FAACT's Roundtable

Ep.263: Holiday Travel - Keep Calm and Preboard

• Season 5 • Episode 263

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The holidays are here—and that means airports, carry-ons, and crowded flights. But for those managing food allergies, air travel comes with extra challenges that require thoughtful preparation and a bit of attentiveness. Joining us today is airline correspondent, safety advocate, and founder of The No Nut Traveler, Lianne Mandelbaum. Lianne has been a leading voice for safer skies for passengers with food allergies, and she’s here to share practical tips—from pre-boarding strategies to proactive planning—so you and your loved ones can travel with confidence this holiday season. 

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Caroline: Welcome to FAACT's Roundtable, a podcast dedicated to navigating life with food allergies across the lifespan. Presented in a welcoming format with interviews and open discussions,

each episode will explore a specific topic, leaving you with the facts to know or use.

Information presented via this podcast is educational and not intended to provide individual medical advice.

Please consult with your personal board certified allergist or healthcare providers for advice specific to your situation.

Caroline: Hi everyone, I'm Caroline Moassessi and I am your host for the FAACT Roundtable podcast.

I am a food allergy parent and advocate and the founder of the Grateful Foodie Blog. And I am FAACT's Vice President of Community Relations.

Caroline: The holidays are here and that means airports, carry ons and crowded flights. But for those managing food allergies, air travel comes with extra challenges that require thoughtful preparation and a bit of attentiveness.

Joining us today is airline correspondent, safety advocate, and the founder of No Nut Traveler,

Lianne Mandelbaum. Leanne has been a leading voice for safer skies for passengers with food allergies and she's here to share practical tips from pre boarding strategies to proactive planning so you and your loved ones can travel with confidence this holiday season.

Caroline: Welcome Lianne. Back to FAACT's Roundtable podcast. I'm very excited about today's podcast because it's so pertinent with the holidays coming and just travel in general. So thank you for being here.

Lianne: I am thrilled to be here and happy to give my two cents and my tips based on years of advocacy and research on how to fly safely with a food allergy.

Caroline: This is gonna be a really powerful podcast just because it's gonna be so packed with actionable information.

And before we start, we're gonna turn to you for just a little bit to catch up with you and what's going on.

We know you have no Nut Traveler and it was born out of a situation you had with your son that I know enraged you, 

and was the catalyst for you starting No Nut Traveler. Can you talk just for a moment or two on no Nut Traveler? And then what you do right now.

Lianne: As an advocate,

you're right, I didn't intend in this lifetime to become an advocate. But when it's your child, as everybody here listening to, or it's yourself, you move mountains.

Right now, after a decade of advocacy, we're waiting to see if FAA issues a ruling to put the right medications for allergic reactions on planes.

The language is not necessarily ironclad and FAA had two years from the reauthorization to make the ruling. So we're keeping a really sharp eye on that. I was part of a survey team out of Northwestern that published with Hugh Sampson and Anna Nowak,

Scott Scheirer, yourself, Rushi Gupta, Chris Warren and Chris and I have been mulling over phase two and actionable tips that that could come out of phase one. So there's that.

I have been speaking to other people that have published in the airline world and talked about various collaborations.

There's a lot going on. There's a lot going on. And I keep, you know, I have my corner, too, where I get enraged and heartbroken over the jokes. And so I keep my eye on that as well.

There's a lot to keep an eye on.

There's outstanding cases with disability rights, Mary Vargas and the DOT that have yet to be answered in a few years. And so there's a pressing need there. And of course, I write for Allergic Living.

And we're going to get into my newest project that finally just published. I worked on a comprehensive airline and allergies flying guide for domestic and international with my editor, Gwen Smith.

It was a team effort. And I think that we have created the most comprehensive living document out there as a resource source for those flying with a food allergy. So, yeah, in a nutshell, no pun intended,

that's what's going on.

