A professional traveler’s guide for traveling with food allergies

This article on traveling with food allergies is my personal experience of traveling with family members with anaphylactic food allergies across 21 countries over the past decade without a severe allergic reaction. It is not medical advice, nor am I a medical professional. 

When my son was diagnosed with a long list of food allergies as a baby, I found it overwhelming. My husband already had a known allergy to gluten, and we had learned to navigate those needs when traveling. But my son felt like a different challenge altogether. He is anaphylactic to many things, with a tree nut allergy, egg allergy, and peanut allergy. He needs emergency medications with him at all times. 

​Travel was and remains a big part of our life and family culture. I couldn’t imagine traveling safely while navigating all my child’s food allergies, but I also wasn’t willing to give it up. This is what I have learned and tried on our travels that have kept us from serious reactions around the world.

Air Travel with Food Allergies

I’m not going to lie, flying with food allergies is rough, especially on long haul flights. Airline policies differ, and flight attendants do not always adhere to the stated policies. Contact the airline ahead of time, at least 72 hours in advance, with your specific allergy information and requests. Many airlines have special meal requests available, though I have never found an airline that allows you to select multiple allergens. Typically it is peanuts only, or vegan, or something similar. With 33% of children having multiple food allergies, this is a huge oversight for airlines. 

I have also found that the flight crew can rarely tell me with certainty what ingredients are in a meal. With the risk of accidental exposure being magnified on an airplane, I usually choose to bring our own meals on planes. This is the best way to ensure safety, even on top-tier airlines. We booked business class on Qatar Airways when in the Middle East and they could not definitively say if ANY of their food was safe for my son, so he stuck to his packaged snacks. It was a huge disappointment on such an expensive flight.

I do find that airlines in the United States are better at allergy friendliness than airlines in other countries, possibly because of customer expectations but also because Americans have a higher rate of food allergies than many other countries.

Personal Experiences on Different Airlines

My personal experiences with airlines and allergen coverage is as follows:

Flying with food allergies on Delta

Hit or miss. I fly Delta often and have lots of experience with them. I notify the airline online several days ahead that my son has a peanut allergy, which is the only allergen Delta recognizes. Good to be able to share this with them…but it’s one of many allergies and some of his other tree nuts are more severe than his peanut allergy, so not that helpful. When the peanut allergy is noted on his ticket, the gate agent typically calls us up to speak with them ahead of time to ask if the allergen is airborne. Ours is not, but they do usually let us board early to wipe down the seats. Sometimes I have to ask for this permission and sometimes it is offered proactively.

On one flight from Cabo to Seattle, even with the allergy noted and having spoken to the flight attendants, my son was served a meal in first class that contained nuts. We recognized it and prevented him from eating it, but it could have been disastrous. Always, ALWAYS be vigilant on flights.

For my husband’s gluten allergy, they have the ability to request a gluten free meal in first class, but not in economy. You can also still denote a peanut allergy, but no other allergies. Delta offers a range of special meal requests, but most are religious or medical restrictions as opposed to allergy-friendly options. 

Flying with food allergies on Alaska Airlines

I also fly Alaska a lot and they too are middle of the road on allergy support. They do not have the ability to denote food allergies on a reservation. Alaska has a more robust food program than Delta does and allows pre-ordering of snack boxes and hot items. These menu items typically clearly state ingredients. In first class, the pre-ordering system denotes if a meal is gluten free and/or vegetarian, but I don’t believe it denotes other allergens. If you want one of the snack boxes or hot items, order when the window opens 2 weeks prior to your flight to ensure that you can get what you want. We have had times when there is too much demand and because their supply chains are so slow, they cannot get more food, even if they know they have sold out days or weeks before the flight. If you do not pre-order, you typically cannot order on board so plan to bring your own safe foods if you miss the ordering window.

I have never requested to board early to clean our seats and can’t speak to whether they would support this or not.

​Flying with food allergies on Virgin Atlantic

We have taken a couple of trans-Atlantic flights on Virgin Atlantic Upper Class and the allergen support has been sufficient. I always inform flight attendants of my family’s allergies and double check whatever ingredients I can. When flying business or first class internationally, I find that the cabin crew is more than happy to offer alternatives if there is limited support for our allergens in the regular meal service. They will get packaged snacks, give you more of something you can eat, etc. Do not hesitate to ask for what you need.

