Why do so many people share their harrowing airline experiences with me yet never document them or file complaints?
Some say they do not want to relive the trauma. Others feel embarrassed for having been ridiculed, either themselves or in front of their child. Many simply want to move on because, thankfully, nothing catastrophic happened.
But silence does not equate to safety.
If I am truly honest, my first negative airline experience was not the one that sparked my advocacy when my son was eight. It happened six years earlier, on the return from a family ski trip.
Josh was two years old, traveling in his car seat. Two members of our family had been upgraded to business class. My husband and I agreed that I would take one of those seats, believing it might be safer. I thought it would be less likely for someone nearby to be eating a peanut butter sandwich.
As I settled in, I informed the flight attendant of Josh’s nut allergy. Her response was chilling. With a smirk, she said:
“You better wipe down the area because I served peanuts on the last flight to everyone. There is dust everywhere. Have fun trying to clean it. You have medication, don’t you? Oh, and I cannot deny my business class passengers nuts because of your son’s allergy, so I will be serving them all around you.”
I was stunned. I said nothing. I started cleaning the area around Josh, my hands shaking.
But then something unexpected happened. People around me stood up. They called the flight attendant over and told her not to serve the nuts. I was deeply grateful. The flight proceeded without incident. We landed. I was so relieved nothing happened that I never filed a complaint.
The incident that truly lit a fire under me occurred when Josh was eight years old. We were waiting to board a flight when three children nearby began tossing peanuts into the air, deliberately missing their mouths and smashing them into the floor. They laughed as they pushed the peanut dust toward my son, even after being told about his severe allergy.
These same children were about to be on our flight. I approached the gate agent and asked for a simple announcement. I was not requesting a buffer zone or any special accommodation, just a brief message to raise awareness and promote safety.
I spoke to many people in the chain of command and then the head manager at United looked at me and said, “If you think he is going to die, just do not get on the plane.”
I was stunned. The cruelty of the children was disturbing, but the indifference and dismissiveness of the adult in charge cut even deeper.
That moment made it clear. It was no longer just about my son. Families like mine were navigating a system that not only lacked safeguards but also lacked empathy. If this could happen to us, it was happening to others too.
That was the beginning of No Nut Traveler. I did not just want to collect stories. I wanted to advocate for change.
It is troubling that public outrage often only ignites when an allergic reaction results in death. This perspective is flawed and dismissive. Experiencing hives, vomiting, or other symptoms during a flight is not merely an inconvenience. It is a serious health event that can escalate rapidly.
Dismissing non-fatal reactions undermines the potential severity of these experiences and fosters a lack of empathy for affected passengers. Every allergic reaction in the air, regardless of outcome, deserves attention and action to prevent future incidents.
Compounding these challenges are studies that, intentionally or not, portray individuals with food allergies as overly anxious or hysterical. For instance, a study published in Archives of Disease in Childhood concluded that the risk of allergen exposure through airplane ventilation systems is minimal.
While that finding may be accurate, the way it has been framed in the media has led to misleading headlines such as “Peanut panic on planes is overblown” and “Nuts on planes are safe for those with allergies.” These oversimplified messages trivialize the real concerns of allergic passengers and may even increase hostility toward those requesting reasonable accommodations.
In reality, the study itself acknowledges the significant risk posed by allergen residues on surfaces such as tray tables and seats. It emphasizes the importance of precautions, including allowing pre-boarding time for cleaning. The media and medical community must present balanced information that reflects the complexity of managing food allergies during air travel.
A recent global study conducted by Northwestern University’s Center for Food Allergy and Asthma Research, published in JACI: In Practice, reveals the deep challenges passengers with food allergies face when flying. Among the most troubling findings, 31 percent of those traveling with food allergies at least sometimes choose not to disclose their allergy.
Why do so many people stay quiet? The study revealed that it was because they are afraid airline staff will penalize them just for speaking up. More than a third of participants also reported experiencing unprofessional or insensitive behavior from airline staff regarding their food allergy.
The consistency of these findings across all countries and demographic groups is striking. This is not a regional problem. It is a global one.
The fear of being treated poorly is keeping people from advocating for their health in one of the most high-stakes environments imaginable: 30,000 feet in the air. Passengers are being forced to choose between speaking up and risking humiliation or staying silent and risking their lives.
