Travelling Safely with Food Allergy

It’s not uncommon for someone with a food allergy or the parent of a food allergic child to feel anxious at the thought of travel. Simple things such as choosing a destination, booking a flight or picking accommodation can be filled with extra questions and things to consider. This Factsheet offers useful information to help plan and prepare for a holiday where food allergy is a concern.

Planning your holiday

Food allergy is individual to a person and is influenced by many different factors including their age, other medical conditions and the severity of their allergic reactions. Time spent at the planning stage is important. Gather information to make informed decisions based on the individual needs of the person with the food allergy. For example, destination and transport choices are important considerations.

Good communication

This is an important part of managing a food allergy and means taking responsibility by sharing clear and consistent information on the allergy / allergies with anyone who needs to know. Be aware that people’s knowledge of allergy will vary – some people will have little understanding, and you will need to explain the situation clearly to them.

Here’s an example: “I have a severe fish allergy, and this means I have to avoid eating fish or fish used as an ingredient in any meal. If I choose to fly with this airline is there an option for me to order a meal which is free from fish? If this isn’t possible, can I bring a safe meal I have prepared at home?”

Travelling overseas may mean that language(s) can be a barrier to communicating the needs of a food allergic person. Translation Cards are a useful way of communicating food allergy(s) in another language and are useful for travel and eating out. Allergy UK offers a translation card service, providing a set of three credit card size printed cards in your choice of language(s) posted to you for a small cost. Contact Allergy UK’s Helpline on 01322 619898 or visit https://www.allergyuk.org/shop/ for more information.

Choosing a travel provider

Choosing an airline or travel provider (depending on the need to travel by air, sea, road or rail) which meets the needs of the food allergic individual will require research.

Things to find out beforehand include:

• Does the travel provider have an allergy management policy?
• Is there an option for a passenger announcement?
• Will the plane/other vehicle be cleaned before boarding?
• Can I pre-board an aircraft to clean (wipe down) the seating area?
• Is the travel provider able to offer an ‘allergen free/ special meal?’
• Have staff had first aid training that covers recognising allergic reactions and providing appropriate help?

Flying with food allergy

It is important that airline staff are informed of a food allergy at every opportunity. This is particularly important when booking your holiday, checking in, boarding the flight and EVERY TIME a snack or meal is offered (different staff members may be involved).

Airlines will have individual policies on food allergy management, and this will vary depending on the provider. There is no legislation to date that determines best practice for managing the needs of the food allergic traveller.

If you want to know if foods containing specific allergens are served during a flight, it’s advisable to raise this question before booking. It is important to note that even when airlines have adopted a nut-free policy or are able to offer a nut-free service (not selling nuts or providing nuts as a snack) this doesn’t stop other passengers eating nuts and/or buying food containing nuts at the airport prior to boarding. This means they cannot guarantee a nut free cabin/ flight.

Some airlines may make an announcement that there is a passenger on board with, for example, a nut allergy and ask other passengers to not eat nuts. This is not a legal requirement and does not guarantee that the other passengers have heard, understood or will comply with the request. If a passenger announcement isn’t made you could consider telling passengers sat next to you or your child about your/their food allergy.

Some airlines offer allergen-free or special dietary meal options. Further information can be found on the airline’s website or by contacting its customer services helpline. Meals should be requested well before the date of travel. Even when an allergen-free meal has been requested, check when it is served that the request has been acted on.

If meals are unsuitable for the person with a food allergy it’s advisable to take safe snacks/food with you. Check that this food can be taken onto the flight and, if needed, discuss storage and re-heating with the travel provider. Think about the amount of food and snacks needed for your flight (short or long-haul) and allow for the possibility of delays. Check the quarantine laws of the country you are visiting – there might be restrictions on foods that you can carry. If you are flying with an infant or child requiring specialist feeds of infant formula for a cow’s milk protein allergy, see below.

A contact reaction can happen in some allergic individuals, for example, with a hard surface such as a tray table which may have been contaminated because of a spillage. Contact on the hands will often then brings the allergen in contact with the face or mouth. This type of contact reaction usually happens at the point of contact and causes mild allergic symptoms such as a rash, redness, itching and/or mild swelling. To reduce this risk, wash hands before eating or putting fingers in the mouth as well as cleaning the tray table.

Allergy medication

Current guidance from the Medicines and Healthcare Regulatory Agency (MHRA) recommends two adrenaline devices are prescribed to people at risk of anaphylaxis, and these should always be kept nearby.

Check the expiry date of your medication before you travel, giving yourself time to get prescriptions and allergy medications. Consider the length of your trip, how far from medical help you may be – which can help when planning on how much medication to take. Avoid extreme temperatures and store your allergy medication according to the manufacturer’s guidance. The 100ml liquid rule for hand luggage doesn’t apply to medication in liquid form (for example, antihistamine solution). Having a copy of your prescription or allergy action plan is recommended.

Documentary proof may be required for adrenaline devices (such as EpiPen, Jext or EurNeffy nasal device). Ensure a copy of the Allergy Action Plan (a written set of instructions on managing allergy) is kept with the medication; this is a medical document and includes a section on the need for adrenaline devices to be carried in hand luggage or on the person. As proof of allergy, a GP or allergy specialist should be able to provide this for you if you do not have one already.