Flying with food allergies on Qatar Airways

Qatar was my biggest disappointment in terms of airline support for food allergies. We flew from Cairo to Seattle with a stopover in Doha and for both flights, they did not have anything my son could eat. They could not tell me ingredients on any prepared foods and the packaged snack offerings were limited or similarly impossible to verify ingredients. We ate through all of our packed snacks and my son was angry and hungry. I was deeply disappointed that a flight so expensive and so long would have so little support for food-allergic passengers, but I also learned on that flight to never assume that there will be something on board that my son can eat.

Flying with food allergies on other airlines

We have flown ITA Airways, IcelandAir, British Airways, and El Al with my son. My husband has flown many more with his gluten allergy, so many I wouldn’t know them all, and all around the world. My general impression is to never trust that an airline will have food labels for you to review nor food that is safe. Bring your own food, and prioritize eating anything fresh during the flight, as you may not be allowed to bring unpackaged food into a new country.

Essential tips for flying with food allergies

1. See if your airline allows early boarding – boarding early lets you use wipes to clean the tray table and seating area with sanitary wipes to prevent cross-contamination and accidental exposures. Not every airline will do this, and you should bring your own wipes.
2. Confirm with the airline if the allergen is airborne and you need special accommodations on the flight – be vocal about what you need…ask for buffer zones on the plane, ask the cabin crew to request passengers not consume your allergen during the flight, etc. Do this with kindness and gratitude, and remember that people who do not constantly deal with food allergies likely lack the empathy to understand how nerve-wracking flying can be.
3. Carry your emergency medical supplies in your personal item – do not put these items in your carry-on luggage that needs to go in the overhead bin (and which is sometimes gate-checked to your final destination if overhead bin space is full). Keep all medicines in your personal item under your seat so that you can access them even when the seatbelt sign is on.

Traveling Internationally with Food Allergies

Once you get to your destination, the real work may begin. International travelers face challenges with eating safely in a foreign country, but it can definitely be done with preparation and planning.

Research Destination Regulations: Different countries have varied regulations regarding food labeling and allergen disclosures. Investigate these rules ahead of time to know what to expect in terms of food safety and labeling practices. Familiarizing yourself with local laws will help you better navigate choices while minimizing risk.

Carry Allergy Travel Cards: I use Equal Eats allergy translation cards when I travel. I order them ahead of time, print them at home and laminate them. You can also order a physical card to be sent to you, or you can use their mobile app. Equal Eats cards have English on one side, so you know what the card says, and the translation in your chosen language on the other side. They are small enough to carry in a pocket or purse, and can be handed to wait staff in a restaurant if you are having difficulty with communication. They offer a ton of different languages to eliminate language barriers. 

Connect with Local Support Groups: Utilize online forums or social media groups for travelers with food allergies. Engaging with others who have experienced similar trips can provide valuable insights and recommendations about safe dining options. These communities can also offer emotional support and practical advice for traveling with food allergies. I found this particularly important when traveling in countries where our allergens are a major part of the cuisine, like nuts in the Middle East. I joined an allergy support Facebook page for Israel prior to our trip there and found a wonderful allergy-friendly bakery in Tel Aviv which I was so happy to support during our trip. 

Download a Translation App: ​I utilize Google Translate when traveling. You can download a language while on WiFi and have it available when you’re out and about. I particularly love the visual translation and use it frequently in grocery stores and while reading menus. You can point your camera at written words and Google Translate will overlay the words with the translation so that you don’t have to type in all the ingredients you need to check.

Use Travel Insurance: Ensure your travel insurance covers allergy-related incidents, including cancellations or emergencies. Investigate policies that specifically address food allergies or provide stand-alone coverage in case of hospitalization due to allergy reactions. Having appropriate insurance will give you peace of mind during your travels. I’ll be honest that I don’t typically buy travel insurance, but I think it’s a good idea since there is always a chance for severe reactions (even at home!)

Choosing Your Destination  

Selecting a destination when traveling with food allergies is foundational to a safe and enjoyable experience. Researching locales that prioritize allergen awareness, food safety, and offer a rich variety of culinary options will enhance your travel. Consider not only the cuisine but also the prevalence of allergen management in that culture, as this contributes to your overall security while exploring.  

