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Put the flag out. And find the passports. I’ve done it at last. I’ve just booked our first post-peanut-allergy-diagnosis abroad holiday.

We’ll be flying to Faro, Portugal with Monarch airlines and will be staying in a self-catering apartment in Vilamoura in the Algarve. We went there several years ago, pre-children, so I’ve taken some confidence from the fact that we know the resort has supermarkets selling some familiar brand foods.

Finding a nut safe flight

I’ve never been the most carefree flyer. I’m certainly not one of those people who cocoons themselves in a travel blanket, dons an eye mask and is snoring before the plane even taxis to the start of the runway. The chance would be a fine thing anyway, with a toddler and a preschooler in tow.

Add to this existing unease the fact that our doctors can’t definitively say that my son wouldn’t react to airborne peanut particles on a plane (it’s unlikely, but he might) and, hands up, I’ll admit it, I’ve not been relishing the prospect of our first post diagnosis flight.

However, my son’s now reached the age where he’s desperate to go on a plane (Dusty Crophopper, I’m blaming you) and, as beautiful as Cornwall is, we do want to venture abroad sometimes too. I know we can’t avoid it forever, so I resolved that 2014 is the year to get it sorted.

I spotted that Monarch fly from Manchester to Faro and gave their customer service helpline a call. They emailed me the following information and asked me to book online, then call them again, so that they could note my son’s medical condition against our booking:

“Whilst Monarch endeavour not to include nuts in any of the meals served on-board, there can never be any guarantee of this. Our meals are supplied from a central kitchen and minute traces of nuts can be found in everyday ingredients.

Passengers with a nut allergy are welcome to bring their own food for on-board consumption.

A note has been added to your booking to advise check-in, security and cabin crew of your allergy and that you will be carrying an EpiPen/sharps in your hand luggage.

The sale of nuts will be restricted on your flight(s) and the cabin crew will make an announcement asking passengers to refrain from eating any nuts or nut based products they may have with them.

Customers are permitted to take their EpiPens/Insulin into the cabin. However, we do require customers to carry a Doctors letter (dated no more than 14 days prior to departure) or a copy of a repeat prescription to be presented at Check-in and Security check points.”

I felt very reassured reading this and, having read about 17-year-old Sam Sadleir’s experience on a Virgin Atlantic flight, I was already planning on taking a packed lunch rather than opt for an airline meal.

I also found a discussion on Tripadvisor, started by a traveller noting that  “yet again, the 6th time in 3 years we were told by Monarch, that someone with a “severe nut allergy” was on board … Is it just a ruse to sell more Pringles and potato chips?”. Having read the subsequent indignant comments by other non-nut allergic flyers, I was further reassured about Monarch’s peanut policies and booked the flights.

Travel checklist

Here are the things I will be doing between now and departure:

  • Emailing the airline to confirm that a medical note has been added to our booking, that the sale of nuts will be restricted on the flight and an announcement will be made.
  • Asking my GP for a doctor’s letter explaining my son’s peanut allergy and our need to carry EpiPens.
  • Printing Allergy Action’s Portuguese translation card for use in restaurants and learning the various words for peanuts and nuts (see the second page). (Both Allergy UK and Allergy Action provide translation cards in various languages).
  • Packing safe food in our hand luggage (plus some basics in our suitcase in case, for some reason, the choice of safe food at the supermarkets is limited).
  • Packing dettol wipes in our hand luggage, so I can wipe down our arm rests and tray tables etc on the plane.
  • Applying for a European Health Insurance Card (EHIC) for us all.
  • Checking that our travel insurance would cover anaphylaxis.
  • Emailing the reception where we are staying to ask whether their restaurant can cater for nut allergies. Although we’re setting our expectations at eating in, it would be fantastic to receive a positive response on this.

If anyone else has any handy tips on other things I could do to prepare, please do post a comment below – I would love to hear from you!

