PEANUT ALLERGIES FINAL SUMMARY

Who Participated in the Peanut Allergy Discussion?

Peanut Allergies generated more discussion than any other issue.  There were 537 total comments:

  • 454 were made by 185 users
  • 83 were made by Regulation Room moderators

Commenters were primarily air travelers. Of those who self-identified a different interest, 3 work for a U.S. air carrier, 2 work for travel agency or Global Distribution System, 1 is a researcher/expert, and 16 are unspecified “other.”  Within their comments, many people identified themselves as peanut allergy sufferers, parents or other relatives of a peanut allergy sufferer, or sufferers of some other type of allergy. Of those who identified themselves as the parent of a peanut allergy sufferer, one self-identified as a nurse and three self-identified as physicians.

From September 1 to September 16, the Draft Summary was available for review.  Seven people made comments.

How this Summary is Structured

The first 6 sections are problems or concerns that people raised during the discussion.

The last 5 sections are possible regulatory responses that were raised and discussed.

Concern: Evidence of Existence and Severity of Peanut Allergies

Commenters generally agree that DOT’s decision about whether to restrict peanuts on airplanes should be based on good evidence about the extent, severity, and nature of peanut allergies, particularly the effect of airborne peanut particles during flight.  However, commenters disagree sharply about whether such evidence exists, and there were some heated exchanges about this.  Several provided links and citations to articles and scientific studies about peanut allergies.  The list of those links and citations can be found here.

Commenters who discussed the evidence on peanut allergies are about evenly divided (about a dozen commenters on each side) on whether it is adequate to justify restricting peanuts on planes.  (N.B. Summaries refer to commenters, not comments; some people made a large number of comments, but multiple comments are attributed to the single commenter who made them.) Those who dispute the adequacy of the scientific evidence point to the fact that many of the studies rely on reported food allergies, rather than allergies clinically diagnosed through IgE testing. At least some of these commenters deny that allergies exist.  Commenters challenging the evidence tend to oppose any regulation. Those who consider the evidence adequate are likely to support a complete ban on peanut products on planes, rather than simply establishing peanut-free flights or peanut-free buffer zones.

Many commenters told stories about their own allergic reaction to peanuts or peanut products, or about a reaction of their children, grandchildren, or other relative.  Because DOT Department of Transportation specifically asked for “scientific or anecdotal evidence” of serious in-flight allergy problems, stories of in-flight medical problems from airborne peanut particles are collected here. Most of those who described an allergic reaction of their own or experienced by their children support restricting any food item containing peanuts.  In general, those who oppose a restriction of peanut food items believe that personal reports of the existence nd severity of peanut allergies are inaccurate, exaggerated, without physiological basis, or not grave enough to warrant regulation.  In particular, they dispute that airborne particles or contact with peanut residue or oils (in contrast to actual ingestion) can trigger serious reactions.  A commenter who self-identified as a flight attendant said that he/she had not seen peanut allergy problems among passengers until recently, and that she doubts their legitimacy.

The disagreement about whether good evidence exists, combined with the unpredictability of allergic reactions and concerns about effective avoidance strategies, is reflected in disagreement about acceptable levels of risk.  Commenters seem generally to agree that attaining zero risk is unrealistic (although one person who commented on the draft summary insists that there is no “’acceptable’ level of casualties/deaths.”).   However, even among those prepared to accept some risk, there are widely varying views on what level is acceptable. Some commenters—especially people who report having children with peanut allergies—advocate reducing risk to a minimum by eliminating peanuts completely from airplanes.  Many of these commenters consider unacceptable risk to include reactions that are not life-threatening.  By contrast, some commenters say that the risk of death is extremely small; they do not include reactions that cause only discomfort in the outcomes they consider unacceptable and are convinced that proper steps could be taken to minimize risk to acceptable levels without regulation.  Many commenters’ perception of acceptable risk falls somewhere in between these two positions.

Because of the importance of scientific evidence on the extent, nature and severity of peanut allergies, the Regulation Room team invited experts to add their views to the discussion.  Go here to read about how we identified experts, and what questions we posed to them based on the discussion.  Unfortunately, although several experts acknowledged receiving our communication, no one participated in the expert discussion.

Concern: Personal Rights and Freedoms

About a dozen commenters think that banning peanuts would unjustifiably infringe on passengers’ rights and personal freedoms.  About the same number of commenters disagree.   (One person commented on the draft summary that people who support a peanut ban should be assumed to disagree with the personal rights and freedoms argument.  To avoid making erroneous assumptions about what people might have meant, summaries try to report what was said in the comments.)

