An expert from Vall d'Hebron leads an initiative of the World Allergy Organization to improve safety in allergic patients in planes

The most serious allergic reactions (known as anaphylactic shock) are potentially fatal. These are reactions that affect the entire organism and manifest rapidly, in a few minutes. They produce typical skin symptoms of allergies, respiratory diseases such as heart disease, or cardiovascular disease, with loss of tension and loss of consciousness. In very extreme cases, they can cause the person's death. When a serious allergic reaction occurs, it is essential to know how to recognize the symptoms and act quickly. People who suffer from anaphylactic shock must receive urgent medical assistance, which includes intramuscular injection of adrenaline, or they can self-inflict adrenaline themselves.

The problem is still more serious if a person suffers an anaphylaxis during a flight and does not carry adrenaline in order to auto-inject or cannot receive the appropriate medical assistance urgently. For this reason, the World Allergy Organization (WAO) conducts a series of recommendations both to airlines and passengers to prevent and combat a serious allergic reaction in a commercial flight. These recommendations are contained in a scientific article recently published in the World Allergy Organization Journal. Dr. Victoria Cardona, head of Vall d'Hebron Allergology and coordinator of the World Allergy Organization's Anaphylaxis Committee, leads this initiative that aims to improve the security in the planes of the patients with allergies.

Food allergies and respiratory diseases

As explained by Dr. Cardona, also a researcher in the Group of Systemic Diseases of the Vall d'Hebron Research Institute (VHIR), there are more and more people with allergies. And the main concern of the Committee of Anaphylaxis of the World Allergy Organization regarding allergic reactions in airplanes are those related to food. "Systemic allergic reactions, which in their most serious aspect reach anaphylactic shock, account for 2-4% of the medical problems that occur in commercial flights and are usually caused by food such as peanuts, walnuts or seafood. For example, it is estimated that approximately 9% of people with allergy to peanuts have suffered an allergic reaction during a flight," she says. Sometimes people who suffer from these reactions can control them through self-medication (adrenaline, in the most serious cases). "Many times, they control the allergic reaction without the help of crew members. But sometimes, we must divert a flight to the nearest airport because a patient is suffering from a shock and neither the patient nor the crew have the medication or the preparation to deal with the situation." During commercial flights it is customary to use snacks and meals that contain allergenic foods, such as those mentioned. If a person with an allergy to any food travels on an international flight and does not understand the labelling of appetizers or meals, or can not communicate fluidly with the crew, it is more likely to suffer from a reaction.

On the other hand, asthma exacerbations (that is, asthma attacks, which can cause total respiratory blockage) can also be caused by the conditions of a flight, such as, for example, "the concentration of oxygen and pressure, which can cause a slight decrease in saturation of oxygen in the blood, or the low humidity level, which can dry out the nasal mucosa," says the Head of Allergology of Vall d'Hebron. It is estimated that respiratory problems are the fifth most frequent cause of medical emergencies on airplanes.

Airline companies progress properly, but they have to improve

Dr. Cardona explains that "the problem of allergic reactions has not received the necessary attention from airlines, although, in general, medical emergence kits on planes have improved in recent years and the training of the crew to assist them. It should be noted that each country has its legislation in this area, and that not all companies are equally prepared." The World Allergy Organization, explains Dr. Cardona, "recommends that in all flights there should be inhaled bronchodilators and oxygen to treat asthma exacerbations, and adrenaline in commercial flights, to deal with more guarantees an anaphylactic shock." Other recommendations are that the crew receive training to help a person with a serious reaction with the help of a remote healthcare professional, who consult a physician prior to the flight when an allergy-friendly patient is traveling. Leaflets and warnings about allergens in food are very clear, that pets go far away from people who are allergic and that they maintain adequate humidity and oxygen conditions. It is important keep in mind, adds Dr. Cardona, "that a person may suffer their first allergic reaction during a flight, and will need help".

And what must be taken into account by allergic people?

People who suffer from allergies may be scared to suffer a serious reaction during a flight or have trouble carrying medications on board or using them. In this sense, Dr. Cardona advises "that patients who have suffered a serious reaction should consult the doctor before taking an airplane, because the medication may need to be adjusted. In addition, they have to go very carefully with the food they serve during the flight. In serious cases, it is advisable to notify the crew of their illness to reduce the risk of exposure to allergens." In addition, people susceptible to a serious allergic reaction should always carry on an adrenaline self-injector, which is the medication necessary to combat anaphylactic shock. "The problem is that this autoinjector has a needle and liquid, which can make it difficult for you to get on an airplane. We advise these people to request a document from their doctor to prove the need to always carry it, even in an airplane," adds the head of the Allergology of Vall d'Hebron.