Caroline: And you keep yourself so busy. I just want listeners to know that no Nut Traveler is now a nonprofit because you've done so much work now you've needed to turn it into a complete organization because of this work.

Listeners, I want you to know Lianne flies around the world speaking and advocating for airline safety. And as a result of her work,

we've all benefited.

And speaking of work, can you just catch us up to date briefly on any of the latest research around food allergies and air travel?

Lianne: Sure. And I just want to just touch base on what you just said, flying around the world. And that's because food allergies don't live in the United States and they don't live in your state and they don't live on your street.

We live in a global world. People travel.

And this I have always advocated for fair, evenly promulgated food allergy policies throughout global aviation. And that means partnering with people in different countries and seeing how we can all work together to make this happen.

Insofar as the research I mentioned, the CFAAR study that actually I badgered Ruchi Gupta on a buffet line in Rome to get that version one done.

And God bless her and Chris Warren for making it happen.

And there's that so that we published about two years ago and Paul Turner in the UK has come out with a new study.

We don't always agree on how the statistics are reached insofar as the amount of reactions taking place, because a survey we found that reactions were taking place at a higher level,

whereas the data that they got was gleaned from airlines which aren't required to collect the data. And the medical kits which we found in our survey usually weren't cracked because people use their own auto injectors.

And just wearing my hat for a second, as reporter for Allergic Living, I can tell you that because airlines are not required to carry easy to use epinephrine. Oftentimes, it's vials, which sometimes are not there because of an exemption that the FAA issued.

And I'm sorry, that's a mouthful,

but what most physicians that I've spoken to do is crowdsource, so it's borrowed epinephrine. So then you're also not counting that data because the emergency medical kit is not cracked in that part.

So what I think the disparities in our two studies show is that we need better studies, right? We need more studies. There's nothing wrong with the studies, there's nothing wrong with the people who put together the studies.

But the world is changing. The world is evolving. Food allergies is a growing epidemic and we need better data to match up to the patient's lived experience. And I do think the CFAAR survey tried to and tried and succeeded in finally catching the data up to the patient's lived experience.

Turner's study did a really nice job of describing the proteins that are left behind from another passenger that was in your seat previously. And I think he used the word sticky.

And you could just picture sticky hands and sticky tables. And I've got pictures from passengers who have flown that have sent me of like someone shelling pistachios and on their tray table and then they push it into the aisle or push it onto their floor or.

Gwen Smith actually sent this picture just is the picture that keeps giving. I use it in every presentation of a girl with a bag of mixed nuts and they're dumped on the tray table and she's sorting through like the cashew and the Brazil nut.

And you cannot imagine cleaning thoroughly enough for that in a general boarding situation.

We don't need to conduct that study.

One has to just have eyes and on your head to see that picture and imagine the invisible dust left behind. And in fact, we do have a study because Mayo Clinic actually Did a study where they found inordinate amounts of peanut residue, which is what they were looking for.

I'm sure there was other residue there as well on airline trays,

actually more than in restaurants that served peanuts.

And these airlines did not serve peanuts either, but they had more peanut residue because it's a snack of choice. Obviously, nuts are synonymous with the flying experience.

So he and I actually had a little bit of a fist bump moment when we were together at a conference in Italy because we realized we agree on so much more than we disagree.

And number one was the pre boarding, which they are trying to get in the UK and he's very much in favor and then not taking the airline meal. And you and I can get into that whenever you're ready.

Caroline: Yes, that's a great segue in. First we're going to talk about the planning of a trip and then we're going to get into that grit where we really want to talk about the food.

So let's start off with just, we know traveling is very stressful, right?

Caroline: Just in general.

Caroline: And then when you add food allergies to the picture, the stress levels just go up.

So when a family or person is planning to take a trip, what are the most important steps that you would suggest they start to take? From booking the flights to boarding day, and then let's get into actual travel day.

Lianne: Okay.

So number one, I think, is talk to your doctor if you have concerns. I think you should talk to your doctor anyway, because what you're going to want to ask them for and what I've been recommending is that you get a letter that confirms your food allergy diagnosis and that you have the necessity to carry safe food and medication.

