RationaleSince publication of the first self-reported surveys of peanut and tree nut allergic individuals, limited follow-up data of venue specific reactions is available.MethodsAn internet-based, self-report survey was openly advertised on the FAAN website.ResultsAge for onset of peanut allergy was 1.63 years and 2.71 years for tree nut allergy (n = 59). 87.2% were peanut allergic, 72.3% tree nut allergic, and 61.7% reported both. Nuts included peanut (68%), cashew (9.7%), and unknown (11%). 27.5% reported severe symptoms, 20.6% moderate, and 51.7% mild. Airlines requested passengers not consume nut-containing products (35%), restricted nut-containing products on-board (25%), created a buffer-zone (15%), and made no special accommodations (15%). 47% did not notify flight crew of a reaction occurring. 76% carried epinephrine while flying, though only 10% received epinephrine. 74% received H-1 antihistamines. 16% received no medication. Changes made as a result of a reaction were notification of airline personnel (69%), avoiding in-flight food (59%), cleaning their seat/tray (52%), requesting a nut-free flight (38%), flying only nut-free airlines or those which will accommodate special needs (37%), traveling with a source of epinephrine (34.5%), and notifying crew of an on-going reaction (31%). 89% continued to travel by commercial aircraft despite this diagnosis.ConclusionsIndividuals continue to fly commercially despite a nut allergy. Crew notification of on-board reactions remains problematic. Epinephrine is under-administered despite being available in 76% of events. In-flight peanut allergic reactions continue to be problematic. On-board tree nut reactions have been poorly characterized previously, but are an emerging source of concern. RationaleSince publication of the first self-reported surveys of peanut and tree nut allergic individuals, limited follow-up data of venue specific reactions is available. Since publication of the first self-reported surveys of peanut and tree nut allergic individuals, limited follow-up data of venue specific reactions is available. MethodsAn internet-based, self-report survey was openly advertised on the FAAN website. An internet-based, self-report survey was openly advertised on the FAAN website. ResultsAge for onset of peanut allergy was 1.63 years and 2.71 years for tree nut allergy (n = 59). 87.2% were peanut allergic, 72.3% tree nut allergic, and 61.7% reported both. Nuts included peanut (68%), cashew (9.7%), and unknown (11%). 27.5% reported severe symptoms, 20.6% moderate, and 51.7% mild. Airlines requested passengers not consume nut-containing products (35%), restricted nut-containing products on-board (25%), created a buffer-zone (15%), and made no special accommodations (15%). 47% did not notify flight crew of a reaction occurring. 76% carried epinephrine while flying, though only 10% received epinephrine. 74% received H-1 antihistamines. 16% received no medication. Changes made as a result of a reaction were notification of airline personnel (69%), avoiding in-flight food (59%), cleaning their seat/tray (52%), requesting a nut-free flight (38%), flying only nut-free airlines or those which will accommodate special needs (37%), traveling with a source of epinephrine (34.5%), and notifying crew of an on-going reaction (31%). 89% continued to travel by commercial aircraft despite this diagnosis. Age for onset of peanut allergy was 1.63 years and 2.71 years for tree nut allergy (n = 59). 87.2% were peanut allergic, 72.3% tree nut allergic, and 61.7% reported both. Nuts included peanut (68%), cashew (9.7%), and unknown (11%). 27.5% reported severe symptoms, 20.6% moderate, and 51.7% mild. Airlines requested passengers not consume nut-containing products (35%), restricted nut-containing products on-board (25%), created a buffer-zone (15%), and made no special accommodations (15%). 47% did not notify flight crew of a reaction occurring. 76% carried epinephrine while flying, though only 10% received epinephrine. 74% received H-1 antihistamines. 16% received no medication. Changes made as a result of a reaction were notification of airline personnel (69%), avoiding in-flight food (59%), cleaning their seat/tray (52%), requesting a nut-free flight (38%), flying only nut-free airlines or those which will accommodate special needs (37%), traveling with a source of epinephrine (34.5%), and notifying crew of an on-going reaction (31%). 89% continued to travel by commercial aircraft despite this diagnosis. ConclusionsIndividuals continue to fly commercially despite a nut allergy. Crew notification of on-board reactions remains problematic. Epinephrine is under-administered despite being available in 76% of events. In-flight peanut allergic reactions continue to be problematic. On-board tree nut reactions have been poorly characterized previously, but are an emerging source of concern. Individuals continue to fly commercially despite a nut allergy. Crew notification of on-board reactions remains problematic. Epinephrine is under-administered despite being available in 76% of events. In-flight peanut allergic reactions continue to be problematic. On-board tree nut reactions have been poorly characterized previously, but are an emerging source of concern.