Commenters who raise personal rights issues tend to question the validity and severity of peanut allergies.   They object to limiting their ability to consume peanuts and peanut products because of speculation and unfounded fears, and so they tend to oppose any regulation.  Commenters who disagree are convinced that peanuts pose a real and serious risk. They insist that the danger to those who are allergic outweighs the benefits others may derive from eating peanuts and peanut products during flight, and so they tend to support peanut restrictions of some sort (see below).  Some commenters respond that the benefits of peanut consumption are greater than just satisfying personal preferences: peanuts are an efficient source of protein (especially for children), are a travel food relied on by people with blood sugar problems, and are one of the few in-flight snack option for those who suffer from low blood sugar and celiac disease, or who are otherwise allergic to gluten products.

Concern: Slippery Slope

Approximately thirty commenters are concerned that banning peanuts will be a slippery slope leading to greater regulation both of food products specifically and air travel in general.  Commenters who raise slippery slope concerns are generally more likely also to voice concern about the economic costs of implementing peanut restrictions, the difficulty of enforcement, too much government regulation, and infringement on personal rights and freedoms (see below).  About half of them add that it should be the responsibility of the allergy sufferer to take necessary precautions.

Roughly fifteen commenters counter that peanut restrictions can be distinguished from other allergen regulation because peanut allergies can be life threatening.  Also, the suggested alternative measures (such as peanut-free flights, peanut-free buffer zones, or other airline accommodations) are criticized as impractical or ineffective (see below).  However, a few other commenters do argue that regulating only peanuts would ignore the dangers from other allergens (e.g., pets, perfumes, latex products), and they support an even broader regulatory approach.

Concern: Industry Self Regulation vs. Governmental Regulation

About a dozen commenters say that restricting peanuts on airplanes is beyond the legitimate scope of government regulation.  Several others predict that the airline industry will self regulate in response to consumer demand for peanut free flights or because of fear of litigation.  Commenters debated whether peanut allergies are covered under existing regulation and legislation (including the American with Disabilities Act) and how allergy litigation would turn out.

Concern: Enforceability Problems

Many commenters are concerned that enforcing a ban or other regulation of peanut products would be impossible.  This concern is expressed by both people in favor of peanut regulation and people against it.  Many say that neither airlines nor the government could completely eliminate peanut products on planes, especially with private individuals bringing them on board (or at least having peanut residue or oil on their hands that can be spread).  Because of enforceability concerns, some worry that regulation might give peanut allergy suffers a false sense of security.  Whether they are for or against peanut regulation, most commenters who discuss enforceability feel that allergy sufferers have a personal responsibility for taking precautions (see below).

Concern: Economic Costs

About a dozen commenters raise concerns that regulating peanuts will create undue costs, both for airlines and for the peanut industry.  Most add that it should be the responsibility of the allergy sufferer to take necessary precautions.  A few commenters countered that banning peanuts is similar to other substances already banned from airlines and could easily be included in existing lists of banned products and substances.

Possible Regulatory Response: Ban Peanuts on All Flights

More than sixty commenters say that some sort of peanut-restricting regulation is appropriate.  (In general, pro-restriction commenters think the scientific evidence is sufficient to justify regulatory action, consider peanut allergies different enough from other allergies that there would not be slippery slope problems, and say that any infringement on personal rights and freedom is outweighed by the danger to peanut allergy sufferers.)  Of these commenters:

  • about one-third  say that banning peanuts on all flights is the only adequate solution.
  • about one-half support something short of a total ban:  these are divided between favoring peanut free flights or peanut-free zones (see next section);
  • the remainder support restricting peanuts but are not specific about how DOT Department of Transportation should do this.

Pro-restriction commenters are divided on how broad the restriction needs to be.  The first question is whom the restriction should cover.  Of the commenters who specifically addressed this issue, some think the restriction should apply only to what airlines serve; the rest think it should also apply to what passengers may bring onto the plane.  Those who think passengers must be covered are worried about any source of peanut residue on plane surfaces or peanut particles in the air.  Those who think only airline peanut service should be covered are concerned that a passenger restriction would be too difficult to enforce.  Furthermore, they say that many passengers opening bags of peanuts at the same time (as happens when an airline serves peanuts) is considerably more dangerous than an isolated passenger consuming peanut products.

The second question is what products should be restricted.  Of the commenters who specifically addressed this issue, a few would restrict only whole peanuts; the rest would include peanut products such as peanut butter and candy bars containing peanuts.  No one argued that food items that may contain peanuts, that are processed in a facility where peanuts are processed, or that just contain peanut oil need to be restricted.

About twenty commenters oppose a total ban on peanut products on airplanes.  Anti-ban commenters tend to raise concerns about a slippery slope of over-regulation.  Also, because many believe that scientific evidence does not establish the need for a restriction, they worry about unwarranted limits on personal rights and freedoms.  Some point out that peanuts are a good high protein snack for travelers, especially children, and are one of the few in-flight snack options available to people on gluten-free diets.

