Health. Food allergies: how to minimize the risks when traveling?

Traveling disrupts our familiar surroundings. The familiar framework, often designed to limit the risk of allergic reactions, disappears. Traveling brings discoveries and pleasure, but also anxiety, as the risk of allergic reactions increases, especially in the case of air travel, lack of allergen labeling, language barriers, or exposure to a hidden allergen.

A US study of 410 families showed that food allergies affect their vacation choices. 42% of families limit the number of trips they take, 68% limit the type of destination (90% prefer to stay in the United States), and 36% limit their means of transportation, with 80% avoiding boats and 65% avoiding planes.

The same is true on this side of the Atlantic. In the European APPEAL1 study, the vast majority of 198 French people with peanut allergies (83%) said they were anxious about being exposed to them on vacation. While flying can cause significant anxiety among those affected, allergic reactions in-flight remain rare.

• When choosing a destination, consider allergens present in local cuisine: soy is widely used in Japan, chickpeas in India, and seafood, cashews, and peanuts in East Asia. Conversely, cow's milk and wheat are less common. However, the globalization of trade is blurring the lines.
• It's essential to know the names of allergens in the host country's language, with the help of pictures if necessary, as well as in English. For children on school trips, it's essential to plan meals ahead of time, inform the host family of any allergies, and offer them guaranteed allergen-free food.
• It is important to research local laws regarding the labeling and display of reportable allergens (RNAs). Each jurisdiction determines priority allergens based on criteria that remain, to date, unknown.

The International Regulatory Chart of Notifiable Allergens: Food Allergens - International Regulatory Chart https://farrp.unl.edu/IRChart/

For example, in the United States, the Food Allergen Labeling Act of 2004 (FALCPA) requires the labeling of the following allergens: cow's milk, eggs, fish, wheat, peanuts, crustaceans, soy, tree nuts, and sesame. In contrast, in France and the rest of the European Union, the guidelines cover a broader list of reportable allergens, including sesame, mollusks, mustard, celery, and lupin. In contrast, Japan applies more restrictive criteria, limiting ODAs to the following six allergens: wheat, egg, cow's milk, peanuts, crustaceans, and buckwheat.

Furthermore, a study of the labeling of pre-packaged products in supermarkets in six Latin American countries found that one in six pre-packaged products wrongly omitted to mention the presence of an ADO in the list of ingredients.

• These regulations regarding reportable allergens also apply to airlines, hence the importance of declaring food allergies. Some airlines implement protective measures, such as offering allergen-free menus or making announcements at the start of the flight to avoid consuming allergens, in order to prevent their spread through ventilation.

• Smartphone applications and websites provide information on local legislation, eating habits, and sometimes help with translating allergens into the language of the host country (Allergobox, Foodallergy.org, Allergyaction.org…). Airline websites and travel forums are a wealth of information. For dining safely in restaurants, there are apps available, such as AllergyEats and US/EatsPossible, an app that helps you find establishments that suit your diet.

• Once you have identified your destination, regulations, and meals, you will need to present your plan to your allergist so they can assess the necessary adjustments and help you plan the required documents. In addition to translating allergens, you will need to provide a translation of the prescription for the emergency kit, including the International Nonproprietary Name (INN) of the medications, as well as the reaction action plan and the Individualized Reception Plan (IPP) for children traveling alone.

• It is recommended to have several emergency kits, especially in case of lost or stolen luggage, especially since adrenaline auto-injectors are not available everywhere: only a third of the world's countries have access to them. The doctor can also provide a medical certificate specifying the allergy, the associated risks and justifying the use of adrenaline, especially on airplanes. This certificate, as well as other medical documents, should be translated into English and the language of the host country to avoid any misunderstanding of vital information.

• Finally, try to identify accessible local healthcare facilities in advance.