Buisnessman with luggage on wheels at the airport terminal, planes are departing in the background.

Which Airlines Make the Grade?

When Cecilia Watson is around dogs, she immediately starts coughing and wheezing. Her Asthma Action Plan calls for strict avoidance, but as a frequent traveler, that’s difficult to do on airlines that increasingly allow pets to accompany passengers. The 54-year-old fears exposure to dog allergens could lead to a severe asthma flare 30,000 feet in the air.

In 2018, 10-year-old Luca Ingrassia suffered a severe allergic reaction after eating a cashew during a flight. It was the first time he experienced an allergic reaction and the airplane’s medical kit did not have epinephrine, the first line of treatment. Fortunately, another passenger on board had an epinephrine auto-injector and Luca recovered.

Air travel is fast and convenient, but the prospect of an in-flight medical emergency is a serious concern for people with asthma and allergies. Nearly 2 percent of in-flight medical emergencies are allergy-related.

Allergy & Asthma Network partnered with the American Association of Respiratory Care (AARC) to evaluate each of the major airlines on their animal and food allergy policies. Some airlines are making progress, but most are still lacking in certain areas.

Reach for The Skies

What’s the ideal standard for airline policies addressing asthma, food allergy, pet allergy and other respiratory diseases? Allergy & Asthma Network and AARC used the following criteria to determine which airlines are making the grade in our Airline Policy Report Card:

Food Allergies

  • Preboarding to wipe down seat and tray offered
  • Buffer zone between people who eat nuts and those who are allergic
  • No nuts served – including as part of in-flight meals
  • Flight crew makes general announcement asking people seated on flight or near nut-allergic passenger to refrain from eating nuts (without identifying the passenger)

Pet Policies

  • No pets besides trained service dogs allowed in cabin
  • No more than 4 pets per flight
  • Pet carriers required
  • Relocation of a passenger with pet allergy permitted

Medical Oxygen

  • Available to passengers in need of respiratory care
  • No pre-flight check-in or special seating required
  • In-seat electrical power offered

In Flight Emergencies

  • Epinephrine auto-injectors available
  • Quick-relief albuterol inhaler available
  • Flight crew is trained on how to use an epinephrine auto-injector and quick-relief albuterol inhaler

The Grades

Allergy & Asthma Network and AARC collected data on each airline, assigning grades for policies in multiple categories, such as whether the airline allows preboarding to wipe down seats and trays, if it is willing to relocate pet-allergic passengers seated near a service animal and whether onboard medical oxygen is available.

The final scores were tabulated using the traditional grade point average (4.0 = A, 3.0 = B, etc.), with the average determining the cumulative grades.

Peanut/Nut AllergiesPet PoliciesMedical OxygenIn-Flight EmergenciesOverall Grade
Air CanadaB+C+B+BB
British AirwaysB+AA-AA-
Swiss AirlinesD-C-B+BC+

Practical Tips for Safe Travel

Ready, Set … Pets

Airlines transport more than 2 million animals each year. Some pets are required to stay in carriers under the seat in front of the passenger, but there may be no such restrictions for trained service animals or therapy/comfort animals.

Under the U.S. Department of Transportation’s Air Carrier Service Act, airlines have an obligation to accommodate people with disabilities who need a trained service animal and people with asthma and allergies.

Of course, airlines cannot guarantee an allergen-free cabin. (Even if there are no animals on the flight, pet allergens can be brought on board via clothing.) What can asthma and allergy patients do to ward off exposure to allergens?

  • Request to sit as far away as possible from pets when making a reservation; some airlines require 24-hour notice.
  • Consider wearing a mask or nasal filters to block pet allergens.
  • Pre-medicate with an antihistamine or a nasal spray.
  • Find out if the airline’s Medical Emergency Kit includes a quick-relief albuterol inhaler.

Don’t Go Nuts

Many airlines no longer serve in-flight bags of peanuts. However some snacks and meals may contain traces of peanut. Tree nuts are still offered on many flights and nonallergic passengers may bring bags of peanuts on board.

The risk of an allergic reaction may be reduced if passengers inform the flight crew of their allergy and request special accommodations. These measures include:

  • Ask to preboard to clean the tray table and seat with a sanitary wipe
  • Request a nut-free meal or avoid airline-provided food
  • Request a nut-free buffer zone
  • Ask the flight crew to request other passengers not eat nut products
  • Avoid the use of airline pillows or blankets which may contain nut residue

While airlines typically carry epinephrine in medical kits, some keep it in a vial to be administered by syringe. This process can take time and may require medical expertise to draw the correct dose. Allergy & Asthma Network has supported federal legislation requiring epinephrine auto-injectors be placed in medical kits due to their ease of use.

The Air Up There

People with severe asthma or chronic obstructive pulmonary disease (COPD) may need onboard oxygen or supplemental oxygen to adapt to reduced air pressure in airplane cabins. (Airplane cabins are pressurized for high altitudes, which means there is less oxygen in the air during the flight.)

First, talk with your doctor to determine if air travel is safe for you and whether you’ll need in-flight oxygen. (It may be a necessity if you have COPD.) Some airlines make oxygen available to passengers as needed (but may require a fee). It’s important to make this request at booking. You may want to provide a letter from your doctor stating why you need oxygen on the flight.

Federal Aviation Administration (FAA) rules allow passengers to bring their own oxygen onboard. Airlines accept most portable oxygen concentrators (POCs) – battery-operated devices that deliver supplemental oxygen. (Visit FAA.gov for a list of approved POCs.) Don’t forget to bring an extra battery pack for your POC.