When our family recently boarded a flight, it marked a decade of traveling with a child who has a life-threatening peanut allergy.

When my son was just a toddler, I had the opportunity to take him with me on a writing assignment to the Caribbean. Having never given him peanuts, I worried he might be allergic to the sometimes-creamy, sometimes-crunchy staple my husband and I both grew up on. But I also knew finding out about a food allergy was just about the last thing I wanted to discover at 40,000 feet. After all, 10 years ago peanuts were the go-to airline snack and our destination required three different planes rides to get to and three more to get back. My head swam with paranoid “what if” scenarios, and the week before our flight, I decided to ask my friend who was a registered nurse to come over for dinner as a “just in case” precaution when I gave my son peanut butter for the first time.

Before dinner was out of the oven, we were racing to the nearest emergency room, my son covered in hives as big as golf balls and vomiting between sneezing and coughing fits. I’ll forever be grateful to my friend, who spoke to him in a calm voice while monitoring his breathing and administering Benadryl from the back seat until she rushed him past the ER check-in desk to receive his first dose of epinephrine. The moments and hours that followed were a nightmarish blur, and I will never forget the lifeless, almost unrecognizable look in my baby boy’s eyes as he was strapped to a gurney and transferred in an ambulance from the downtown ER to Dell Children’s, nor spending the night curled up next to his exhausted little body in a hospital bed consumed with guilt and unimaginable gratitude for the fact that he was still breathing beside me.

From that moment on, my days of fretting about in-flight turbulence and rocky landings evaporated, replaced by a new and greater fear: How do I keep my son safe when he is in the air and far away from emergency medical care? As a travel writer and mom of three, we’ve logged lots of air miles as a family and, as it turns out, flying with a peanut allergy isn’t all that different from going through everyday life with one.

When you have a child with a life-threatening food allergy — peanuts, tree nuts, milk, eggs, wheat or any other food allergy that can cause anaphylaxis — air travel can be a frightening experience. But it doesn’t mean it should be avoided, says Dr. Allen K. Lieberman, an Austin allergist-immunologist and last year’s recipient of the FARE (Food Allergy Research and Education) Vision Award.

“People should not avoid air travel because they or their children have food allergies,” says Lieberman, who believes flying is a safe form of travel even for those with life-threatening food allergies. “It’s the same thing we tell people concerned about sending their children with food allergies to a public school or to baseball practice. The key is planning in advance.”

Below are 10 tips our family has collected over countless trips that have made our flights a little less scary and a lot safer — all doctor approved.

1. DO YOUR RESEARCH BEFORE BOOKING. Before booking a ticket, research which airlines serve peanuts or tree nuts on the plane, as some airlines are more accommodating to passengers with food allergies. For years, we avoided flying Southwest Airlines, a company with a long-running peanut culture and history. But as of Aug. 1, Southwest Airlines made a decision to no longer offer peanuts to help ensure a safe cabin for customers with peanut-related allergies. In doing so, they joined several other big-name carriers such as American Airlines, United Airlines and JetBlue Airlines that do not serve peanuts.

2. KNOW THE AIRLINE’S POLICY BEFORE BOARDING. Bottom line: no airline can guarantee a completely peanut- or nut-free flight or prevent other passengers from bringing them on, but allergy policies vary greatly between airlines and it’s best to know them before boarding. Airlines have this information on their websites and a quick search for “peanuts” or “allergies” should bring it up, says Lieberman. It’s always best to notify the airline of severe food allergies at the time of booking and remind employees at the gate and attendants on the plane. Upon request, certain airlines such as JetBlue will discretely create a buffer zone for nut consumption one row in front of and one row behind a passenger with the allergy. While Delta does offer peanuts as a complimentary snack option, the airline states it will not offer peanut products on flights where a customer has informed them of a peanut allergy. We’ve experienced inconsistency in the way food allergies are handled on flights, even on outbound and inbound flights on the same airline, so it helps to have an airline’s policy printed and handy.

3. BRING YOUR EPI WITH YOU. Always have two doses of epinephrine with you. Why two? “You need to carry two doses in case a second dose is required,” says Lieberman. While there is epinephrine on the flight, Lieberman says it’s not as easy to use for the average person because it has to be drawn up in a syringe. You don’t need a doctor’s note to carry on epinephrine, either. “TSA cannot take it away from you,” says Lieberman. “If there happens to be someone in security trying to take it away, just ask to speak to a supervisor.”