Because every once in a while you get that flight attendant or you get that gate agent or you get that TSA agent that questions, why are you carrying this food?

Why are you carrying this medication? You know, is this allowed? It doesn't happen often, but even in situations where there have been passengers that have disclosed their food allergy and the crew doesn't know what a food allergy is, and they're like, well, maybe you shouldn't fly.

Well, when you produce that letter, instead of arguing, it's like, yes, my physician knows I'm flying. He's given me a letter. I just need to have my safe food and medications.

And I think we have to learn, even in situations where we might very well be right, how to tone down the situation because the pilot has the final say. And if the flight attendant says to the pilot, this is an aggressive passenger.

They have the right to kick you off and there is no recourse.

You know, we need to learn to live within the constraints of the world. We can fight for better. Unless you want to be thrown off the plane. And I have been placed in these situations myself where I want to scream and yell and get upset.

I know it wouldn't have done me any good.

That's the first thing. Speak to your physician. Get the letter. Make sure your action plan is up to date and that your epinephrine,

auto injectors or nasal sprays are current and that you're not looking the morning of and saying, wow, I don't have them or it's expired. Just make sure you know where they are.

Number three Research Airline policies.

A really great place to start is my new guide that I just talked about because we really dug into the weeds.

What are their policies? What snacks do they serve? Not because you want to know what snack to eat, but because you need to know if an airline serves your allergen and how you're going to be proactive about it.

Then you want to know, do they have a policy?

Delta has a policy if you have a peanut allergy that they won't serve peanuts to the whole plane,

but they will serve tree nuts, but not to the row you're in.

Southwest just added pistachios and originally the guide said that they don't serve any nut snacks,

so a lot of people with nut allergies chose to fly them.

However, they've now added pistachios. So we updated our guide, meaning it's a living document, so that you are fully aware that starting in January you will encounter pistachios in the even more legroom seats.

I really advise you not only to do the research, but if you do have any communication with anyone in the airline that is telling you that they're going to do something,

even something that particularly isn't in their policy,

try to get it in email form and keep it on your phone. Again, that takes down any sort of argument that can come up. I would also say have that airline's policy.

You could take a screenshot of it from our guide or you could just have a PDF of our guide on your phone because again,

someone may not know. I have had people encounter that Delta flight attendant and I'm not picking on Delta. It's just a recent something that somebody shared with me that wanted to serve to the row where the mom and the allergic child are.

And wouldn't it have been easier Instead of getting upset that you could pull out your phone and say, actually, this is your policy.

There are ways to diffuse a situation.

Choose your flight wisely.

Obviously, the morning flight is the cleanest. We all know what happens as the day goes on and the delays go on. Everybody disembarks the plane and five minutes later the new passengers go on.

I mean, there's absolutely no way they are cleaning that plane. I mean,

I'm sure you could agree with me when we have pre boarded, which is your right under the Air Carrier Access act. And it is the only right we have. And food allergy was never named a disability in writing by the Air Carrier Access act until Mary Vargas and I got together.

One of my collected testimonials, which is one of the functions of no nut traveler is to collect testimonials, good and bad, from families and adults flying with food allergies. One of those testimonials led to this change for everybody flying to the United States and flying from the United States.

So some people are like, well, I don't need to pre board.

And then I've taken testimonials of people that didn't pre board with a toddler and the toddler sits down and everyone's already on the plane and they're getting ready to buckle up.

And before the mother has a chance to pull out the wipe, the child finds a stray peanut, put it in her mouth and went into a reaction.

So that's step one. Also, I had someone who the plane changed, there were delays, they ran to get to the plane. They were the last people on gate check safe food and medication, which is another reason I tell you to not go on last try to get on that pre board group that you're entitled to.

