allergies? He told me ‘there is no pollen at 30,000 feet’, my reaction had to be ‘something’ in the cabin… I am PN/TN allergic, PN-ANA. but he also said that it was unlikely that airborne exposure could cause ANA, so I asked him to explain that further.  This seems to be an issue of medical semantics. Here is what I was told:

Anaphylaxis is when the allergen gets in the bloodstream and then triggers a catastrophic avalanche that ends with multi-system reactions.

There would be insufficient allergen in the bloodstream from contact or airborne to trigger anaphylaxis per the medical definition, HOWEVER it is entirely plausible that airborne could be sufficient to cause a severe bronchospasm like asthma and severe asthma can be fatal if not treated.

In other words, I could die, but the cause of death would be bronchospasm, not anaphylaxis. 

This is frustrating. There seems to be a debate going on whether or not airborne anaphylaxis is real, but that misses the point entirely. Even if both sides of the argument are right from their own perspective, but this isn’t doing anything to further research on the subject. Once again, it feels like we are being told that we are overreacting, or it’s all in our heads. Ugh!  The medical industry seems to dismiss the fundamental idea of SELF-PRESERVATION.  Their argument is that if Airborne is real then why aren’t there any deaths from it?  The answer is surprisingly simple.  If you were exposed to something that physiologically triggered an impending sense of doom then why wouldn’t you go to any length to avoid that exposure? 

The flight home

We flew home; this time on a flight late in the day so according to the airlines even greater likelihood of peanut residue in the cabin. Again Delta was very accomodating at trying to put me at ease and again upon entering the cabin I felt a twinge in my sinus and was not looking forward to a repeat performance.  I dug in my bag and pulled out the respirator and put it on. I was feeling pretty self concious but I wanted to give it a try. At first I wasn’t sure it was doing anything and I had another anxiety attack, but after about 30 minutes my symptoms started to subside on their own and I was able to fall asleep.  I woke when we arrived with no symptoms! It was great! I was rested and NO ALLERGY HANGOVER.

I had this mask in my workshop. You only have one set of lungs and if you are doing dusty work there is no reason to not use the best protection possible.  The respirator pictured cost about $40 and is very comfortable. The replacement filters are $12 and last for 100’s of hours of use.

The two important aspects of a mask are that it is comfortable enough to wear for extended periods and that it filters out what needs to be filtered. On the latter point, here’s where to find out more about filters:

http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/

Select a type of respirator to see all approved models:

N95 – Filters at least 95% of airborne particles. Not resistant to oil.

Surgical N95 – A NIOSH-approved N95 respirator that has also been cleared by the Food and Drug Administration (FDA) as a surgical mask.

N99 – Filters at least 99% of airborne particles. Not resistant to oil.

N100 – Filters at least 99.97% of airborne particles. Not resistant to oil.

R95 – Filters at least 95% of airborne particles. Somewhat resistant to oil.

P95 – Filters at least 95% of airborne particles. Strongly resistant to oil.

P99 – Filters at least 99% of airborne particles. Strongly resistant to oil.

P100 – Filters at least 99.97% of airborne particles. Strongly resistant to oil.

Next Flight

My daughter is graduating from college, so today I’m in Seattle again having flown Delta this morning on the first flight of the morning. I bought this $8 N100 mask from Amazon:

The results today were mixed. I donned the mask when I boarded the aircraft and I wore it for the first half of the flight with no symptoms. Yay! I did find however this mask is not as comfortable as the true respirator. Not horrible, but I don’t think I could wear this all day long. Will try again on the flight home.

BUT, midway through the flight I removed the mask and this time did not develop any symptoms, so the effectiveness of this mask is inconclusive. Was it because the aircraft was cleaned for the morning flight? Or what?  My next flight is going to be an early morning return on Monday.

Then after that a redeye to Detroit, then a late evening return.

There has been very little research on airborne exposure. The 2009 Journal article on this is just a rehash of the original 1999 work.  No research has been done further.  And there has been no research as far as I can tell on the effectiveness of masks on this exposure path.  Perhaps the airlines would be willing to step up and help out with this?

© MICHAEL G SPORER AND LIVING WITH PEANUT ANAPHYLAXIS:ADULT VERSION, 2015

2 thoughts on “More flying with PA and airborne reactions

  1. Thank you for this article and this blog. Someone gave me this link when I talked about my fear of flying because of my ANA peanut allergy.

    When I was diagnosed in 1997 (I was 6) I was simply told to never fly on a plane. I think a lot may have changed.

    Again, thank you.

    Like

  2. Thank you for doing this blog! Someone shared it in one of the allergy support groups on facebook.
    We have a 3 year old boy that had airborne reactions to peanuts more than once landing him in the ER. He is anaphylaxis to peanuts, dairy, eggs, honey, and wheat. We are terrified of flying with him and only do road trips. This gives us hope in flying in the future! Thank you so much for sharing!!! I will be following!

    Like

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