Food Allergies and Travel

Planning a Trip

Before booking a holiday or making travel arrangements, time spent on the planning stage is important. This involves gathering information to make informed decisions based on the individual needs of the person with the food allergy.

The severity of a food allergy will depend on the individual. Some people react to very small amounts of a food and it is not possible to predict how severe an allergic reaction may be. Food allergy is individual to the person and is influenced by many different factors including the age of the person, other medical conditions, and severity of previous allergic reactions.

The destination of your travel and choice of transport are important considerations when planning a holiday or travel with a food allergic person. Communication is such an important part of managing a food allergy and involves taking responsibility for your own needs by sharing information on your allergy with those who need to know in a clear and consistent way. It is important to be aware that people’s knowledge of allergy will vary with some people having very little understanding and may need further explanations of what this means for the person with food allergy. An example of this is: I have a severe fish allergy this means that I need to avoid eating all fish or fish containing ingredients in the food I eat. If I choose to fly with the airline will there be an option for me to request a meal that is free from fish, if this is not possible can I bring a safe meal I have prepared at home or brought at the airport terminal?

Travelling overseas may mean that language(s) can be a barrier to communicating the needs of a food allergic person. Translation Cards are a useful way of communicating food allergy(s) in another language and are useful for travel and when eating out whilst on holiday. Allergy UK are able to provide a translation card service, providing a set of 3 small credit card size, printed cards in your choice of language(s) that is posted to you for a small cost. Please contact Allergy UK’s Helpline on 01322619898 or click here for more information.

The availability and access to medical treatment is also an important consideration if the destination is, for example in a remote area. (The number to call emergency services will vary on destination-find this out before you leave and save it in your mobile phone). Other considerations based on destination should include the availability of foods suitable for the food allergic person. Whilst most countries will cater for a range of diets, specific countries may use food(s) in their type of cooking for example, Asian countries commonly use ingredients which contain peanut and tree nut; places such as Scandinavia and Japan use fish; whilst Italian food commonly features egg and dairy.

Choosing an airline or travel provider (depending on the need to travel by air, sea, road or rail) that meets the needs of the food allergic individual will require some research and homework before you travel.

Things that may be useful to know beforehand include:

• Does the travel provider have an allergy management policy?
• Is there an option for a passenger announcement?
• Will the plane/train/boat/bus be cleaned before boarding?
• Can I pre-board the aircraft to clean (wipe down) the seating area?
• Is the travel provider able to offer an ‘allergen free/ special meal?’
• Have staff had first aid training that covers recognising allergic reactions and providing appropriate help?

Flying with Food Allergy

It is important that airline staff are informed of a food allergy at every opportunity. This is particularly important when checking in at the airport, boarding the flight and EVERY time a snack or meal is offered (as it may be by a different person).

Individual airlines will have their own policy on food allergy management and this will vary depending on the provider. There is no legislation to date that determines best practice for managing the needs of the food allergic traveller.

If you wish to know whether snacks or foods containing specific allergens are served during the flight then it is advisable to raise this question when you make contact with the airline before booking. It is important to note that even when airlines have adopted a nut free policy, or are able to offer a nut free service (not selling nuts or providing nuts as a snack) this does not stop other passengers eating nuts, and/or nut containing foods at the airport prior to boarding or bringing these foods onto a flight and eating them. This means they cannot guarantee a nut free cabin/ flight. Some airlines may make a request to passengers seated in aisles around the person with the food allergy to not eat nuts but other passengers may not understand or comply with this request.

Some airlines offer allergen free or special dietary meal requests. Further information can be found on the airline’s website or by contacting their customer services helpline if available. These meals will need to be requested well before the date of travel. Even when an ‘allergen free meal’ has been requested it is important to check when the meal is served that this is ‘free from’ the food allergen(s) that needs to be avoided.

If these meals are unsuitable to the requirements of the person with a food allergy it is advisable to take safe snacks/food with you. Checking that these foods are able to be taken onto the flight, and if required the availability for the storage and re-heating of these foods will need to be discussed individually with the travel provider. Consider the amount of food and snacks needed for the length of your flight (short or long haul flights) allowing for the possibility of travel delays. It is also important to check the quarantine laws of the country you are visiting which may have restrictions on the food that you can take with you. If you are flying with an infant or child requiring specialist feeds of infant formula for a cow’s milk protein allergy please find further information in our travelling with the allergic infant Factsheet.

Some airlines on request may make an announcement to other passengers about a food allergic passenger. This is not a legal requirement and does not guarantee that the other passengers have heard, understood or will comply with the request. If a passenger announcement is not made you may consider telling other passengers sat next to you or your child of your food allergy.