Because by the time the flight has boarded and if you're at the end or running late for the plane,

that overhead luggage space is often gone. And so they'll gate check your bag and if you're frazzled and if you're running late, you may forget that your safe food and medication is under the plane.

And I have taken testimonials, unfortunately of people going into anaphylaxis and the safe medicine is under the plane.

These are things that you can do to make your life much less stressful.

Watch out for code sharing.

What do I mean by that? American Airlines, for example, code shares with British Airways. So I have taken numerous testimonials of families that have come from the UK where British Airways has a great policy.

They will suspend serving nuts. They will make an Announcement. They're actually good with peanuts, tree nuts and sesame. They will make the announcement, which is unusual to find these days.

Then they get to their destination in the US and the next plane is is a US domestic plane and it's American Airlines because they code share with British Airways, who won't do anything.

They will serve the tree nuts all around you.

I took a testimonial about three months ago where they made a mom and a young child stand at the back of the plane and also asked them if they could use the EpiPen prophylactically.

So you can see how much education we still have to do. But these are things you can ask when you book the ticket.

First of all, you can usually see online who's operating the plane. You just don't think to look.

So I'm telling you to think to look.

Caroline: That's a very good tip. I've had that happen to me before when we saw one airline and then when we got to the airport it was a different plane and I just missed that.

I think that's a really good important.

Lianne: Not everyone thinks about that. And it takes two seconds.

And if you're not sure, you know, you can do a quick search.

You can call up the airline. Do you code share with anyone?

Do they have the same, you know, food allergy policy? You can go and look. I also think that you should try to document the allergy in your reservation if it's available online, but if not, call.

And in our allergic living chart, that's one of the questions we ask the airline. So that's in there.

You actually should register for TSA Pre check and TSA Cares because TSA Precheck doesn't just save you time.

Usually,

usually they don't inspect the food.

Now, if you're really concerned about the food, there is a program called TSA Cares and that point they have passenger support specialists. They'll walk you through, they'll meet you at the airport.

You have to register for this beforehand and you can just Google that. And it's also an excellent program.

So I've taken some good testimonials from that. Those are options that are available to you and you choose to use them if you feel that you need them.

And last but certainly not least,

carry your medication on you.

Yes, it can be in the carry on when you wheel it on the plane. But I suggest before you put it in the overhead bin, take it out, put it on you.

You don't know if there's turbulence and you having a reaction to a meal and you can't reach it,

there's situations where it would be really helpful to have it on you. If you're traveling alone,

tell the person next to you where your safe medication is or tell the flight attendant.

In the US no airlines are required as of yet to carry easy to use epinephrine and you don't know which airlines do. And the ones that have the vials could have them not there because of an FAA exemption.

And you can read more about all that and the epinephrine. I've done multiple allergic living articles and I could speak about it for an hour and that's just not what this podcast.

So take my word for it. Make sure you have your safe medication.

Make sure you leave the house with it. Have a checklist, put a post it. I've had taken a testimonial of a woman who went into anaphylaxis, had an emergency landing and where was her auto injector?

It was in the wrong purse. Before we leave, I always have like a note on the door like with the post it. Don't forget EPI that I'm looking right before we leave.

And I pray and hope that my now at college son remembers how crazy I was because I'd rather be remembered as crazy than have him make a mistake which we can all make.

Caroline: Very true.

That's true. It's so easy to forget and especially for our children who are growing up and going to college or going into the workforce, they get so used to us taking care of those little details.

So that's really good. You put the big note on the door. I do the same exact thing. I use the 8 by 11 sheet of paper and actually tape it on the door that we're going to walk out of because I'm so worried about forgetting the epinephrine.

Lianne: We're not perfect. Throughout our day we're making these little errors. But somehow people expect people with food allergies to be perfect. And the truth is you have to be. But the reality is a little different, which is the same thing when people start opining on airline travel.

And the reality of airline travel is it's very different than it was 10 years ago. It's very, very different.

Security is different, the crowds are different.

The staff has gone through COVID. It's a different world.

