Every summer I often find I am chatting with parents of my food allergic patients about their anxieties around summer holidays with sometimes exotic trips planned to far-flung places. Inevitably this raises all sorts of issues around eating safely when overseas. It is perhaps a positive reflection on how good food labelling legislation has been more recently in Europe that we quickly see the dangers of travelling outside of this area. My experience has been that accidental reactions can happen more often whilst travelling. Whilst these tend to be mild, a few sensible precautions taken in advance of travelling can make a real difference to the likelihood of holidays being disrupted. It is also worth remembering that foreign holidays are a really important part of family life and it would be an enormous shame not to travel because of worries about food allergy.
Most commonly, I direct my patients to the website of The Anaphylaxis Campaign or Allergy UK, both of which have excellent sections on travel advice and tips. For me, the most important things are to ensure that patients are very familiar with the emergency management plan and have gone through exactly what they might do if they have a reaction when they are away. This includes making sure that their adrenaline autoinjectors (e.g. EpiPens) are in date, that they have enough of them and that they know exactly how to call for help when overseas as emergency service numbers vary in different countries. It is also important to make sure that you have translation cards to show in restaurants, which explain exactly what the allergy issues are in the local language. You should also have a card for emergencies that explains that your child is having an allergic reaction and please can they assist you in calling for help. It is also a really good idea to have plenty of safe snacks available all the time for the occasions where it is just not clear whether it is safe to eat the food available or not.
One of the main sources of worry is flying and this is actually a much more contentious issue than many people realise. Fortunately, in-flight emergencies are rare even though air travel is increasingly common. Allergic reactions are the seventh most common reason for an aircraft to be diverted and around 9% of patients with nut allergy have reported a reaction whilst on a flight at some point. Fortunately, these tend to be mild and managed very effectively just with antihistamines. The main area of contention is whether it is possible to have a significant reaction as a result of simply breathing in something that is being eaten nearby. Whilst patients report this from time to time, a recent publication from experts in the United States failed to demonstrate any clear evidence that exposure through inhaling nut allergen from nearby passengers could cause anything significant. Whilst the debate goes on, I think the most important thing is to make sure you have let the airline know in advance (although airlines can be frustratingly variable in their response to this) and that you have plenty of safe food available to eat during the journey, as well as all the medication you might need in your hand luggage. Some people also advocate wiping down the seat of the child who has allergies and those directly next to them, to reduce the risk on any accidental contamination from previous passengers, although the risk here is very small. With these simple precautions, you can dramatically reduce the risk of a significant reaction happening on board.