Imagine being way high up in the air–when an allergic reaction strikes. For many who live with peanut or tree-nut allergies, the thought of being stuck in such a state of powerlessness prompts real anxiety and fear, even a dread of flying in some, who take to the airways only when absolutely necessary.

And, to be fair, with somewhat good reason. When researchers in a new study published in the Journal of Allergy and Clinical Immunology-In Practice surveyed 3,200 passengers about in-flight experiences, among the 349 who had reported having had an allergic reaction in-flight, only half of these reactions had been reported to the flight crews on board.

What’s more, the common (and known to be effective) treatment epinephrine was found to be used to treat only 13 percent of those who reported having had an allergic reaction in-flight. Even though 98 percent of them actually had their own epinephrine with them, said study author Matthew Greenhawt, MD, MSc, in a statement.  Similar findings were reported in a study performed in the US a few years back.

Good news: After analyzing the results of the survey, researchers established helpful steps that, when followed by passengers with peanut or tree-nut allergies, led to fewer reported allergic reactions.

Recommended Preventive Steps Include:

1. Requesting a peanut- and tree-nut free meal; or, not having a meal provided by the airline
2. Wiping the tray table with a store-bought cleansing wipe
3. Requesting with the airline pre-flight that other surrounding passengers not eat peanut/tree-nut containing foods
4. Avoiding the use of airline blankets and pillows
5. Requesting with the airline that there be a peanut/tree nut-free buffer zone around you

Many airlines still serve peanuts and tree nuts as snacks, pointed out study author Greenhawt. Canada is the one and only country that currently has a formal policy in place that requires a three-row buffer zone around flight passengers with peanut or tree-nut allergies on advance notification. Even still, this is only the case on Air Canada flights.

Overall, stress the researchers, the risk of an in-flight allergic reaction to peanuts or tree nuts is small. If and when it happens, though, those affected can feel helpless. More study is needed in future to further validate the effectiveness of the risk-mitigating behaviors that have been uncovered by the researchers.

What is the worst public place You’ve experienced an allergic reaction to a food?