I hugely underestimated this in the Middle East and we really struggled to find safe food for my son. I was constantly stressed out and he was constantly frustrated. It really negatively impacted our experience, and to be honest, I’m avoiding traveling there with him again until we complete oral immunotherapy to hopefully reduce the severity of his allergies and reactions. 

If you will be traveling somewhere without a lot of support for allergies, I have two main suggestions.

1. Choose accommodations that you know can support your allergy needs. I canceled hotels for the later part of our Israel trip because I could not reach them to confirm their ability to support my son’s allergies. After the difficulty we faced in a major city like Tel Aviv, I worried that the more rural property I had chosen would have even less for him to safely eat. I spent up a lot more than we had planned to move to an American luxury hotel chain that I felt confident would have policies in place to accommodate us. We stayed at the Ritz-Carlton Herzliya and I will not forget the kindness they showed us in catering to my son’s allergies. The chefs routinely came out to meet with us and one pastry chef even invented a safe dessert for my son. They went so far as to give us an entire tub of a chocolate spread similar to Nutella but without nuts. It was a dream to be able to let down my guard a little knowing that the staff understood the importance of food safety.

2. Consider access to medical care when selecting a destination or lodging. This was a major reason that I moved hotels in Israel…I realized that we were going to be staying somewhere pretty remote, and if we did have an issue, I wasn’t confident that we could get to a medical facility in time. If I felt super confident in the hotel’s understanding and treatment of food allergies, I might not have worried so much about this. As it was, my experience throughout the country was poor and I wasn’t willing to assume the potential risk.

Most Important Things You Should Know  

• Assess Food Allergy Awareness: Investigate regions known for their strict food safety regulations and public awareness of food allergies, which can indicate how well restaurants handle allergens. For instance, countries like Canada and the United Kingdom often have robust food labeling laws. Make informed choices based on this awareness to minimize risks.
• Look for Allergy-Friendly Destinations: Seek destinations with a solid reputation for catering to food allergies, such as cities featuring vegan or vegetarian restaurants that frequently accommodate allergen issues. Popular areas like San Francisco or Berlin often have a variety of options catering to dietary needs. Prioritize cities that have resources like allergy-friendly guides.
• Consider the Culinary Scene: Be mindful of the culinary traditions of your desired destination; countries with rich agricultural practices may offer fresher and safer food choices. Engaging with local markets or farmers can lead to safe and delicious food options. Additionally, regions where flavors and ingredients are clear-cut can foster a safer dining environment.
• Review Traveler Experiences: Look for feedback and reviews from travelers with food allergies who have visited your desired destination. Websites, blogs, and social media platforms can provide insights into real-life experiences. Gathering diverse perspectives will enhance your understanding of how well allergy management is implemented in various eateries.
• Public Health Infrastructure: Evaluate healthcare access in your destination, ensuring nearby hospitals or clinics are adequately equipped to handle allergy emergencies. Opt for regions with established medical services, providing reassurance that you’ll receive prompt assistance if needed. Understanding the local healthcare landscape is crucial in managing your health effectively.

Researching Local Cuisine  

Deep diving into local cuisine enhances your travel by allowing you to appreciate flavors and regional specialties while keeping your food allergies in check. It’s vital to identify how local dishes are commonly prepared and which ingredients are typically used. Understanding this landscape aids you in making safer choices that resonate with the culinary culture of your destination.  

Most Important Things You Should Know  

• Understand Regional Ingredients: Familiarize yourself with staple ingredients specific to the cuisine, including potential allergens and cross-contact risks. Research can help you identify foods that you may need to avoid, providing a clearer portrait of what meals are safe. Consider creating a list of traditional dishes that prominently feature your allergens, allowing you to steer clear of them effectively.
• Learn Key Phrases: Equip yourself with essential phrases regarding allergies in the local language to communicate effectively at restaurants or markets. Utilize language apps that let you translate vital allergy-related inquiries, ensuring your message is conveyed appropriately. This direct communication can help avoid misunderstandings that might otherwise lead to adverse reactions.
• Explore Diverse Dining Options: Investigate various dining options, from street vendors to fine dining, to discover which are more accommodating for your allergies. Visiting local markets can provide safe, fresh ingredients in a setting where you can ask questions directly. Understanding the culinary scene is key to having a rich experience without compromising safety. Don’t assume that restaurant staff are familiar with dietary restrictions or which will be safe meals for your particular conditions. Ask questions and request to speak with the chef when necessary.
• Engage with Chefs: When feasible, establish conversations with chefs or kitchen staff about how meals are prepared and the potential for cross-reaction. These staff members can provide insights about ingredient sourcing and preparation methods, allowing you to gauge the safety of a meal better. Building this rapport can enhance your dining experience and ensure you’re making informed choices. Carry food allergy cards to help with the conversation.
• Sample Safe Cuisine: Opt for traditional meals that are free from your food allergens, providing an avenue to enjoy local flavors without individual risk. Often, dishes made from whole ingredients without complex preparation lend themselves to safer dining. Choose simple preparations that avoid sauces and seasoning mixtures, known for frequent allergen inclusion.