And we need to be very kind to people that are flight attendants because I feel like they deal with a lot and it's not their fault if they don't know what a food allergy is.

I'VE come across many highly educated airline executives, for example, who think food allergies are runny nose. And so our job is to gently educate, not talk down, because that will not help.

Caroline: Now let's dive in a little deeper into the actual day of travel when you're boarding the plane and pre boarding and wiping down and food.

Let's talk about all of that. Now let's go into the really deep.

Lianne: I'm assuming you're going to use your right to pre board. I'm assuming you're telling the gate agent. I'm assuming you have your safe medication. I'm assuming that you're not putting it in the overhead bin.

So I'm already assuming all that. And I'm assuming you've wiped all the surfaces because I have taken testimonials from reactions coming in the strangest places. So let's move past that and talk about the food.

I don't think I feel as strongly about any issue as I feel about the food.

You should never take an airline meal with a food allergy, no matter what the reassurances are.

It's risk versus reward. The risk is huge. The reward,

an airline meal. I mean,

whoever said I can't wait to fly X airline again because of the great meal,

no meal is worth it. And in fact,

Dr. Anya Nowak at NYU, she sent me a patient who went into anaphylaxis on a flight from her meal of pasta and red sauce. The young lady had a tree nut allergy.

The meal was labeled may contain milk, eggs, wheat, nowhere on there was a tree nut. So the flight attendant assured her it was safe and assumed it was safe based on the label.

And she assumed and she went into a reaction.

What I found out when I investigated for allergic living and I inquired to the FDA about the labeling laws in the air, assuming this was like a huge mistake,

they told me no, that the labels in the era do not have to be accurate, that they like transparency, but they don't require it. So if you have a packaged good like a, a bag of Cheetos,

those are labeled according to the same labeling that we have on the ground where you go into a deli and you pick that up, same thing. But the meals are as if you're in a restaurant and most restaurants don't label and they're not required to.

So that's what we have in the air. Which is why I have taken countless pictures of social media posts of vegan meals with milk and egg, of gluten free meals with wheat and it's not worth it.

It's just not. I've had so many passengers. I had one passenger who went into anaphylaxis, assured by the flight attendant, that flight attendant had a nut allergy. And she eats this meal all the time.

So it's totally safe. You can't take assurances from people who don't have the information and they also don't understand the limitations. And recently I wrote for Allergic Living about an ER doc who trains people in emergency situations who herself has a shrimp allergy, took the meal, they gave her a meal with shrimp,

she almost died. They had an emergency landing. It's a case now. That's going forward.

This is why this has become like my raison d', etre, if I even said that right. Because if an ER doctor who trains people for emergency situations, including anaphylaxis,

that has an allergy doesn't know not to accept the airline meal. We are not educating who we need to educate. We're not reaching who we need to reach. And I mean this of the physicians and the patients,

we're just not reaching them. Everywhere I go, I find someone that has a food allergy. I don't know what it is. And none of them, until I speak to them, know not to take the airline meal.

None of them. I know that's not research, that's completely anecdotal, but it's happened so many times.

And most of the doctors I work with, when I sent them the FDA article I did, did not know that this was the case. So I'm putting it out there that we need to reach more people.

And these are risks we can eliminate. We can wipe down the area from past contamination, which is the most likely source of an allergic reaction. That your child or yourself touches something, you put your finger in your eye or you chew on your finger in your mouth, or a toddler picks up a stray nut,

Cheeto, whatever it is that someone has left there. And that is going to be a severe reaction because it's ingestion. And that's really one we can control with our cleaning and getting on early,

not taking the meal and bringing our safe food. I've had people say, but you don't understand.

I have a 12 hour flight and I went to South Africa with my family and we brought sugar, chocolate, cereal, which is something my son loves and doesn't get at home.

When he was that age and he was very happy. I asked the airline for a bowl or some milk or whatever it was, and I took the napkin and Covered the tray and he was plenty happy.

