The attack quickly escalated to the level that would normally land Silver in the emergency room, and she pushed the button for the flight attendant. “As she got to me, she looked at the man beside me and said, ‘Sir, you can’t have your cat on your lap like that,’” she recounts.

Silver had no idea she’d been seated next to a cat owner and his pet. “He had snuck the cat out of the carrier and had it on his lap under his jacket. And I said, ‘I can’t sit here – I can’t breathe.’”

Silver was immediately moved away from the cat, but it was too late: by then the asthma attack was in full swing, and her inhalers were barely keeping her any relief as she suffered through the flight. “When we arrived, my dad took one look at me and said, ‘What happened?’ He could see I couldn’t breathe.”

Silver’s travel tale could become far more common. As of July, Canada’s largest airline similarly began allowing owners to fly with cats or small dogs. In a policy reversal, Air Canada dropped a  2½-year ban on animals in the cabin – a move that has outraged pet-allergic travelers and asthma and allergy organizations, alarmed medical practitioners and spurred the Canadian Lung Association to launch a write-in campaign to bring the issue to the federal government.

Cash-strapped Air Canada says the decision to drop the ban on pets came after customers complained they were unable to travel with their small pets, as they could on WestJet and other carriers. “We looked for the best way of balancing the needs of all of our customers,” says Air Canada spokesperson Angela Mah. “By doing this, we are aligning our policies with the vast majority of international airlines as well as our major domestic competitor.”

At least three million Canadians suffer from asthma and allergies, and with some of the most potentially dangerous allergens being allowed on board, travel options for hundreds of thousands of passengers are becoming more limited.

Mah stresses that pets are limited to either two or four per flight (depending on the size of the aircraft), and that animals must be kept in their pet carriers under the seats. If an allergy sufferer ends up sitting near a pet, the airline will make “all reasonable efforts” to move one or the other to a different seat or flight.

Pet Hair on Clothes

Even when the pets ban was in effect, Mah adds, the airline could not guarantee a “dander-free cabin”, because many passengers have pet hair on their clothes, and because the airline must allow service animals for passengers with disabilities. Most planes are equipped with high-efficiency HEPA filters, and she says the cabin air quality “compares favourably” to that in other indoor environments.

Dr. Donald Stark is not convinced. The Vancouver allergist lobbied to have animals removed from airline cabins so that people with pet allergies – roughly 10 per cent of the population – could breathe more easily when they travel. Having a pet in the cabin is far worse than having a pet owner with a little hair on the clothes, he says, because the levels of allergen being released into the air are much higher.

Stark adds that air filters can only do so much – especially if they’re not changed frequently – and air moving through the cabin can affect allergic flyers before it even gets to the filter.

While the air quality in some cabins may be similar to other indoor environments, there is one key difference: on the ground, an allergic person can walk out the door.

1. Stick to countries where you speak the language. So far, that has limited my family to English- and French-speaking countries. It is critical that you can explain allergies clearly to people without any risk of miscommunication. When our younger daughter, who has multiple food allergies including peanuts, nuts, eggs, dairy, barley and kiwi, is a little older, we may relax this rule and there are allergy translation cards available. But for the first adventures, I recommend abiding by this rule.

I will never forget our trip to Italy when Kieryn (our older daughter who has no allergies) was a year old. She spiked a fever of 40 degrees C on the first night at our rented villa. We were staying in the middle of nowhere in Umbria and did not know where the nearest hospital was.

I called the villa’s agent for directions. She not only drove us to the hospital, but also translated what the doctor was saying. I can only imagine that this experience would have been even more stressful if we were dealing with an anaphylactic emergency in Italian.

2. With allergies in the family, it’s essential to know the distance to the nearest hospital before you book accommodations. We like to stay within an hour’s drive of a hospital, and to know that there is also a doctor or a clinic nearby.

3. Given my environmental allergies, we try to find places with tiled or wood floors instead of carpet. We look for wicker furniture or leather instead of stuffed couches. We always ask if the place has dogs, cats or other pets, as some villas and ski chalets are also people’s homes for part of the year.

4. Research local food labeling laws. If you’re thinking of traveling to the Caribbean this winter, I can report that much of the food is imported from the U.S. and Canada. So labeling on these products is not a problem. But you need to be more careful with locally produced items.

5. Check the import restrictions on the country you are going to as well as any countries you will be connecting through on flights. Like the U.S., many countries have restrictions on bringing in meat, fruit and vegetables, but most are OK with dry goods.

The Flight

We limit the number of flights to get to our destination, and avoid connecting via a third country. Since we’re traveling from Ottawa, this means looking for places we can fly to directly from Toronto or Montreal. We prefer not to fly through the U.S. because if we bring meat and fruit for the meal on the plane, we’ll have to throw them out if disembarking to catch another plane.

Time To Eat

1. Our motto and Number One rule for traveling with anaphylaxis is: Have Kitchen, Will Travel! We always try to stay somewhere that has a kitchen. There are a surprising number of options, including condos, villas, ski chalets and hotels with kitchenettes. We wash all pots, plates and cutlery on arrival, since we don’t know what foods were on them before.

