Everyone knows how laborious a task preparing for a holiday abroad can be, and going on vacation with an anaphylactic allergy can present obstacles of its own. Ensuring you have enough auto-injectors to take with you, researching your destination to help you avoid aggravating agents, and notifying your travel providers about your requirements; these are just some of the extra measures anaphylactic patients will have to take.
Although the prospect of making extra preparations might seem like a nuisance, these shouldn’t put those with allergies off travelling by any means. If celebrities with severe allergies can travel all over the world, then the rest of us can too. And as awareness and understanding of allergies increases on an international scale, thanks to campaigning efforts from organisations like the Anaphylaxis Campaign and Allergy UK, holidaying with severe allergies is becoming easier than it has been previously.
The tail end of summer is fast approaching and peak flying season is drawing to a close. But no matter what time of year it is, helpful travel advice from allergy experts is always useful. This week we got in touch with Moira Austin, Helpline and Information Manager at Anaphylaxis Campaign, to get her input on what measures patients with anaphylactic allergies should take to make sure their trip goes smoothly.
Preparing for the Flight
Successfully managing an allergy isn’t just about what you do when on holiday. Making all the relevant preparations beforehand is vital too. For those with severe allergies, having access to emergency medication is essential at all times, should the unexpected happen; and obviously this includes during your trip.
Here’s what advice Moira had on the subject:
- ‘Check the expiry date on your emergency medication. Ensure that it isn’t going to expire whilst you’re away.
- If you have been prescribed adrenaline auto-injectors, carry at least two with you.
- If you’re going to a country that doesn’t have adrenaline auto-injectors or if you’re going to a remote location, you may need to take extra. Speak to your treating doctor or allergy specialist.
- Practice regularly with a trainer injector so you’re familiar with what do if you do need to use it. Get your travelling companions to do the same.
- Make sure you have your medication with you in your hand luggage.
- Get a letter from your GP to confirm that you need to carry your medication or injectors in the cabin.
- If possible, keep your medication in its original box, or at least take the box with you.
- Don’t forget your medical alert or other medical ID, indicating your allergies.
- Keep a copy of your emergency care plan with you at all times.’
It’s also important to consider that there isn’t at present any standard practice which all international airlines adhere to when it comes to allergies. So before you fly, Moira advises the following:
- ‘Always contact the airline in advance to find out what their policies are for passengers flying with severe allergies. Don’t make any assumptions as to whether they will or will not be serving or selling your problem allergens on the flight.
- If they normally serve or sell peanut or nut snacks, ask if they will refrain from serving or selling them for your flight or in your cabin.
- Some airlines may offer nut-free or other allergen-free meals, however mistakes are sometimes made or the request may not have reached the cabin crew. You may wish to play safe and take your own food.
- Ask if they will make an announcement requesting other passengers not to eat peanuts or nuts during the flight.
- Take responsibility for your own safety. Communicate your requirements to all relevant parties (such as your travel agent, your check-in desk assistant and cabin crew).’
When your airline or travel agent agrees to make arrangements to meet your requirements, Moira advises that it’s crucial to have this in writing.
- Take copies of emails or letters logging your correspondence with you, and make sure these contain the names of any reps you’ve spoken to.
- Remind your airline of these arrangements at the check-in desk, and confirm that they have been considered by the flight staff.
Moira notes that occasionally, an airline operator may not be the same company actually running the flight itself.
If your flight has been designated to a subsidiary or sister company, make sure you notify this third party of your requirements too.
Moira also adds that:
‘Some airlines may allow you to board the plane early to wipe clean the area around your seat and your fold-down tray. Take wet wipes with you for this.’
Staying at the hotel and eating out
The risk of encountering allergens during a flight is perhaps the one which gets the most media coverage. But obviously the hazards don’t end there. Raising the issue with your accommodation providers during booking is just as important.
‘If you’re staying in a hotel, let them know in advance about your allergies.’ Moira tells us. ‘If possible, speak to the caterers. Ask about allergen training and their knowledge of allergen-related issues such as cross contamination.’
‘Remember that all EU countries are governed by the same allergen legislation, so caterers will be legally obliged to tell you if any of the major allergens are present as intended ingredients in the food they serve.’