The possibility of a contact reaction can happen in some allergic individuals who touch something (for example a hard surface like a tray table which may have been contaminated with the food they are allergic to) from, for example, food spillage. This contact is usually from the hands which bring the allergen in contact with the face, or mouth. This type of contact reaction usually happens at the point of contact and causes mild allergic symptoms like a rash, redness, itching and mild swelling. To reduce this risk, handwashing before eating or putting fingers in the mouth as well as cleaning the tray table is important.

Allergy Medication

Current guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) recommends that two Adrenaline Auto-Injectors (AAIs) are prescribed, which should be available at all times. This is most important for those who also have asthma because they are at an increased risk of a severe allergic reaction.

Check the expiry date of your medication well before you intend to travel, this enables time to get prescriptions renewed or stock up on allergy medication. Consider the length of your trip and how far from medical help you may be which can help when planning on how much medication to take. The 100ml liquid rule for hand luggage does not apply to medication in liquid form (for example antihistamine in syrup form) but a copy of your prescription or letter from your doctor as proof of need may be required.

The same documentary proof is required for AAIs (such as EpiPen and Jext). Your GP or allergy specialist should be able to provide this for you for that year of travel. The British Society for Clinical Immunology and Allergy (BSACI) has a template letter for children travelling with allergies. This can be accessed and downloaded from http://www. bsaci.org/about/download-paediatric-allergy-actionplans under the heading ‘Medical authorisation letter to carry an AAI’. Please note this should be signed by a health professional only.

Allergy action plans (written emergency treatment plan) are recommended. These plans are a useful reminder of allergic signs and symptoms, and which medications need to be taken in the case of an allergic reaction. They may also support the documentary proof required of a food allergy.

The BSACI has allergy action plans for children either not requiring or requiring an adrenaline auto-injector device that are free to download and print and can be found on their website please note this should be signed by a healthcare professional only.

It can be useful for those travelling with the person with food allergy to know how to recognise the signs and symptoms of an allergic reaction and how to give an adrenaline auto-injector. Trainer pens specific to the type of AAI you have are available from the manufacturer and are useful to show others how they work and for practicing. They do not contain medication or have a needle and are only for practice.

Allergy medication should be easily accessible for use at any time during travel to and from the travel destination, and should be taken on board in your hand luggage when travelling by air, as medication should be stored where it can be easily accessed and close to the person who needs it. The aircraft hold is not suitable as it is not only unaccessible during the flight, it may be subject to extremes of temperatures which are not advised for the storage of medication. Overhead storage is not suitable as items can move, become damaged and can be difficult to reach.

If safe and appropriate, the seat pocket in front of the person with the food allergy can be easily accessed in the event of an allergic reaction. However do remember to pick up your medication when getting off. Not all people with food allergy will experience severe symptoms/reactions. Some people are able to manage mild allergic symptoms with antihistamine medication which can be in liquid or tablet form. Those with asthma and a food allergy are at an increased risk of a severe allergic reaction and should always have their asthma inhaler(s) and allergy medication available.

AAI storage tips:

• Adrenaline auto injectors should be kept away from extremes of temperature (e.g., left in a car)
• They should be kept away from direct sunlight
• AAIs should be kept at room temperature (in line with manufacturer’s guidelines)
• They should not be stored in a refrigerator

Travel Insurance

Travel insurance policies must meet the needs of the person travelling with food allergy, and/or any other medical conditions they may have. It is important to declare a food allergy(s) like you would any other medical condition so that the right cover can be provided. Individual requirements of the food allergic person must be discussed with the insurance provider. A comprehensive policy is recommended for the food allergic person as the severity of an allergic reaction cannot be predicted and this will ensure that any reaction related to a declared food allergy will be covered. Remember to read the small print before purchasing a policy and check that the policy includes:

• Emergency treatment
• Ambulance transfers
• Hospital admissions
• Replacement of allergy medications

Top Tips for Travelling with a Food Allergy

1. Communication is key – make sure allergy needs are communicated clearly and consistently
2. Plan ahead so decisions are not made when tired and/or hungry or rushed
3. Check the expiry date of adrenaline auto-injectors and/or other allergy medication and ask your doctor to prescribe new ones before they expire
4. Make sure you have been trained to use the type of auto-injector that you have been prescribed, technique varies between brands
5. Carry Translation Cards that can be used to communicate food allergy in countries where English is not understood
6. Take a pack of wipes with you, to clean down the seating area especially the tray table

Reference: MHRA (2018) ACCESSED ONLINE 18/01/2021 https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review