I will report back on how everything goes! In the meantime, if anyone has holidayed somewhere that was particularly good for nut allergies, please do share your recommendations below. I’ve recently heard good things about:

  • Esprit (who Nick recommended as they offer fully catered family holidays in ski chalets, with English chefs onsite).
  • Eurocamp (where Helen found well stocked supermarkets, when shopping for gluten free foods for her son).
  • Thomson Dream cruises (where Angela’s family had their own chef to look after their 16-month-old grandson).

(Thanks all, for these top tips!).

Further information

For further information on holidaying safely with allergies, see:

There are also some excellent articles on the Allergic Living website about flying with allergies. For example, see:

 

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Planning a holiday in the UK? Does someone in your party have a peanut or nut allergy? If so, I’ve compiled the information below (with links to useful resources), which I hope might assist a nut allergic visitor to Britain.

Medical help

  • Dial 999 in an emergency
  • Contact NHS Direct (“if you need medical help fast, but it’s not a 999 emergency”). The telephone number varies by area (it is either 111 or 0845 4647) – to find the correct number for your area, see this list.
  • The NHS Choices website also has search tools to find your local hospitaldoctor (search for “GP”) and pharmacy.

Other sources of advice

The following charities have allergy helplines:

If English isn’t your first language, the Allergy Action website has free translation cards.

For details of Embassies in the UK, see the London Diplomatic List.

Grocery shopping

Understanding UK food labelling

The ingredients list on prepacked food must be accurate. So if even a tiny amount of peanut (for example) has been intentionally added to a food, “peanut” must appear in the ingredients list.

“Peanuts” and “nuts” are two of the top 14 allergens listed in the legislation. If a prepacked food or alcoholic drink contains peanuts or nuts (or an ingredient made from them), this must be either specified in the name of the food or clearly marked elsewhere on the label.

Although the law is due to change in December 2014, for now the allergen labelling requirement does not apply to, for example:

  • Foods sold loose.
  • Cake or pastries baked and sold in a cake shop.
  • Bread rolls baked in-store at a supermarket.
  • Ice cream sold by the scoop in an ice cream shop or ice cream van.
  • Meat sold from a delicatessen counter.
  • Meals served in a restaurant, cafe, take away etc.

Some manufacturers may also use:

  • Allergen warning boxes (for example “Contains: nuts”).

allergy_advice_1

  • “May contain” wording (for example “May contain nut traces” or “Produced in a facility that also processes nuts”), to cover allergens that have got into the product by accident via cross-contamination.

allergy_advice_2

Both allergen warning boxes and “may contain” labelling are voluntary. So if there is no:

  • Allergen warning box, this does not necessarily mean the product is free from nuts: you must read the ingredients list.
  • “May contain” label, this does not necessarily mean that the product has not been accidentally contaminated with nuts or nut traces. You could contact the manufacturer to check their policy on using “may contain” labels and enquire whether the product is made in a nut free facility.

For more detail on UK allergen labelling law (both now and when the law changes in December 2014), see Deciphering UK food allergen labelling law.

One final point to note is that some companies are already introducing the new look labelling (compulsory from December 2014). So you might see the (voluntary) “Contains” boxes on some products, and the allergens highlighted (in bold, italics, underlined or in a different colour) on others. For an example of the “new look” labelling, see page 5 of Advice on food allergen labelling by the Food Standards Agency.

  • A quick note on “Ingredients: Cannot guarantee nut free”

A reader from the US recently contacted me about the Tesco advisory labelling:

“Recipe: No nuts. Ingredients: Cannot guarantee nut free. Factory: No nuts”.

What does the ingredients statement mean, if the factory was nut free?

I wondered the exact same thing when my son’s peanut allergy was first diagnosed (see Mission: create a nut free home). My understanding is that “Recipe: No nuts” is confirming there are no nuts listed in the product’s ingredients (i.e. which have been intentionally added to the recipe). Then “Ingredients: Cannot guarantee nut free” is used if they cannot vouch that all of those raw ingredients have not been near nuts at some point during the production process (before coming to the final “no nuts” factory).

