Today’s guest post is by Michelle Byrne, who runs the Manchester Allergy Support Group. Since my son’s peanut allergy diagnosis, we have so far holidayed in Britain. When I began attending the support group in May 2013, one of the things I wanted some advice on was how to go about holidaying abroad, in the least stressful way possible. Michelle had spoken about this to the support group back in January and had lots of information about what you can do (particularly before departure) to reduce the risks. I’m delighted that Michelle has kindly agreed to share with Nutmums.com her tips on how to travel safely with allergies (and eczema and asthma). The message? Preparation is key! Louise
by Michelle Byrne (see Biography below).
It is possible to have an enjoyable holiday if you have allergies – it just takes careful planning. You need to think carefully when choosing your destination, which time of year to travel, your accommodation and mode of transport. There are also various things you can do before departure and items you can pack, which will minimise your risks.
- Extremes of climate are often detrimental to those with asthma.
- Colder or more temperate climates tend to be preferable for those with insect allergy and eczema.
- Unless you (or a travelling companion) are fluent in a foreign language, then English-speaking countries are preferable.
- Check whether a translation product has been produced for the country you are visiting. Allergy UK and Allergy Action provide translation cards.
(Louise’s note Jan 2014: a reader has also recommended Dietary Card).
(Louise’s note Jan 2015: when holidaying in Turkey, one nut mum discovered that most restaurant staff were Russian! Her recommendation would be to also take Russian translation cards to Turkey).
Standard of Local Healthcare Provision:
- Third-world countries are unable to provide a standard of healthcare comparable to that in westernised places.
- Some destinations may be remote, making access to healthcare difficult.
Availability of Replacement Medication:
A report in 2003 found that adrenaline auto-injectors were:
- Readily available in most European countries as well as North America, Australia, Israel and South Africa.
- Not available in many other popular travel destinations including Turkey, Egypt, Thailand, Malaysia or Indonesia.
The current situation can be clarified through contacting the embassies of the intended destination(s).
Availability of Food:
- Check whether there is, for example, a supermarket in the locality where you can purchase allergy safe food.
Time of Year
When choosing a time of year to travel, check:
- Your destination’s climate.
- (If relevant to you) when plants/vegetation will be pollinating/flowering.
- Camping holidays can be an issue for those who have pollen and insect allergies.
- Consider cotton-lined sleeping bags if you have a skin condition.
- Self-catering holidays are usually preferable for those with food allergy.
- If you have a dust mite allergy, think twice about staying in olde worlde destinations, carpeted and exuberantly furnished hotel rooms or highly ornate places.
- Those with allergy to animals must avoid staying in accommodation that permits dogs/cats.
Means of Travel
- Flying can be problematic for those with nut allergies.
- Different airlines have different/no nut allergy policies. Here are links to various airlines’ nut allergy pages: British Airways, Aer Lingus, Alitalia, American Airlines, United Airlines, Virgin Atlantic. Always check as the policies can change. It is always advisable to contact the airline BEFORE booking and outline any specific concerns.
- Keep in mind that just because an airline does not serve peanut snacks, it does not mean it is peanut-free. The airline may include peanut ingredients in its meals, or other passengers may carry peanuts on the plane with them.
- A nut-free meal can be requested, but cannot be guaranteed to have been produced in a nut-free environment and may therefore contain traces of nuts. It is prudent for those with nut allergy to take their own food onboard flights.
- Surfaces of cabin furniture may possibly have traces of nuts. Such exposure can be minimised through wiping surfaces that you are to come into contact with.
- Changes in air pressure within an aircraft may be problematic for those with long-standing breathing problems. Consult your GP/chest physician prior to booking a flight.
- Fumes from steam trains/narrow boats etc can exacerbate asthma.
- Open-air modes of transport expose one to insects/pollen/fumes/dust, all of which potentially exacerbate allergic disease conditions.
- Those with asthma should avoid animals as fur can exacerbate the condition.
- Those with insect allergy should also remember that animals attract insects.
European Health Insurance:
- UK residents should take a (free) European Health Insurance Card (EHIC) (formerly form E111) to obtain medical treatment if visiting a European Union country, Iceland, Liechtenstein, Norway or Switzerland.
- Those seeking cover for potential anaphylaxis should not have to pay an additional premium when travelling within Europe, as anaphylaxis is an emergency and covered by the EHIC.
- Mainstream insurers do provide cover for those with severe allergies, though this may require medical screening and payment of an extra premium. Should difficulties be encountered, contact the Anaphylaxis Campaign Helpline (01252 542029).
- It may be cheaper to purchase annual travel insurance as opposed to travel insurance for each individual holiday.
- Avoid holiday health insurance policies that exclude treatment of any “pre-existing health condition” (as this could include allergies).
Prior to Travelling
Important Telephone Calls:
- The airline to check their current (1) Peanut Policy as it can change and (2) rules for carrying medication. Request written confirmation from the airline. Such documentation may help if flights are rescheduled en route.
- Your GP to request written confirmation for the necessity to carry adrenaline auto-injectors. Some GPs may charge a fee (around £10-£15) for providing such documentation.
- Your chest physician (if you have a chronic chest condition), as investigations may be necessary to ascertain if one can withstand the changes in pressure inside the aircraft whilst in flight.
- The Anaphylaxis Campaign (01252 542029) for any further queries, and also information on equivalent support organisations in the country you are visiting.
- The Embassy and/or Tourist Office of the countries to be visited, for advice on:
- emergency numbers in that country (for example, 911 in North America, 112 in Europe, 000 in Australia, 111 in New Zealand, 119 in parts of Asia);
- the ambulance provision at your destination. For instance, in France it is the fire service that provides an ambulance service;
- the local food specialities and their likely ingredients; and
- whether the medications you plan to pack are actually permitted in the destination country (it illegal to possess some medications in certain countries).
