Practical Traveler; Coping With Food Allergies
By SUSAN CATTO The New York Times April 27, 2003
For the Tedesco family of Bergenfield, N.J., carefree holidays ended five years ago when their daughter Annie, then 15, had a severe reaction after eating shellfish. On their next trip to Florida, said Mike Tedesco, Annie's father, ''we had to keep an eye on her at all times and watch what she ate.'' Even french fries prepared in the same oil used to fry shrimp could have sent Annie into life-threatening anaphylactic shock again. ''One minute she could be fine and the next she could be in respiratory distress.''
To many people, sampling foreign flavors is one of travel's greatest attractions. But six million to seven million Americans are estimated to have serious food allergies, according to the Food Allergy and Anaphylaxis Network, a nonprofit advocacy group in Fairfax, Va., and for them travel can be a minefield. As I know from traveling with my husband, Andrew, who is allergic to peanuts, the usual concerns about restaurant and airline meals are compounded by language and cultural differences.
Trouble-Causing Foods
According to Dr. James Li, a professor and consultant in allergic diseases at the Mayo Clinic in Rochester, Minn., a diagnosis from your doctor is essential to determining the exact nature of an adverse reaction to food. On one end of the spectrum is anaphylaxis, a life-threatening immune-system response that can result in hives, swelling of the lips, hands and throat, difficulty breathing and cardiovascular distress. Just eight foods are responsible for 90 percent of adverse reactions to foods, according to the Virginia group: peanuts (responsible for 50 to 100 deaths a year in the United States), tree nuts (e.g., almonds), eggs, fish, shellfish, soy, wheat or milk. Gastrointestinal symptoms are far more common than allergies, said Dr. Li, and are usually called food sensitivities or food intolerance.
While food sensitivities are a concern for travelers, a potentially fatal food allergy obviously requires greater cautionary measures. With tightened airline security, some people have reported difficulties boarding with EpiPens, needles containing epinephrine, which can buy you enough time to get to a hospital. Travel with a letter from your doctor stating that the medication must be carried with you at all times. Leave your prescription in its original packaging, and make sure the paperwork includes the telephone numbers of your doctor and pharmacist. Your doctor may suggest carrying an antihistamine like Benadryl as well. Ask for a letter outlining the treatment you should receive and have it translated if necessary.
Obviously, avoiding exposure is the best way to deal with a food allergy. As a first step, Anne Muñoz-Furlong, founder of the Food Allergy and Anaphylaxis Network, suggests being realistic about where you go. ''It's going to be nearly impossible to get a non-shellfish-contaminated meal in Japan,'' she points out. Some vacationers mail food in advance. But the odds are long that Andrew and I will ever go to, say, Thailand.
Ms. Muñoz-Furlong also suggests printing up (and translating if necessary) laminated sheets or business cards explaining your allergy and listing the food or foods that will cause a reaction. The cards can be used in English-speaking restaurants -- you can ask the server to deliver them to the chef.
Reading labels and talking to waiters and chefs are useful, but they are not guarantees. ''The quality of the information you get is sometimes quite variable,'' said Dr. Li. Desserts and breads may come from outside suppliers; sauces and flavoring pastes may have dozens of ingredients; cooking equipment or serving utensils may have come into contact with allergens. For a recent trip to Mexico, Andrew and I chose a resort with buffet meals so that he could see the food and pick items likely to be peanut-free. He subsisted on fruit, cheese, grilled fish and bread, but Ms. Muñoz-Furlong pointed out that he might have been better off at a traditional restaurant. Buffet dishes are subject to cross-contamination, not only by servers but also by diners who use their utensils in more than one dish. She also said that international chains might prepare food differently. Just because you can eat the United States product, don't assume the Russian version is safe for you.
If your sundae arrives covered with nuts or your burger smothered with cheese, Ms. Muñoz-Furlong suggests keeping the offending dish at your table to make sure you get a new, uncontaminated serving. ''I've heard of cases where nuts are just scraped off the top of a sundae and more whipped cream put on,'' out of pure ignorance.