Where to shop and finding safe brands

If you are going to be staying somewhere where you can have your food delivered, then I personally find the Ocado site really handy for grocery shopping, as you can filter by allergen and they also have very detailed product descriptions. As a family, we tend to stick to Ocado or Sainsbury’s, however the FreeFrom Foods Matter website has a detailed list of those UK Supermarkets, retailers and on-line stores which sell free from foods.

See also the Nut free food page, which has links to the allergy information pages for various food brands.

Eating out

Advice

For advice on eating out safely with food allergies in the UK, please see:

Restaurant recommendations

For national chains, our local branches of Pizza Express have always looked after us well (see Let’s hear it for Pizza Express!). I also understand that McDonald’s tends to be a safe bet, although my son hasn’t yet visited. Otherwise, local pubs who cook their food from scratch have tended to be the most helpful/willing when it comes to preparing a nut free meal. Here’s a list of the restaurants, pubs and cafés we have so far visited in:

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I recently blogged about nut detection dogs, the medical alert dogs who are trained to sniff out nuts in both food and the air. Two stories have caught my eye in recent weeks, which highlight that nut allergy service dogs may not always be allowed into the environments where they are most needed.

Last week, KOMONews reported on a dispute in Ohio involving a school girl with autism and her special education teacher. The six-year-old has a service dog; her teacher has a dog allergy. As a result, the girl has been asked to change schools.

Earlier in the month, the Canadian Transportation Agency ordered Air Canada to do more to protect dog allergy sufferers. For planes using HEPA filters, provided the dog allergic passenger gives 48 hours notice of travel, Air Canada must ensure there is at least a five row buffer zone between the dog allergic passenger and any dogs (including service dogs) in the cabin. They must also ensure there is separation whilst boarding, leaving the aircraft and accessing washrooms. If a plane doesn’t have a HEPA filter, pet dogs will be banned from the cabin if there is a dog allergic passenger onboard. For service dogs, priority will be given to the passenger who booked their ticket first.

If a child is so sensitive to nuts that they need a service dog, you could well imagine that they would need the service dog’s help whilst in school or travelling by air. These two stories show that the dog may not be allowed into the classroom or on the plane, if someone else has a severe dog allergy.

Source:

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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

Holiday preparations

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.

Destination

Climate:

  • 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.

Native Language:

  • 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.

Accommodation

Camping Holidays:

  • 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.

Residential Breaks:

  • 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

To Destination:

  • 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.

Around Destination:

  • 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.

Health Insurance

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.

Travel Insurance:

  • 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:

Call:

  • 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?)

ICE:

  • 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.

Packing

Medication:

  • 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. 

Sun Creams:

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).

Insect Repellents:

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.

Medical Pendants:

Consider wearing a pendant which details emergency medical information. For example, Medicalert or SOS Talisman.

Apps:

  • 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.

Translation Card:

  • 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.

Medication Carry-Cases:

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.]

Plug Adaptors:

  • Many countries have different plug sockets to the UK.  An adaptor must be packed in order to use a nebuliser in certain destinations.

Clothing:

  • 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.

Sterile Wipes:

  • 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.

Perfumes:

  • Should be avoided by those with asthma/eczema/insect venom allergy (insects are attracted to perfumes).

Food:

  • Pack some safe non-perishable snacks.  Some of which should be taken in hand luggage on flights for consumption during the journey.

Bedding:

  • Consider taking one’s own bedding, especially if one has a marked allergy to dust mite or synthetic coverings.

Cash:

  • 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.

On Arrival

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:

  • Medication must be carried at all times.

Food:

  • 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.

Water Sports:

  • 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.

Biography

michelle_byrneMichelle 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.

For more information, see the group poster (which includes Michelle’s contact details) and a list of the group’s discussion topics for 2013.