This is the third in a series of articles with advice for traveling with severe food allergies. The first article contained practical advice from real parents about traveling with food allergies. The second article was about Cruise Travel with Food Allergies.
This is an interview with Dr Brad Weselman of the Kids Health First Pediatric Alliance, a coalition of 34 of the leading independent pediatric practices in Atlanta, with more than 180 participating pediatricians. It includes his helpful advice about traveling with severe food allergies. You can learn more about his practice and more safety tips for caring for children at KidsHealthFirst.com
What advice do you give parents who plan to travel with a child who has severe food allergies?
Plan well in advance and allow time to negotiate with the airline. Book by phone to allow you to convey how serious the child’s allergy is, and find out specifics of the possible carrier's policies regarding peanut-free snacks or a “peanut-free” buffer zone etc.
Choose the first flight of the morning when the plane is the cleanest.
Reconfirm your request multiple times with multiple airline representatives (reservation agents and supervisors, airline caterers and/or the food services department, gate agents, and flight attendants) to make sure items that cause a reaction are not present on the flight or near your seat.
Regardless of the assurances you receive from staff – do not eat airline meals or snacks.
Do you ever recommend that a child not be allowed to fly? How do you make that determination?
Travel is a wonderful experience for a child – whether sight-seeing in exotic locations or just visiting out-of-town relatives. Recommendations restricting airline travel would be on a case-by-case basis and would depend on the how bad the past reactions were, whether they were the result of eating the food, or simply touching or inhaling it. How well and how fast the child responds to their medication is also very important.
Unfortunately, no airline can guarantee an area is completely free of a substance a child is allergic to since it cannot control what passengers bring on flights. Children who have an inhalation-based allergy, one that is "set off" by the child breathing in a very small amount of the substance they are allergic to, might need to be restricted from flying. Thankfully such reactions are relatively rare. The key is to talk with your child’s pediatrician or allergist. Parents need to be comfortable giving their children medication and should be prepared to handle a reaction anytime since they can occur anywhere.
What should parents bring with them on a trip?
Obtain proper documentation of the allergy to be on your person at all times. Bring a note written on your physician’s stationery, documenting the specific food allergy and the need to avoid it.
The information I look for in a patient’s medical records include:
- The type of allergic reaction (i.e. True anaphylaxis – which means difficulty breathing or swallowing or skin rashes – like hives or urticaria)
- The cause of the reaction (Eating the food or simply touching or inhaling it)
- The treatment prescribed for the reaction (e.g. Benadryl or Atarax by mouth; Injectable epinephrine (Epipen or Epipen JR.))
- The response to the medications and how long the reaction lasted (this allows the physician to know what to expect and how long they will need medication)
- Make sure you have all of your child’s medications and are comfortable administering them. Know the appropriate dosage of your child’s antihistamine—which might be Benadryl or Atarax, depending upon your child’s weight--and be sure the medication has not expired. Check the expiration date of your epinephrine injection and carry at least 4 separate syringes in 2 locations (two on your person – not in the overhead compartment – which you may not be able to get to during a flight) to ensure they are available if needed. Make sure current TSA regulations allow you to carry on these medications and that you have documentation that they are needed.
How do you recommend that parents carry their medical records?
While a zip or thumb drive for a computer with your records may be helpful remember that in an emergency there may not be access to a computer or time to access this information so always have it on paper.
I also recommend a medic alert bracelet documenting the allergy in case you are not with your child and a reaction occurs. This is also recommended for older children.
Most resources recommend that parents arrive at their destination with the name of a pediatric allergist. How do you recommend that families find a good doctor at their destination?You can obtain recommendations from your local pediatrician or from friends or relatives in the area to which you are traveling if they have a clear idea of your needs. You can also contact local medical schools or societies like the American Academy of Pediatrics to find reputable specialists. You should have the name of a general pediatrician, a pediatric allergist and a pediatric hospital/emergency room. Pediatric specialists and facilities are important because they know the specific doses necessary for children at each weight and have appropriate sized equipment such as IV needles and intubation equipment to assist with breathing if necessary.
What recommendations do you have for eating out in a foreign country?
Call restaurants ahead of time and see if they can meet your needs – if English is not the main language, make sure you have a good interpreter. American based hotels or resort chain restaurants in these areas may be better able to accommodate you than local restaurants.
Once you have arrived at the restaurant, tell the server about the allergy. Ask about ingredients including where and how the food was prepared (for example a pan used previously for shellfish may still have enough in it to cause a reaction) – the kitchen needs to cook with fresh, clean pots, work surfaces and dishes.
Order simple meals without sauces, which can hide foods your child has a reaction to like peanuts or shrimp
If you are uncomfortable with how well your needs can be met, arrange for a room or suite with a kitchenette where you can prepare your own meals.
What steps would a parent take if their child has an allergic reaction on a plane?
Before you travel, make sure you have a clear idea what symptoms you are looking for and speak with your doctor to develop a plan to evaluate and treat the symptoms. Make sure you are very comfortable with the steps and when and how to give a shot of injectable epinephrine. Studies have shown that parents may give this medicine wrong or too late when they are uncomfortable with their use. In an emergency situation a parent’s anxiety level can lead to mistakes. Make sure other adults traveling with you know the plan as well.
Symptoms of a life threatening allergic reaction may include flushing (or turning red), a tickle or tingling in the throat or mouth, an itchy rash, a feeling of the throat closing, difficulty breathing or wheezing, or drooling. If you suspect your child is having a reaction on a plane, have someone notify the flight crew immediately and concentrate on your child who will likely be scared. Give the medications according to your prearranged plan. Have someone else make sure that the flight crew is identifying doctors or nurses on the flight who can help, contacting medical professionals on the ground and/or allowing the pilot to arrange to divert and land the plane if necessary. Do not count on flight attendants to administer the meds as they may not be trained or authorized.
Above all, remain as calm as possible. Concentrate on your child and their welfare and calmly talk to the flight crew. After the situation is controlled and your child is safe and comfortable there will be time to identify how the reaction occurred or to file a complaint if arrangements were not handled appropriately. Be aware that after a reaction has improved, it may come back if the item that caused it has not been found or removed or is still in your child’s system.
What should parents be prepared to do if their child has an allergic reaction at their destination?
On the ground, in addition to the above steps (and the substitution of wait staff or hotel staff for flight crew) activate local Emergency medical systems immediately. If a child has a reaction severe enough to require the administration of epinephrine, they should be evaluated as soon as possible for a persistent reaction requiring further medication and/or hospital observation.
Are any travel immunizations disallowed (or risky) when there is a severe food allergy (e.g. eggs)?
Influenza vaccine (Flu) and Yellow Fever Vaccine (required for travel to Africa and parts of South America) should not be given to patients with severe Egg allergy. Vaccines should not be given if the child had a previous allergic reaction to them or to one of their components. The travel vaccine section of the CDC website can direct you to which vaccines are needed for traveling to specific areas and can advise which vaccines may be safe for your child. As always, talk to your doctor about your plans – in order to be effective, some vaccines or medicines have to be started or given months ahead of time.Related Links
Tips and Advice for Travel with Severe Food Allergies
Cruising with Food Allergies