And I had lots of snacks. And in fact, I had them in my carry on, my husband's carry on, and my two older children's carry on just in case they lost our luggage with all our safe food.

And then when we left South Africa,

I had enough food for the way back and more. So I donated to a food bank. You plan ahead. It was great. We found so many places that did accommodate, but you could get to a foreign country and they don't accommodate.

For a great example is. So I was born in South Africa and I grew up on something called Smarties and they have them in Canada and I always got them for Halloween for my son because they're safe and quite frankly, I think they taste better.

I happen to have brought a whole bunch with me when we went to South Africa. They also sell Smarties, but their sed may contain peanuts. Again,

this is a little outside airline travel, but something else to look out for that just because a food product is safe in your home country, you still need to read the label and be vigilant.

That's just a neither here nor there.

Also, pack twice as much as you think you'll need on that plane in case you're delayed because they're not going to have safe food for you as I'm telling you not to take it.

So make sure you include in your.

Caroline: Thought process delayed and actually jumping onto the food conversation. What we learned with our family is you can't carry a big jar of sun butter or soy nut butter or one of the the butters that you might be using, but you can bring those individual packets.

So we'll go online and buy those small little individual packets because one, they're great on the plane, everybody can carry a bunch of them. And then as we're moving about, wherever we are,

we can just have a few of those in our pockets. But it's protein, it's fat, it's satiating enough. So we actually look for those little tiny single servings of any of the different butters or protein bars or things like that.

Lianne: Yeah, I think that's great. Yeah. And people love turkey jerky,

dried fruit. There's so many choices. It might not be a meal, but trust me, you're not going to die going on snacks for 24 hours. But you really could have a disastrous start to your vacation.

If something happens in the air,

both.

Caroline: Of my kids will sit there and tell me it's not about this gourmet moment. It is all about just eating enough so that we don't get hangry by the time we get to where we're going.

And so they will happily bring a sandwich and very simple things. Rather than eating at the airport or trying food, they won't even try packages of items that are typically safe for them.

It all has to come from home. And that way that reduces their stress and they have a better time and they get to focus on the trip and the people and everything else.

Lianne: I mean, another thing that our CFAAR study showed was that 98% of people flying experience anxiety. And it's not because they're anxious, it's because everything is so uncertain with flying.

You just don't know what crew you're going to get,

the whole process because there's no globally accepted standard policies.

But these are things that we can control and these are things that we can do. Bring our own food, have a plan,

have the wipes pre board the plane. And I think having that structure tampers down that anxiety so much because like you said, you're prepared, your kids are not anxious flyers.

And I think that being prepared is just such an important part of empowering your child and yourself to take back some of that uncertainty.

Caroline: Absolutely. So well said. And we've gone over some great tips here that are so actionable that really are going to make a difference. So before we say goodbye today, is there anything else that you want our listeners to hear from you?

Lianne: I just want to leave you once again to say that you need to cooperate with the crew.

So be respectful,

be prepared and reinforce your requests with documentation so that you can tone down the situation if you're flying by yourself. I may have said this already, but in case I didn't,

and I'd like to say it again anyway, please make sure that you tell somebody, anybody, where your safe medication is, because the reality is that airlines are not required to carry this medication and you may need it.

Caroline: That is a great piece of advice.

Lianne: Leanne.

Caroline: Thank you so much for your time. I know you're really busy and getting ready for next presentation and you've got so much going on. So we appreciate the work that you do in our community and just for spending some time with us.

So thank you.

Lianne: You're welcome. And I want to stress that with the right planning, you can reduce risks, fly confidently, and I want you to have safe travels this holiday season and I wish you a happy and safe holiday season.

Caroline: Thank you for listening to FAACT's Roundtable Podcast. Stay tuned for future episodes coming soon.

Please subscribe, leave a review and listen to our podcast on Pandora, Apple Podcasts, Spotify,

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Have a great day and always be.

Caroline: Kind to one another.