The following is a summary of the “Frequency and characteristics of epinephrine use during in-flight allergic events,” published in the January 2023 issue of Allergy and Clinical Immunology by Kodoth, et al. 

Account for allergic reactions for 2% to 4% in medical events in-flight and 5.5% in all medical events during passengers 18 years and below.

To assess the frequency of allergic reactions during air travel, including epinephrine availability, administration, and patient outcome. Researchers looked back at data on allergic reactions and epinephrine administration from January 2017 through December 2019 in the ground-based medical service (GBMS) database. Initial data retrieval revealed a total of 140,579 in-flight medical events (IFMEs) from January 1, 2017 through December 31, 2019, of which 4,230 (3.0%) were recognised as allergy incidents. 

GBMS suggested giving epinephrine to 398 passengers. The majority, or 328 people (82.4%), were given epinephrine. Autoinjector availability (OR, 2; P<.001; 95% CI, 1.55-2.58), flight diversion (OR, 11.21; P<.001; 95% CI, 3.60-34.89), and hospital transport (OR, 6.58; P<.001; 95% CI, 4.62-9.38) were significantly different between the 2 groups in multivariate analysis. Epinephrine was more likely to be given to passengers over the age of 12 due to their increased risk of anaphylaxis. Secondary analysis of 51 airlines that routinely utilise GBMS for all IFMEs revealed an allergic incident incidence of 0.91 per million passengers. 

Yielding every 12.5 million passengers, there was just one severe allergic reaction needing epinephrine treatment, for a rate of 0.08 incidents per million passengers. Epinephrine administration for an IFME is only needed once every 12.5 million passengers, hence the condition is quite uncommon. Passengers older than 12 years old had a much higher risk for epinephrine administration, which is linked to significantly higher rates of flight diversion, hospital transport, and volunteer medical participation.