Allergy medication should be accessible all the time during travel to and from the destination. Allergy medication should be stored where it is easily accessible and close to the person who needs it. The aircraft hold is not a suitable place for medicine as it is inaccessible during the flight and may be subject to extremes of temperatures which are not advised for the storage of medication. Overhead storage is not suitable as items can move, become damaged or be difficult to reach.

If safe, the seat pocket or in a bag underneath the seat that can be easily accessed in the event of an allergic reaction is best. Remember to pick up your medication when leaving a plane (or another vehicle). Anyone with asthma and a food allergy is at an increased risk of a severe allergic reaction and should always have their asthma inhaler(s) and allergy medication available.

Travel insurance

Travel insurance policies must meet the individual needs of the person travelling with food allergy and/or any other medical conditions they may have. It is important to declare a food allergy(s) in the same way you would any other medical condition so the right cover can be provided. A comprehensive policy is recommended as the severity of an allergic reaction cannot be predicted and this will ensure that any reaction related to a declared food allergy will be covered. Remember to read the small print and check that the policy includes:

• emergency treatment
• ambulance transfers
• hospital admissions
• replacement allergy medications.

Top tips for travelling with a food allergy

• Communication is key – make sure allergy needs are communicated clearly and consistently.
• Plan ahead so decisions are not made when tired and/or hungry or rushed.
• Check the expiry date of adrenaline auto-injectors and/or other allergy medication and ask your doctor to prescribe new ones if necessary.
• Make sure you have been trained to use the type of adrenaline device that you have been prescribed.
• Carry translation cards that can be used to communicate food allergy in countries where English is not understood
• Take a pack of wipes to clean down the seating area, especially the tray table.

Access to emergency medical treatment

This is an important consideration especially if you are heading to a remote area. The number to call emergency services varies – check before you leave and save it in your mobile phone. Add medical details/allergies and emergency contacts to your smart phones Health App under the section ‘Medical ID’ or ‘Emergency Information’. Using maps on smart phones to pin nearest Hospital/Emergency Department.

Other considerations based on destination should include the availability of foods suitable for the food allergic person. Whilst most places will have for a range of diets, traditional dishes may pre-dominate, for example, Asian countries more commonly use ingredients which contain peanut, tree nut and sesame; Scandinavia and Japan use plenty of fish; Italian food will commonly feature egg and dairy.

Travelling with an allergic infant

Travelling with an infant or child involves a lot of preparation and planning – this can be overwhelming in addition to thinking about the needs of a food allergic infant or child. There is no one ‘rule that covers all’ and restrictions on the quantity and storage of specialist allergy milk products (including milk alternatives, such as soya milk) will vary from one type of transport carrier to another. Individual carriers may have further detailed information on allowances and restrictions, under the ‘family travel’ section of their website.

The UK Government website has a dedicated information section on travelling with baby food and milk. It can be accessed under the ‘hand luggage’ restrictions area of their website, or via this link https://www.gov.uk/hand-luggage-restrictions/baby-food-and-baby-milk

Breast milk

Breast milk can be carried in hand luggage even if you are not travelling with a baby. Expressed breast milk in containers up to 2,000 ml is allowed, however, frozen breast milk is not permitted.

Formula milk

Formula milk, cow’s milk, other types of milk, sterilised water and baby food are not subject to the100ml hand luggage restrictions that apply to other liquids, gels and aerosols. However, this is only true if you are travelling with the baby. In addition, baby milk or food does not need to fit into a transparent bag but must be available for inspection by security staff if requested. The concept of a ‘reasonable quantity’ is mentioned on many of transport carrier’s websites with no formal guidance and therefore will be at the discretion of the security screening officer at Customs.

Hand luggage allowances will vary from carrier to carrier, with some airlines allocating a luggage allowance to the infant or child and others not. Have your baby milk and food – powder, carton, bottle or jar – available, as you may be required to present it for airport screening. Depending on the country you are departing from and arriving at, airport security may ask you to open the containers and taste the contents.

If you don’t have enough hand luggage to accommodate your babies’ feeding requirements, speak to the carrier in advance of your travel date. You can request an extension to your hand luggage allowance to ensure your baby’s nutritional requirements are met, especially if travelling long haul. Do not rely on the carrier having a supply of baby milk, as this is unlikely to be appropriate for your child if they have a milk allergy.

Additional milk and feeding supplies can be carried in your checked baggage. It is good practice to share these supplies between your packed cases, just in case your luggage is delayed, lost or stolen.

When planning your baby’s feeding requirements, consider the travel time to/from the airport, the total amount of time you are away for and possible delays.

Infant milk and the availability of specialist milk formulas, food varieties and brands may vary between the UK and the destination country. Do not assume your required brand will be readily available. If visiting family or friends, task them to research milk brands beforehand. Otherwise, you will need to plan for this when buying and transporting your baby’s milk supply.

Travel tips for your allergic infant or child

Ensure you have enough formula feed and food to cover unexpected delays and stop-overs. Liaise with your GP or healthcare professional well in advance to ensure sufficient supplies are available, especially if this needs to be prescribed and then collected from a pharmacy.

Plan ahead by researching the carrier/airline’s individual guidance on baby milk and food and make the appropriate adjustments to adhere to ensure you are well prepared.

Larger pharmacies at UK airports may offer a pre-order service for baby milk, which can be collected on passing through security. Check and order in advance.

To reduce the risk of infection, make up feeds one at a time. If your baby doesn’t finish a bottle, don’t be tempted to put it away for later. Germs can breed quickly in left-over milk and can cause an upset tummy – the last thing you need at the start of your holiday!