That is not just a customer service issue. It is a public health concern.
The CFAAR study also found that 70 percent of respondents were assured of various allergy accommodations that were ultimately not provided, such as announcements or alternative snacks. In addition, more than 12 percent were either removed from a flight or denied boarding after disclosing their allergy.
Too many people, including health care providers, do not realize how unprepared airlines still are to handle severe allergic reactions. As of 2025, many airlines still do not carry easy-to-use epinephrine, such as auto-injectors or nasal sprays, in their emergency medical kits.
These are widely available, lifesaving medications. Their absence at cruising altitude represents a critical and overlooked gap in safety.
In the United States, the FDA encourages transparency in labeling airline meals but does not require it. As a result, food may be served without complete allergen disclosure. Many physicians and food allergy patients remain unaware of this.
This is where the medical community can make a real difference.
Start conversations. Ask patients about their travel experiences and concerns related to food allergies. Offer guidance and share strategies for managing allergies during flights, including how to communicate with airline staff and fellow passengers. Tell food allergy patients to bring their own safe food.
Advocate for policy changes that recognize food allergies as real and serious medical conditions, not merely an inconvenience to those who want a snack with their drink.
We must speak up about the urgent need to stock appropriate medications in every airline medical kit. No passenger should be left vulnerable in an in-flight emergency. No medical professional should be asked to treat anaphylaxis without the best tools for a positive outcome.
Auto-injectors or nasal epinephrine are simple, effective, and essential. The fact that they are still not required is utterly unacceptable.
We need to encourage patients and families to share their experiences, not only with advocacy organizations like No Nut Traveler but also with their health care providers. Medical professionals can help legitimize the issue, document risks, and use their voices to demand better policies.
We must also recognize that travel is not confined to domestic borders. We live in a global society where patients travel for work, family, and education. We need global policies that ensure patients with food allergies are safe no matter where they fly.
Ask your patients about travel. Prepare them. Support them. Report patterns.
I often think about a testimonial submitted to the No Nut Traveler website early in my advocacy. A family was removed from a flight after disclosing their daughter’s peanut allergy. The next day, they flew on the same airline without mentioning it.
After the flight, the parents told me their daughter, just a child, felt ashamed, as if she had done something wrong. It still haunts me to think about what messages she internalized that day.
If we teach children that their health needs are inconvenient, they may grow into adults who no longer speak up. And what happens then, if they have a reaction mid-flight? Will the crew know what is wrong? Will they know where the passenger’s medication is?
Education and action must come before someone boards a plane. Before someone stays quiet out of fear. Before someone eats a meal that they did not know could harm them.
We have the opportunity to act before a preventable anaphylaxis tragedy occurs.
The longer we wait, the greater the risk.
Lianne Mandelbaum is a leading advocate for airline safety measures to protect food-allergic passengers. As president of No Nut Traveler and airline correspondent for Allergic Living, she drives policy change by collecting testimonials from food-allergic families to share with lawmakers, media, and advocacy groups. She can be reached on X @nonuttraveler, Facebook, and LinkedIn.
A sought-after speaker and media source, Lianne participated in a Medscape panel on emergency medical kits on planes and contributed global data on airline travel and food allergies at the GA²LEN Anacare Anaphylaxis & Food Allergy Forum. Her travel tips were also featured by Stanford’s Sean N. Parker Center for Allergy Research. She also appeared on Bloomberg to discuss the challenges faced by food-allergic travelers and advocate for policy changes.
Her advocacy led to a Department of Transportation ruling recognizing food allergy as a disability. She co-designed a global air travel and food allergy survey with Northwestern University’s CFAAR, which was presented at AAAAI and published in The Journal of Allergy & Clinical Immunology. She is the co-author of “Understanding Experiences, Barriers, and Facilitators of Safe Airline Travel—A Global Survey of Food Allergy Patients and Caregivers” (The Journal of Allergy & Clinical Immunology). She also contributed to “10 Practical Priorities to Prevent and Manage Serious Allergic Reactions: GA²LEN ANACare and EFA Anaphylaxis Manifesto” (Clinical and Translational Allergy) and “Ever Treat a Patient on a Plane? Why Med Kits Need an Update” (Medscape). Additionally, she collaborated with stakeholders to include anaphylaxis and necessary medications in the FAA Reauthorization Act of 2024.