4. BOOK AN EARLY FLIGHT. “Consider booking the first flight of the day, which tends to be cleaner,” says Lieberman. Since some airlines are cleaned at the end of the day, there is less chance of finding food crumbs on seats and smears on trays.

5. BOARD EARLY AND BRING WIPES. “Most airlines will let you board early and wipe down surfaces,” says Lieberman. I can’t tell you how many WetOnes I’ve used to wipe down my son’s seat, seat belt, food tray and arm rests to get rid of food crumbs. When Austin mom Allyson Mangum’s daughter was first diagnosed with food allergies, she took along inexpensive twin-fitted sheets to cover the airplane seats when they traveled. “It looks strange, but it prompted people around us to ask about it and gave us the opportunity to tell them about her allergies,” says Mangum, adding that it was especially helpful on flights years ago when the flight attendants told her they weren’t able to make announcements about food allergies to other passengers.

6. BRING YOUR OWN FOOD. Don’t expect to find safe foods on the plane — many snacks and meals served contain labels that warn of milk, wheat, nuts, peanuts and other common allergens, while others might not have labels at all. “Always bring safe foods with you and plan on delays so you have extra food available,” says Lieberman. “You don’t want to consume airplane food you can’t double and triple check. Planning ahead is the real key.” There have been many times when I thought I would have ample time between connecting flights to find a safe meal for my son to eat, only to be caught in a frenzied and panicked food search while dashing to the next gate. We’ve learned to pack all of our kids’ meals and snacks on flight days, which eliminates stressful scenarios when you’re short on time and safe food options.

7. SHARE SAFE SNACKS. Some families with food allergies, like the Mangums, have handed out safe snacks with little notes to everyone around them to help encourage other passengers who might have brought peanuts or nuts to put them away. “If you do it in a very non-confrontational way and just ask the person if they would mind eating this instead and why, most people will do it,” says Lieberman.

8. REMEMBER THE REAL RISK. Even if others are consuming peanuts or nuts on the same plane as an allergic individual, Lieberman says he or she will not suffer an anaphylactic reaction. Further, he argues there is now a significant amount of research that proves the commonly feared airborne peanut allergy known as “peanut dust” is a myth. The real risk of a systemic reaction to a food allergen is primarily through ingestion, with contact and inhalation exposures being low risk. “A peanut allergy is not an airborne allergy — a peanut really has to be consumed to result in anaphylaxis,” says Lieberman. “Even if person next to you is eating peanuts or nuts, you are not at risk. It’s really more of an uncomfortable situation. As long as you police your own area and regulate what an allergic child or adult eats, air travel can be safe.”

9. DON’T FORGET AIR TRAVEL IS SAFEST. Airline travel is still the safest form of transportation in terms of relative risks. “People will say they can’t fly because they have a peanut allergy,” says Lieberman. “But it is much safer to fly from Austin to Chicago than to drive, even if there are peanuts on the plane.” Flying is the safest form of travel if you plan ahead, bring safe foods, carry your epi-pens and do all of the other things to mitigate your risks, says Lieberman. “Those are basic lifestyle things these families are doing anyway.”

10. BE PREPARED WHEN YOU LAND. These days, safe restaurant options abound for allergic diners. After all, we are in the middle of an allergy epidemic — Lieberman says peanut allergies have tripled in the past 15 years and 8 percent of all children have food allergies. But what if you’re speaking a different language or aren’t confident in your ability to communicate the severity of a food allergy? When our family traveled to Barcelona and some of the more rural areas of Catalunya in northeastern Spain, my brother thoughtfully made us laminated print-outs that explained our son’s peanut allergy in English, Castilian Spanish and Catalan. At each restaurant, we handed these cards to our server. In most cases, the chef would visit our table and reassure us about the dishes that were safe for him to eat. In all instances, our son was able to enjoy safe foods in a different country — and he was able to bring his love for traditional tapas spanning paprika-dusted octopus and patatas bravas to croquettes and hand-carved jamon back home with him.

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