Risk of anaphylaxis on commercial flights

Turner, Paul J. Current Opinion in Allergy and Clinical Immunology ():10.1097/ACI.0000000000001090, July 14, 2025. | DOI: 10.1097/ACI.0000000000001090

Abstract

Purpose of review 

Air travel has now returned to prepandemic levels, with over 10.5 billion passengers in 2024. Many of these passengers have food allergies, and there is a perception that allergic reactions are common during commercial flights.

Recent findings 

Estimated rates of food-induced allergic reactions
in people with known food allergy during
commercial flights 

A recent systematic review and meta-analysis reported an incidence of in-flight medical events due to allergic reactions of 0.7 (95% CI 0.4–1.1) events per million passengers. For those with food allergies, the incidence of allergic reactions is around 10–100 times lower than that reported for reactions ‘on the ground’ – equivalent to one reaction per 3600 food-allergic passengers in any 1-year period. Reassuringly, there is no evidence that this rate had increased over the past 30 years, despite significant increases in both the prevalence of food allergy and passenger numbers.

Summary 

Allergic reactions during commercial flights are uncommon

; however, this is very likely to be confounded by the many precautions food-allergic passengers and their families take when flying. Nonetheless, the data confirm that flying can be safe for those with food allergies. While air travel continues to present numerous challenges to those with food allergy, this can be mitigated by consistent and helpful airline policies, which address the concerns of food-allergic individuals.

KEY POINTS

• While there is a perception that food-induced allergic reactions are common during flights, evidence demonstrates that the risk of an allergic reaction is around 10–100 times lower than when ‘on the ground’.
• Anaphylaxis is even less common, with less than 1 in 10 in-flight medical events due to an allergic reaction being anaphylaxis.
• Despite a perception that reactions due to airborne allergen are common, evidence suggest that this is incredibly rare on board flights.
• The most effective measures to reduce risk is for passengers to wipe down their seat area, including the tray table and the seat-back entertainment system.

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