2. We bring our own food for our daughter for every flight. We never let our daughter eat something if we don’t know the ingredients, and she never eats anything without her auto-injector on hand. We carry at least four EpiPens on every trip.

3. We pack and check one suitcase full of non-perishable food for every trip. You can’t count on being able to buy allergy-free foods abroad. Some items to consider (depending on the allergies): egg replacer; sesame-free bread; nut-, dairy- and egg-free cookies; nut- and dairy-free cereals; and gluten-free pasta. You can include a small freezer bag for perishables (like dairy-free margarine).

4. Bring enough food for your first day, so you don’t have to shop the moment you arrive. Think pasta and a can of pasta sauce for a first night’s dinner – or instant noodles for an overnight in a hotel room without a kitchen.

5. Are you staying longer than a week? Then bring allergy-free bread loaves and freeze some once you get to your destination. That way, the bread will last.

6. We eat as many meals as possible in our rental unit’s kitchen. When we go out for a day trip, we pack lunches and snacks to bring with us. If we absolutely have to eat out, we will not count on a waiter to communicate about the allergies. We try to speak directly to the person preparing the food and explain: the allergies, the fact that they are life-threatening, and to ask about possible cross-contamination. We prefer smaller restaurants because you have a better chance of speaking to the cook.

Stick with plain, simple foods (no sauces) to reduce risk. For example, plain rice, plain pasta, plain vegetables and grilled chicken or fish. Ask if an allergen has been on the grill before ordering.

Related:
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• Tips for traveling with allergic kids

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The Toronto Star featured a woman with asthma who flew from Paris to Toronto with a cat as a fellow passenger – and struggled to breathe the entire trip. She used her reliever inhaler, but wasn’t able to get her asthma under control during the flight she describes as “eight hours of distress.”

Meanwhile, Maclean’s spoke to a man whose dog died in the cargo section of plane (note: this larger lab mix dog would have been too large to be allowed in the cabin under the new rules). The article addresses the concerns of those with serious allergies, but stresses the happiness of pet owners with the news. The executive director of the Humane Society of Canada is quoted as saying:

“As a veteran air traveller, I would find [pets] much less objectionable than some of the people who’ve sat next to me on a flight.”

The Toronto Star also published a Q&A with Air Canada, which explains what the airline will do to accommodate those with allergies. It includes this quote from the airline: “We will make reasonable efforts to move you or the pet and pet owner. Where feasible, it may even be possible to allow passengers to change flights at the last minute at no extra charge if you prefer not to be on a particular flight with an animal.” Read the rest of The Star’s Q&A here.

What do you think? Have your say on our Talking Allergies Forum.

See Also:
• Survey: 80% want Pet-free Flights
• Forum: Food Allergies And Airlines
• Airlines and Allergies: Chart comparing allergy policies of 11 airlines (Note: doesn’t include new Air Canada rules.)
• Tips on Flying with Food Allergies

Discuss this issue on the Forum.

Of particular concern to researchers from the University of Michigan division of allergy & clinical immunology and the Food Allergy & Anaphylaxis Network was that only 10 per cent of survey participants who had an in-flight reaction used an epinephrine auto-injector to treat symptoms. (Most opted for antihistamines, which allergists don’t consider adequate for anaphylaxis.)

“These symptoms are not just – ‘I’m getting a little itchy, I’m getting hives, my mouth is itchy’. These are people having hives, vomiting, diarrhea, wheezing,” allergist Dr. Matthew Greenhawt, co-author of the study, told Allergic Living. As well, few of these passengers informed the flight crew that there was a reaction in progress.

Of 285 people who expressed interest in this study, 150 were chosen to participate since they (or their children) had experienced one or more allergic reactions aboard a U.S. commercial flight. This group answered the full questionnaire, and 50 of those individuals fit the criteria for having anaphylaxis while a passenger on a plane.

“If you think about the circumstances: you have 50 people who had a fairly severe reaction on airplanes in the middle of nowhere, there’s a lot of risk to be taken if you’re just going to have Benadryl,” said Greenhawt, whose study appeared in the November issue of the Journal of Allergy and Clinical Immunology. As well, six of the 15 allergic passengers who did receive epinephrine required a second dose while still in the air.

Greenhawt says the discrepancy between the severity of symptoms and the passengers’ hesitation to use auto-injectors shows the allergists’ message of what constitutes anaphylaxis, and when to use epinephrine has yet to get through. “Perhaps that’s the next step in education: to explain exactly when we want them to use their epinephrine,” he said.

Another interesting point in the study was that 88 per cent of study participants continued to fly despite a reaction in the skies.

See Also:

• Air Canada Ordered to Offer Nut-free Zones.
• What the Transport Agency Said – Highlights of the Ruling
• Exclusive Chart comparison – 11 airlines and their food, pet allergy policies.
• Allergic Living’s Reduce-the-Risk Airlines Campaign
• Feature Report: Flying Allergic by Jennifer Van Evra
• What about Pet Allergies on the Plane?