As world travelers, my husband, Victor, and I want to expose our children to different cultures. Both of us have worked abroad – he in Brazil, I in Japan – and have visited many countries in Europe, Asia, South America and Africa. We would love to take our children to Japan and India, the birthplaces of our ancestors. But we’ve been reluctant to do so because of our son Julian’s food allergies. Given his sensitivity to several foods and the challenge of language barriers, it may be a while before we work up the courage to go to either country.

When we first embarked on this food allergy journey, the world felt like a dangerous place. Taking baby steps, we opted for North American destinations with a high level of food allergy awareness and quick access to medical care.

As Julian matures, we recognize that we need to do more to prepare him to travel without us. Now in Grade 7, it is only a matter of time before he goes to a foreign country with classmates and adults who may be less knowledgeable about his allergies. His ability to self-protect, in many ways, will be his greatest safeguard.

Julian feels that he can fend for himself and points out my tendency to “hover”; his way of saying that I can be over-protective. However, he agrees that to gain more independence, he must speak up more and ask questions about which foods are appropriate.

Recently, my family made its first international trip. We started slowly, visiting England and Ireland, where we could communicate in our mother tongue. The trip helped to build our confidence. International travel with food allergies does require a lot more planning – but it can be done. If you’re thinking of going overseas, here are some tips to consider:

Connect with international allergy associations

Visit www.foodallergyalliance.org, the website for the Food Allergy and Anaphylaxis Alliance, where you will find links to associations from North America, Europe and Asia. Though none will provide a list of safe foods, they can point you to resources about food labeling regulations and possibly food policies on local airlines. Some provide links to services that can translate allergy-related information, which may be especially useful for travelers who don’t speak the local language.

Take extra epinephrine auto-injectors

In case bags are lost, our habit is for Julian to carry two auto-injector devices (as usual) and Victor and I to each carry one backup. We also take a note from the allergist which supports Julian’s need to carry an auto-injector in case we are stopped by authorities. And don’t forget to wear MedicAlert identification, which is recognized internationally.

Be prepared for an emergency

Find out the emergency number in the country or area you will be visiting. (For example, it’s 911 in most Canadian and U.S. locations.) Learn how to operate the local payphones, which are often different outside of North America, and carry change. Remember that you may not have cell phone service abroad so look into renting a local cell phone. Be sure to always have an epinephrine auto-injector available and review how to use it. Some ambulances may not be equipped with epinephrine, and some paramedics may not be allowed to administer it. When selecting a hotel, ask how far it is to the nearest hospital.

Pack your own food for the flight

Only bring foods that have been consumed safely before, and pack extra safe snacks in case of delays. Don’t bring foods that require heating, as airlines do not have microwaves (they have equipment to keep airline meals warm). Although attendants may be willing to reheat food in oven-ready containers or foil after the meal service, you need to think about the possibility of cross-contamination.

Use dining out experiences to train your child

Encourage your child to think through the questions to ask food service staff ahead of time, then role play. When he’s ordering, don’t interrupt, but jump in if his questions are not thorough. Though Julian remembers to ask about the oil and ingredients in French fries, he often forgets to ask whether shellfish, to which he is allergic, is cooked in the same fryer as the fries.

The only negative experience on our trip happened after we landed in Toronto. Security staff scolded us for bringing in one green apple, which I had packed with Julian’s food, and we were held back for more than an hour. Lesson learned: Remember to find out about local restrictions on foods you can take into a country, even your own country. This being our only glitch, we’re now ready to venture onward. Next stop – visiting relatives in Spain!

First published in Allergic Living magazine, Summer 2007.
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WestJet, however, remains cautious in what it tells passengers. “It should be noted that we cannot confirm all of our snacks are free of trace amounts of peanut or nut products,” a WestJet spokesperson told Allergic Living. While WestJet won’t serve any nuts or peanuts, other travellers are free to bring them on board.

Still, an optimistic Rousseau is asking people to contact the airline: “We need to encourage WestJet to keep the policy, and let them know the positive impact it has. And maybe other airlines will follow suit.” To provide feedback, write to Lorne MacKenzie, lmackenzie@westjet.com.

First published in Allergic Living magazine, Summer 2008
(c) Copyright AGW Publishing Inc.

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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:
• The scoop on air travel
• Traveling to sun destinations with allergies
• Tips for traveling with allergic kids

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Specifically, DOT said it was considering these options: banning peanuts from being served on flights; banning them from being served when there was a peanut-allergic passenger on board; or requiring a peanut-free zone around a person with severe peanut allergy.

DOT did state at the time that Congress had restricted it from using public funds to limit peanuts on aircraft without a scientific study showing passengers can have severe reactions to peanuts from airborne peanut particles, but the department appeared willing to forge ahead anyway.

However, two weeks later the department said it would comply with this requirement. A DOT spokesman told Allergic Living that the agency will still review all comments received. (See you can comment below).

Does a study exist?

Allergic Living has previously reported on studies showing that allergic individuals are at risk of serious reactions while aboard aircraft. A July 2008 study from the University of California’s Davis School of Medicine looked at allergic reactions aboard airliners among 471 people with severe peanut, nut or seed allergies. Forty-five of these passengers – almost 10 per cent – reported having reactions while in the air, with symptoms such as vomiting, wheezing, hoarseness, hives, diarrhea and light-headedness.

Six people went to an emergency department after landing, including one following a flight diversion for medical attention. Most study participants treated themselves, and in only three cases of severe reactions were the airline crew even made aware of the medical situation in progress.

Then in 2009, a study from the University of Michigan and the Food Allergy & Anaphylaxis Network (FAAN) found that one in three people who had an allergic reaction to peanuts or tree nuts aboard an airplane suffered anaphylaxis, the most severe form of a reaction.

Despite the findings to date, a spokesperson for DOT told Allergic Living that it has not received a study that would meet the requirements of Congress. However, he also acknowledged that such a study would likely have to be commissioned by DOT and, at this point, the agency has no plans to do so.

Still, the agency wants to hear the public’s views about peanuts being eaten in airplane cabins. The deadline to comment with DOT has been extended to September 23 (see below).

A ray of optimism

Many members of the allergy community have expressed disappointment in the delay of action by the transportation department on the issue of peanuts served on planes. But the allergist who led the University of Michigan study remains optimistic that change is coming.

Dr. Matthew Greenhawt told Allergic Living: “There have now been three studies about this issue over the past 10 years, countless reports from peanut allergic passengers or their families detailing adverse events, and just simply too much circumstantial evidence of a problem for this issue to be ignored further.”

He says it’s critical the scientific community understand that the government must have “further scientific evidence of the scope and nature of the problem before federal funds can be used to implement policy.”

The University of California at Davis, his own research and earlier findings on the issue from the Mount Sinai School of Medicine have laid the groundwork that a problem exists. But Greenhawt says the evidence has to evolve beyond self-reported allergy incidents, a common feature of the work on this issue to date.

“I am confident that one or more investigative groups will step up and deliver further scientific evidence that will hopefully result in a policy that can protect the vulnerable peanut allergic passenger at 35,000 feet,” he says.

And while stipulating the need for greater scientific evidence, DOT does seem genuinely aware of the issues involved for those flying with allergies.

“We asked for public comments because of the significant number of children diagnosed with peanut allergies, some of whom do not fly because of concerns over the serving of peanuts on aircraft,” the DOT spokesman said.

You Can Comment

• Visit DOT’s Enhancing Passenger Protection document (see point 12), and click “Submit a Comment.”
• Join Allergic Living’s discussion on the Talking Allergies Forum.