Possible Regulatory Response: Create Peanut-Free Flights or Peanut-Free Zones

Among the commenters favoring some sort of peanut-restricting regulation, about a dozen support peanut-free zones—that is, a ban that applies to designated rows in the aircraft.  Several pro-restriction commenters think this approach is inadequate because they are concerned about peanut particles in recycled air and peanut oils being spread throughout the plane by touch.

Among commenters favoring some sort of peanut-restricting regulation, roughly 20 think that peanut-free flights are a good solution.  Commenters who support a complete ban argue that, from a practical point of view, partial bans wouldn’t work because of peanut residue and airborne particles.  They point out that peanut free flights would not necessarily require airlines to maintain peanut-free aircraft.  They also note that if a flight were delayed, the allergy sufferer could miss a peanut-free connecting flight.

Those in favor of peanut-free zones or flights tend also to advocate some sort of airline accommodation, such as including epinephrine auto-injectors in first aid kits or allowing allergic passengers to pre-board to clean off their seating areas (see below).

The discussion summarized in the previous section about whether a restriction should cover only airline peanut service, or also what passengers bring on the plane, also applies to peanut-free flights.  The discussion about whether a restriction should apply to only whole peanuts, or also to products containing peanuts, also applies to both peanut-free flights and peanut-free zones.

Some of the commenters who think a total ban on peanuts is unjustified (see previous section) also oppose peanut-free flights.  Several argue that if such flights are created, airlines should be required to give all ticket holders clear, advance communication that their flight will be peanut-free.  This is important because, for example, passengers with gluten free diets often rely on peanuts as snacks.  Similarly, some of the commenters who oppose a full ban also oppose peanut-free zones.  They point to excessive government regulation, a lack of scientific evidence, infringement on personal rights, and the need for all passengers to have healthy, protein-filled snacks as reasons for their view.

Possible Regulatory Response:  Education

Some commenters who support peanut-restricting regulation also see a need for more education. About a dozen commenters are concerned about the stigma attached to those who suffer from peanut allergies, and a similar number favor more wide-spread education about the problem.  Some told stories of personal embarrassment or ridicule when they requested that no peanuts be consumed during the flight.  Many suggested that flight personnel be required to receive training about allergies, and should be expected to be more sympathetic to afflicted passengers. No commenters specifically opposed more widespread education about peanut allergies, although as noted earlier in this summary, there is sharp disagreement about the extent, nature and severity of the problem.

Possible Regulatory Response:  Personal Responsibility rather than New Regulation

More than 50 commenters, including many who support total or partial bans of peanuts on flights or other accommodations, mention the allergy sufferer’s personal responsibility to take precautions.  No commenter argued that allergy sufferer should not have some kind of role in ensuring that they do not have reactions.  The disagreement came about what this responsibility should be, and whether airlines and other passengers also have a role in reducing the risk of allergic reactions.

Many of the commenters who oppose any peanut restricting regulation (see above) say they take this position because the problem is the personal responsibility of allergy sufferers.  Several offer suggestions for how those allergic to peanuts can protect themselves: wearing surgical masks or clean room suits, carrying and using epinephrine auto-injectors, and bringing anti-bacterial wipes on board to sanitize seating.  Those who support some peanut-restricting regulation respond that these suggestions are either ineffective or unrealistic.  They are concerned that self precaution is not enough to prevent potentially serious reactions.  Specifically, with respect to epinephrine auto-injectors, many commenters note that these are intended to provide only a temporary solution (perhaps only as little as 10-15 minutes) until additional medical treatment can be obtained, and that this will be impossible on many flights.  Some also say that the use of Epi-pens is not entirely risk-free, especially when multiple injectors must be used, with one commenter expressing concern that stroke is a possible side effect.

Possible Regulatory Solution:  Accommodations by Airlines other than Peanut Restrictions

More than thirty commenters made various suggestions for how airlines could accommodate those concerned about peanut allergy reactions:

  • Planes should have epinephrine auto-injectors available, and flight staff should be trained in using them.
  • Airlines should provide surgical masks, gloves, wipes, and cleansuits.
  • DOT should create a passenger’s bill of rights/responsibilities to encourage people with allergies to carry two or more self-injectors.
  • Airlines should give people with food allergies the option to board the plane early.
  • Airlines should print any food restrictions (such as a peanut-free flight) on the ticket and boarding pass.
  • Airlines should make any allergy accommodation plans easily accessible on their websites, so individual customers can make informed decisions.
  • Airlines should disclose the ingredients of meals and snacks before passengers are required to pay for/receive them.

Of the commenters who made at least one suggestion for accommodation, about one-third say that airlines should have to make some accommodation but that peanut-restricting regulation is not appropriate.  The remaining two-thirds say that accommodations should be on top of some type of peanut-restricting regulation.  Many of those who favor airline accommodations also favor education about peanut allergies, as well as personal responsibility of allergy sufferers to take precautions.

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