Emergency Preparedness  

Being prepared for emergencies surrounding food allergies is crucial, especially while traveling. Having an emergency plan in place allows for calmness during crises, ensuring quick responses and appropriate care in unexpected situations. Understanding the best practices ahead of time may significantly enhance your confidence while abroad.  

Most Important Things You Should Know  

• Understand Emergency Protocols: Familiarize yourself with local emergency numbers and medical facilities at your travel destination to respond effectively in emergencies. Knowing how to access assistance enhances your sense of safety and allows you to have instant resources if needed. Research the nearest hospitals or medical facilities in advance, preparing you for any necessary visits.
• Always Carry Emergency Medication: Keep your Epinephrine auto-injectors or any seasonal medications readily accessible, ensuring they’re stored in a location that’s easy to reach. Additionally, have a backup supply if you are traveling for an extended time. Carry a note from your doctor if you are bringing prescribed medications across borders, permitting a smooth experience.
• Connect with Local Emergency Services: Research local healthcare systems’ response to food allergies beforehand, ensuring you know how to alert help effectively. Develop knowledge of their protocols, understanding their processes regarding food allergies and cross-reactions. This insight can alleviate worry and promote safety throughout your adventure.
• Create an Action Plan: Establish a step-by-step plan of action should an allergic reaction occur, detailing targeted actions you or your travel companions should follow. Share this plan with trusted travel companions, ensuring they understand your methods for handling emergencies. Arm those traveling with you with the knowledge they require to keep you safe.
• Inform Travel Companions: Encourage discussions about your food allergies with your travel companions so they can help identify risks and react appropriately to emergencies. Collaborative efforts often lead to more vigilant monitoring and can aid in prevention strategies. By reinforcing your safety, they can strengthen the support system you have while traveling.

Traveling with Medication  

Traveling with medication requires careful planning and awareness to manage allergies effectively. Understanding local regulations and preparation guidelines proves essential, assuring you maintain your health throughout the journey. Proper handling of your medications alongside your food allergies can greatly influence the success of your travel experience.  

Most Important Things You Should Know  

• Carry a Doctor’s Note: Always bring a note from your doctor detailing your medications and allergies, which can provide essential documentation at border controls. This paperwork may ease crossing borders or navigating customs when you possess necessary medications. Presenting formal documentation not only validates your needs but also fosters respect for your priority needs. Though I have not needed this, I have carried it across multiple countries and my son’s allergist was happy to provide a note.
• Understand Local Regulations: Research the laws around bringing and transporting your medications in your destination country, as certain drugs may have restrictions or require prescriptions. Gain clarity on what documentation is required, minimizing delays or misunderstandings. Checking with local embassies can also clarify their importation policies surrounding medications.
• Keep Medications in Original Packaging: Always carry medications in their original packaging with clear labels and dosages to ensure legitimacy and proper identification. This thoroughness protects against potential losses or confusion during medical evaluations. Utilizing organized medication cases can provide both safety and easy access during travels.
• Pack Extra Supplies: Bring an adequate supply of medications based on your duration of travel, including extras for unexpected delays or emergencies. Relying solely on local pharmacies may not suffice, as rules regarding medications can vary widely. Having additional supplies ensures you are covered while managing your allergies effectively.
• Set Medication Reminders: Use smartphone apps or alarms to remind you when it is time to take your medications, ensuring you maintain your regimen. Even while traveling, adherence to your regular schedule supports your well-being and reinforces your safety practices. Utilize technology to your advantage, as timely reminders can curb complacency or distractions.

