How Common Are Allergic Reactions During Commercial Flights? A Systematic Review and Meta-Analysis
Abstract
BACKGROUND: Global passenger demand for air travel has increased by over 7% annually since 2006, with a strong recovery following the coronavirus disease 2019 (COVID-19) pandemic. Prior to COVID-19, individuals with food allergies reported significant concern and anxiety over the risk of reactions when travelling by air. However, published data of in-flight medical events (IMEs) due to allergic reactions are limited.
OBJECTIVE: To undertake a systematic review with meta-analysis to estimate the incidence of IMEs due to allergic reactions on commercial flights.
METHODS: We searched MEDLINE, Embase, PsycINFO, and TRANSPORT databases and the Cochrane Register of Controlled Trials for relevant studies reporting IMEs of allergic etiology, published since 1980. Data were extracted in duplicate for meta-analysis, and risk of bias assessed.
STUDY REGISTRATION: PROSPERO CRD42022384341.
RESULTS: Seventeen studies met the inclusion criteria. At meta-analysis, a pooled estimate of 2.2% (95% confidence interval [95% CI] 1.6%-3.1%) of IMEs are coded as being due to allergic reactions. This may be higher in children (3.1%; 95% CI 1.5%-6.6%). The incidence of allergic IMEs at meta-analysis was 0.7 events per million passengers (95% CI 0.4-1.1). Reassuringly, the rate of allergic IMEs has been stable over the past 30 years, despite increasing passenger numbers and food allergy prevalence.
CONCLUSIONS: Allergic reactions coded as IMEs during commercial air travel are uncommon, occurring at an…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 19 participants or records.
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