If you have allergies - to food, pets, pollen, mold or something else - or if you have asthma, borrow a lesson from the Boy Scouts: Be prepared - all the time.
According to the American Academy of Allergy, Asthma and Immunology (AAAAI), allergies affect as many as 40 million to 50 million people in the United States, triggering more than 8 million visits to office-based physicians each year. More than 17 million people, including 5 million children, have asthma.
Allergic reactions range from merely annoying - a friend’s cat may trigger a bout of sneezing - to potentially deadly. According to the AAAAI, approximately 100 people in the United States die each year from food-related anaphylaxis and at least 40 die from reactions to insect stings.
Experts say the cardinal rule for allergy sufferers is to know what you’re allergic to and to predict and avoid situations where you’re likely to be exposed to those allergens. This is particularly important whenever you are away from home, whether you are visiting a friend or traveling abroad. Even if you are rarely affected by your allergies or asthma, you cannot always predict what reaction you might have in a new environment. Make sure you are armed with the medications you might need if you have a reaction.
People with food allergies, in particular, need to be on alert. There are numerous cases of people suffering a reaction to a food they thought was safe. U.S. Food and Drug Administration inspections have found bakeries using potential food allergens in products without listing those ingredients even when a business thought it was in compliance with food-labeling regulations. Therefore, you should assume that foods may contain trace amounts of unlabeled food allergens. You should be on special alert if you have an allergy to cow’s milk protein, peanuts, nuts, eggs, or wheat (gluten). Beginning in January 2006, the Food Allergen Labeling and Consumer Protection Act that was recently signed into law will require food manufacturers within the United States to clearly label their foods if they contain common allergy trigger ingredients. When there is not obvious labeling, it can be important to recognize your allergy trigger by alternative names: for example, cow’s milk may be included on an ingredient list under the name “casein” or “caseinate,” soy may be named “textured vegetable protein,” and eggs may be referred to as “albumin.” You should request a list from your doctor or allergist that shows foods to avoid for your allergy.
When traveling, you must be especially careful about the foods you eat that are prepared by others. If you have had serious, potentially life-threatening reactions to food in the past, especially if you have a peanut or nut allergy, make sure you take emergency medications with you when you go out to eat. To keep up to date with the latest alerts about unlabeled food allergens, check periodically with the Food Allergy and Anaphylaxis Network.
What You Can Do
When you’re on the go, you can take steps to make sure your travels don’t become memorable for all the wrong reasons. The AAAAI offers these tips:
- Be prepared. Do your homework for your trip and be prepared for any unexpected event. Travel with a medical kit, including any allergy medications - prescription or over the counter - that help relieve your symptoms. Also pack medications in your carry-on luggage in case your checked luggage is delayed. If you have a potentially dangerous food or insect allergy, your doctor may have prescribed an epinephrine injection for emergencies. You should have one with you at all times. If you are traveling by air, an epinephrine syringe is permitted on board but it must be labeled with a professionally printed label from the pharmacy or manufacturer, which states the name of the medication or the manufacturer. It is strongly advised that you also carry a letter from your health care professional stating your medical condition and the need for you to carry your medication on board. You should carry this documentation with you through all airport security gates, and you should carry your own supplies or stay with your traveling companion who is carrying them. Do not eat airline food if you have a peanut allergy; it is best for you to bring your own food along. If your asthma is particularly severe, your doctor might prescribe prednisone for you to take with you when you travel. You and your doctor might have a plan for when you might have to use it or when to call for instructions. Take your physician’s phone number with you. You never know when you might need to contact him or her. And here’s one last tip: Don’t forget to obtain travel medical insurance (or check to see what your own insurance policy covers). You may need it.
- Take extra precautions if traveling abroad. If you’re traveling abroad, check with your physician for any immunizations you may need. Remind your doctor if you have an egg allergy, because egg protein is contained in some vaccines. Make sure to carry your physician’s phone number at all times. Take your allergy medications in their original containers, which are easier for customs officials to identify. And if you use a portable nebulizer, find out the local electrical currents of where you are going; if you need to, invest in an adapter for the electrical plugs.
- Avoid triggers of food allergies. If you have any potentially life-threatening food (or insect) allergies, always carry an epinephrine kit to administer emergency medication. When eating in restaurants, ask how the food is prepared. You may want to contact the chef beforehand and outline your special dietary needs, especially if you’re staying in a resort or taking a cruise and will be eating several meals in the same place. Bring extra food with you when traveling, just in case you experience any travel delays.
- Check pollen counts. Check pollen counts and weather forecasts for your destination. Pollen doesn’t affect all regions of the country at the same time. So if you’ve got a particular vacation spot in mind, go when you’re least likely to experience symptoms. Good vacation bets, the AAAAI says, are the beach or mountains any time of the year. Ocean breezes are generally free of allergens, and dust mites don’t thrive above 2,500 feet. In addition, snow kills mold spores. Also keep in mind that pollen counts are highest in the morning. Try to schedule your indoor activities in the morning and your outdoor activities for the afternoon if possible.
- Ask the hotel staff questions. Concentrations of dust mites and molds in carpeting, mattresses and upholstered furniture can worsen your allergy symptoms. Fumes from cleaning products also can cause problems. So if you are planning to stay in a hotel or a bed and breakfast, ask in advance if there are allergy-proof rooms available. At a minimum, ask for a nonsmoking room with air conditioning and portable air filters. Also ask if any rooms are available with wood, tile or vinyl floors. If you’re sensitive to molds, ask for a room away from the indoor pool.
- Air out the car. Once on the road, keep the car windows rolled up and use the air conditioner if you are in a polluted area or if it is pollen season. You can avoid excess air pollution by traveling early in the morning or late in the evening when the air quality is better and traffic isn’t as heavy.
- Prepare for the airplane. If you have bad nasal congestion from allergies at the time that you take an airplane flight, then you will be more susceptible to having ear pressure problems during your flight. It is optimal to treat your allergy symptoms aggressively in the days leading up to a flight, and it may be necessary for you to use a decongestant medication in addition to antihistamines. Alert the airline if you have food allergies so you can get special meals. If your allergy reaction is anaphylaxis, then you should not rely on the airline meals and should bring your own food. In addition, make sure your seat is as far as possible from the smoking section. All domestic flights are now smoke-free, but some international flights are not.
- Investigate the ship. If you are taking a cruise, you should ask in advance about the capabilities of on-board medical staff and what type of medical issues they’re prepared to handle. Check the climate and season of your destination and talk to your allergist about any potential hazards. Ask for smoke-free accommodations.
- Don’t let your guard down in private homes. Do your friends have pets? It may be wise to take an antihistamine - or any other “pre-exposure” medication or inhaler that you use - before visiting a friend or relative with pets. Holiday treats can contain hidden, significant food allergens. The key to visiting is to talk to your hosts and plan for any potential difficulties.
The Bottom Line
Having allergies does mean some extra work on your part to travel safely, but being aware of potential hazards and using an ounce of prevention can ensure you’ll have an enjoyable and memorable trip for all the right reasons.
Revision date: July 8, 2011
Last revised: by David A. Scott, M.D.