It goes without saying that restaurants present significant risks to those with severe food allergies (such as to nuts and shellfish), whether they’re abroad or at home.
Eating out at home with a food allergy or intolerance is a subject we’ve touched on before, but when doing so in a foreign country, extra measures should be observed.
‘Take translation cards to help with communication in catering establishments and in case you need to call for the emergency services abroad.’ Moira advises. ‘See Allergy Action for free phrases to print off in a number of European languages. There are lots of companies (such as the Dietary Card scheme) that sell pre-laminated translation cards.’
- If you’re travelling abroad with a food allergy always mention your allergies as you would back home and stick to plain, simple food without sauces or dressings (as they are less likely to contain “hidden” allergens).
- Large international restaurant chains may have allergen information on their websites and have pretty much standardised menus.
- If you wish to eat at a smaller, local restaurant, try to speak to the staff before you go: maybe earlier in the day when it’s less busy.
- If you must eat at a remote location, make sure what you’re eating is safe. Keep it simple and don’t take any risks!’
In addition to the above, Moira urges those with anaphylactic allergies to keep the fundamentals of eating out in mind too, which are:
- ‘Carry your medication with you at all times!
- If you’re not sure what’s in a food don’t eat it!
- In the unlikely event you have a reaction and feel ill, don’t go off to the toilet on your own. Take someone with you and don’t lock the toilet door.
- If you have a reaction, follow your emergency care plan.’
Where to go and where to avoid
It’s often the case that holidaymakers will try to avoid those destinations where local cuisine is abundant in offending allergens. As Moira notes: ‘Nuts are common ingredients in many Far Eastern and African countries and in dishes from these countries.’
However, those with severe allergies should be vigilant wherever they go. Crossover between different cultural influences is becoming more common in dishes offered in eateries both at home and abroad. That means it isn’t always possible to completely eliminate the chances of running into an allergen merely through picking a specific location or a type of restaurant.
Obviously, seafood restaurants are much more likely to contain risks for those allergic to shellfish; and South-East Asian restaurants will be more hazardous for those allergic to nuts and sesame seeds.
But it’s generally better, as Moira advises above, not to make decisions based on assumptions. Even if you visit a restaurant without your allergen in sight, the staff handling your food need to be made aware of your requirements.
A word on travel insurance
Most travellers with pre-existing conditions will know that some insurance companies are more accommodating than others when it comes to providing cover (this is also a subject we've discussed previously). As a result, those with allergies may have to shop around to get the best rate.
‘Some insurance companies are happy to cover travellers with severe allergies, although they may charge extra.’ Moira explains. ‘Some may also charge extra, or not offer cover at all if you have been hospitalised with your condition in the past 12 or 24 months.’
This however doesn’t mean that travellers with severe allergies (or pre-existing conditions) should simply forego seeking cover before their holiday. It’s even more crucial for them that they find a suitable policy, in case the unexpected occurs.
Moira advises travellers with allergies to get in touch with the Anaphylaxis Campaign for a list of insurers who may be able to help.
What other advice should travellers keep in mind?
Finally, here are some additional (but no less important) tips from Moira that holidayers might consider when travelling abroad with an allergy:
- ‘Take some safe, non-perishable snacks with you.
- Remember that pre-packed food (such as branded chocolate bars) bought abroad may not have the same ingredients, or the same “may contain” status as they do in the UK. Always check the ingredients and other allergen advice.
- Adrenaline injector pens should not be kept in distinctly hot or cold conditions. If going somewhere hot, keep them out of direct sunlight and check for any discolouration or visible deterioration of the adrenaline (the adrenaline solution should be clear and colourless). Refer to the patient leaflet or manufacturing company website. There are a number of companies that sell insulated storage cases, and these can be used to store your medication within the required temperature range.
- Contact the embassy or the tourist office of the country you’re visiting to find out how to contact the emergency services and to see if they have any other advice.
- If there’s a patient support group in the country you’re visiting they may be able to offer some tips (contact the Anaphylaxis Campaign for further information on these).’
You can find more guidance and resources on travelling with an allergy, including all the latest news as well as information on how to make a donation, over at the Anaphylaxis Campaign website.