How to limit the risks linked to travel

Traveling is an important source of stress for patients with food allergies. Precautions to be taken before the trip, during transport and on site limit the risk of accident. There DRE Audrey Martin-Blondel (Pneumo-allergologist pediatrician at the Toulouse children’s hospital) recalled them during a session of 20^th French -speaking allergology congress (CFA 2025)^[1].

Travel: a source of stress

This anxiety generated by the idea of ​​traveling abroad was evaluated in several research works.

European study APPEAL 1 showed that among 198 French participants allergic to peanuts, 83 % declared that they were anxious at the idea of ​​being exposed to peanuts during their trip^[2].

A fear that is not unfounded if we believe the results of an Irish study which included 326 participants with a food allergy that were going on vacation^[3].

Among them, 33, that is to say 15 % had food allergic accidents during their stays. The allergen was unidentified in 43 % of reactions. In the other cases, the allergens found were peanuts, hull fruits, cow’s milk, eggs, fish. The incriminated foods were cakes, pizzas, ice cream, chocolates and fish.

In 61% of cases, the reactions occurred in hotels and restaurants, but three reactions took place by plane, especially twice despite food provided by the patient. Two other reactions have been reported at the airport.

The risk of allergic reaction was higher during a trip abroad (two thirds of reactions occurred in non-English-speaking countries), but also for hotel stays compared to the stay where participants were preparing their meals (RR = 3.1 CI95%: 1.7-4.58).

Fill in and inquire about the problematic allergens

To restrict the risks as much as possible, it is necessary to prepare the trip according to the choice of the destination, said the speaker.

The place of allergens in local cuisine must be known before departure because current allergens are different from country to country. In Japan, soybeans can be a problem, in India, you must be wary of chickpeas … On the other hand, cow’s milk and wheat are less widespread allergens in Asia even if the westernization of customs and globalization increase the risks of exposure to a greater variety of food allergens.

Allergens must also be known in the country’s language and translated into English. A food allergic card with images of the food allergens involved is useful.

In the case of children on a school trip or on a linguistic trip, it is advisable to anticipate meals on site, to contact the host family in order to warn them of food allergies and to offer guaranteed food without allergen. It is even suggested to take vacuum dishes without allergen as well as safe non -perishable snacks.

Regarding food labeling and the display of allergens, laws differ between countries and it is not always advisable to trust it.

In the United States, for example, the law of 2004 on the labeling of food allergens and consumer protection requires the labeling of cow’s milk, eggs, fish, wheat, peanuts, crustaceans, soybeans, hull fruits and sesame, while in the European Union, the directives have established a list of allergens with compulsory (teen). Mustard, the clerk and the lupine.

Conversely, Japan seems more restrictive since only wheat, egg, cow’s milk, peanuts, crustaceans and buckwheat are among the teenagers.

In Latin America, a study that was interested in the labeling of prepackaged products in supermarkets in six countries has shown that in average, one prepackaged in six product did not, wrongly, mentioned the presence of allergens on the label^[4].

Note that these regulations are valid for airlines. Some companies provide menus without allergens or make an ad at the start of theft so that some allergens are not consumed and thus conveyed by ventilation.

Anticipate emergency measures

The preparation of an action plan in the event of an allergic reaction on site is essential.

Before the trip, it is recommended to identify the local care structures to be solicited in the event of an allergic reaction.

Also, the allergist should guide the patient on the adaptations to be made and provide a translated emergency kit prescription, preferably using the international common denomination of drugs. The action plan in the event of a reaction must also be translated just like the individualized reception project for children traveling alone.

Several emergency kits must be swept away due to possible loss or baggage flights, but also because adrenaline self-injectors are not available everywhere. Only a third of countries around the world currently have access to adrenaline auto-injectors^[5]. As a reminder, it is important to know how to handle adrenaline self-injector and train with expired pens.

Regarding documents, the doctor can also provide patients with a medical certificate translated into English and in the local language justifying the wearing of adrenaline on oneself, especially for the plane.

Finally, it is recommended to have a European and international social security card, with the extent possible repatriation insurance.

In conclusion, in order to reduce the risk of anaphylaxis and not to develop an anxiety of avoidance during their trip abroad, it is necessary to anticipate travel by collecting information, documents and useful and necessary drugs before departure.