- The proprietor at your destination to discuss, for example:
- if the food prepared on the premises is suitable for your food allergies; and
- the bedding (can feather pillows be substituted with synthetic? do you need to bring your own?)
- Store your next of kin’s telephone number in your mobile phone’s contact list under ICE (In Case of Emergency). Emergency services look for this when assisting unconscious patients. Obviously, make sure the contact list is accessible without a password.
- Discuss travel intentions with GP reception staff when requesting more medication than usual (or an earlier repeat prescription), to avoid GP rejecting requests.
- Order and pack more medication than is required – in case there are journey delays or spillages.
- Ensure all medication (1) is comprehensively labelled (2) complies with fluid restrictions enforced by airline (3) will remain in date throughout the duration of the planned trip.
- Pack a copy of the repeat prescription request form/current medication list (using non-proprietary/generic terminology) for reference in an emergency.
- Ensure that you and your companions know how and when medication (especially adrenaline auto-injectors) should be administered.
- Give your travelling companion a spare adrenaline auto-injector to carry, so that if your bag goes missing, you will have a back-up.
- Obtain a doctor’s letter explaining necessity to carry adrenaline auto-injector.
Patch test sun tan lotion prior to travelling. For advice, see The National Eczema Society’s factsheets “Eczema and the Sun” and “Sun Screens and Ingredients: What to Look For”. Generally aim for at least SPF 15 with both UVA and UVB protection. Sunscreen to be applied about every two hours (and after swimming).
This will deter biting insects, but not venomous insects. Check you can tolerate the product before travelling. Consider that asthma may be exacerbated through use of vaporised/aerosol products.
- St John Ambulance First Aid App (free) Guidance for first aid responders to emergencies, including how to administer CPR (Cardio-Pulmonary Resuscitation).
- Anaphylaxis Coventry University Medical (free) Personalised anaphylaxis management plan, including your allergens, emergency contacts, medications and emergency procedures (including video explaining how to inject epinephrine). Users can also set reminders for auto-injector expiry dates.
- A translation card containing allergy information and what should be done in an emergency should be obtained (see above).
- Translation cards can be hand-written by someone who knows the native language. For a school trip, members of the language department could provide invaluable advice/assistance.
- Obviously a more foolproof means of conveying information about allergies is to be able to communicate in the native language (or travel with someone who can).
- If you have internet access on your phone, Google can be used to provide on-the-spot translations.
If you carry all medication in one pouch/case, this makes accessing them easier in an emergency. It is advantageous to use a purpose-made carrier as they:
- Are frequently brightly coloured and thus highly visible to/easily found by medical personnel/others for use in emergencies.
- Provide protection to the medication from extremes of temperature and mechanical damage through knocks/bumps.
[Louise’s note – for details of the online stockists I have come across, see EpiPen accessories.]
- Many countries have different plug sockets to the UK. An adaptor must be packed in order to use a nebuliser in certain destinations.
- Cotton clothing is best for those with skin conditions as it is cooler and less irritating.
- Avoid bright colours if allergic to insect stings.
- Shoes are preferable to open footwear for those with insect sting allergy and skin conditions.
- Important for those with food allergies, to wipe surfaces off which food is to be eaten, to ensure any contamination by possible allergens has been removed.
- Should be avoided by those with asthma/eczema/insect venom allergy (insects are attracted to perfumes).
- Pack some safe non-perishable snacks. Some of which should be taken in hand luggage on flights for consumption during the journey.
- Consider taking one’s own bedding, especially if one has a marked allergy to dust mite or synthetic coverings.
- It is prudent to carry some cash (say, at least £100) in the local currency when abroad as some medical establishments refuse to treat patients without a cash payment in advance.
Clarify Local Healthcare Provision:
Make sure you know:
- The location of the nearest hospital (and whether it is state-run or private)
- The location of the nearest pharmacy.
- Whether your hotel has an in-house doctor.
- Contact details of local taxi firms.
- All of the phone numbers one is likely to need in an emergency.
- Medication must be carried at all times.
- Choose plain simple foods without sauces or dressings.
- Do not eat foods, the constituents of which are not known.
- Ensure those preparing food are aware of your specific allergies. For non-English speaking countries, provide a written translation detailing your allergy and what to do in an emergency.
- Be aware of international culinary differences and methods of food preparation. For instance, Spanish chefs frequently use ground almonds in place of flour in cakes, French bakers often use lupin flour in bakery products (this can evoke reactions in those allergic to nuts).
- “Standard” items on chain restaurant menus are cooked with different ingredients from region to region, so it is possible that one’s “usual” from the UK may not be suitable abroad. Contact the International Customer Helplines of the chain restaurant prior to travelling.
- Chlorine in swimming pools can exacerbate both asthma and eczema. (Use medication/creams prophylactically if chlorine has provoked exacerbations on previous occasions).
- Sand/salt in seawater often exacerbates pre-existing skin conditions. Avoid direct contact with the skin through wearing of adequate clothing/footwear and use of appropriate creams.
Michelle Byrne is allergic to nuts and various other foods and is also asthmatic. Although she had a reaction to nuts aged 3, it was not until she was 19 that, whilst training to be a doctor, she realised she could have a severe allergy and need to carry an EpiPen. In February 2012, Michelle set up the Manchester Allergy Support Group, which meets 7.00-8.30pm on the first Monday of the month in Flixton, Manchester.
The group is supported and endorsed by the Anaphylaxis Campaign and regularly has guest speakers including, for example, specialist allergy doctors and nurses and representatives from the National Eczema Society.