My Experience in Different Countries

I’ve written about our experiences traveling in a few countries with food allergies. Check out my food allergy stories here:

• Traveling with food allergies in Iceland
• Traveling with food allergies in Egypt
• Traveling with food allergies in Israel

New Treatments We’re Trying

As a reminder, I am not a doctor or medical professional. These are the treatments and therapies we are personally doing to alleviate my son’s anaphylactic allergies to eggs, all tree nuts, and peanuts and both of which make travel plans significantly easier. You absolutely need to do your own research and consult with your medical professionals to decide what is right for your particular needs.

neffy

Neffy is a new, FDA approved ephinephrine nasal spray that I’m super excited to have (I have no affiliation to them and am just an actual customer). Our allergy doctor said that epinephrine can be effectively delivered in a lot of different formats and that he was really happy to see a less-painful and scary mechanism for delivery. He helped us get a prescription for neffy, and he sent it to an online pharmacy called BlinkRx. That pharmacy helped us navigate the pre-authorization required by our health insurance, and the manufacturer also has discount coupons available if your insurance won’t cover it. 

I’m excited about neffy because it is smaller and lighterweight than epi pens, which is great for travel. It is also less invasive, so I feel less scared honestly if we needed to use it. I also feel like it has less of a learning curve for my son’s other caregivers, and I feel more confident that my son could dispense it to himself if needed. I also love that it is more temperature-resistant than an epi pen, which I have always worried about in places like beaches. You are not supposed to get epi pens too hot or too cold, so baking on the beach is a no-no, but so is putting it in a cooler. What exactly are you supposed to do? Neffy solves a lot of that.

Oral immunotherapy

We have been doing immunotherapy for a couple of years now, and while it is a massive commitment of both time and money, it is showing promising results in alleviating my son’s allergies. This treatment is more controversial because it is only FDA approved for peanut allergies. I am working with a doctor to do it for all my son’s allergens, and not everyone may feel comfortable with this. 

We started with sublingual immunotherapy (SLIT), where he was exposed to micro doses of his allergens in a glycerin liquid placed under his tongue while in a doctor’s office. We evaluated him for reactions and slowly increased the dose. When we would hit a plateau, we continued that same dose daily at home until our next appointment. After completing SLIT over the course of many months, we did a food challenge in the doctor’s office and he was deemed to no longer react to eggs nor several of his nuts. There are 5 nuts that he remained allergic to after completing SLIT. 

​After he passed the food challenges, we started adding those foods to his diet weekly in a very specific dose. We did this for many months until he graduated to just having it in his diet normally, as much or as little as he wants. In reality, we have found that he still reacts to raw eggs, which are sometimes in protein bars or shakes and in uncooked things like cookie dough or brownie batter. He has not had any reactions to nut exposure of the nuts that tested negative for. It is absolutely huge from a lifestyle perspective for us to be able to have eggs and almonds in our daily life!

After finishing SLIT, he remained allergic to 5 nuts. We then went on to oral immunotherapy (OIT), where the process is the same as for SLIT but it’s with higher doses of the actual nuts as opposed to them being in smaller doses and suspended in a liquid. After another many months of increasing his exposures via doctor’s appointments and maintaining those doses at home daily, we are now in the “maintenance phase.” We do daily exposures of those 5 nuts and will do so for a full 2 years, after which the doctor expects that his reactivity will subside on IgE blood tests and we can consider him non-reactive, though he will always qualify as allergic. 

We will likely always carry ephinephrine, but this set of treatments brings me tremendous peace of mind when traveling to know that if he does react to something, even now as we are not all the way through the treatments, that the reaction will be less than it would have been previously and we will have more time to get medical help.

We have traveled to many countries with these therapies with us. Now that we are in the maintenance phase, I grind up his 5 nuts and measure them out daily. We travel with a small food scale and ziploc bags with his nuts in them. Previously, we traveled with his bottles of SLIT therapy, which have to be refrigerated and which were smaller. It is entirely possible for food-allergic individuals to travel the world while doing this therapy, but the entire thing is a massive investment and you have to be ready to stick with it. I have almost quit several times because it is such a long (multi-year) process.

You can travel safely with food allergies

It’s not easy, but you can travel safely with food allergies, even internationally. Plan ahead, speak with your doctor, and prioritize your safety when organizing your travel. Carry translation cards, do your research, and look into alternative treatments that might make travel easier in the long run. Good luck, and I’d love to hear personal experiences so we can make this article as comprehensive and useful as possible.