The sad state of allergy awareness in modern travel – and how to protect yourself
I recently took my mother to a noted farm-to-table restaurant in Athens. It is not especially seafood-oriented, but when I visited, its ship had apparently come in. When I advised the hostess, as she seated us, that I had a shellfish allergy, she looked at me like I’d told her I was a shellfish. She skittered off to find a copy of the prix fixe, crawling with off-limits ingredients. Sea urchin? Wouldn’t chance it. Octopus? Squid? A hard no from me.
While mum suckled at a langoustine, I ate fungi six ways. But I’m used to being fobbed off with mushrooms and free table-bread. There are worse things – anaphylactic shock, for example – than a hastily defrosted burger at a wedding in Mallorca, after a chef pointlessly scooped the mollusks out of a long-simmering paella. (Hours earlier, I’d implored him to put aside a vegetarian portion; he’d clearly found that absurd.)
I’ve been side-eyeing spring rolls and sniffing out oyster sauce since first travelling on my own as a teen. Living in Shanghai in the 2010s, I used my allergy to dodge sea cucumbers and abalone. But I’ve also paid the price of inattention: dashing to the loo to “expel” clandestine crab, or detouring to the closest hospital on a road trip.
I saw another side of Mumbai from a hospital gurney, then toured a strip of roadside chemists to fill my prescription. In one Canadian emergency room, I was denied the customary adrenaline jab and forced instead to drink a litre of activated liquid charcoal.
Seafood allergies can be grave, but reasonably easy to manage – despite the fact that a few major airlines still serve shrimp salad in coach. On a recent week in Japan, a veritable Squid Game for sensitive eaters, restaurant staff were comically vigilant, whisking me and my peanut-allergic friend Ben into the kitchen for stilted consultations with the chef. Ben had learned “peanut allergy” in Japanese and packed two EpiPens. He’s never had to use the EpiPens, even though mega-bags of peanut M&Ms are a plane-snack staple still sold at Duty Free.
Another friend, Hannah, an executive-function coach and coeliac, fills suitcases with gluten-free bread and cereal because, despite assurances to the contrary, a chef in Mexico won’t always grasp the high stakes. Others assume “coeliac” to be Western parlance for “lifestyle choice”.
“Restaurants are more aware,” she says, “but an 80-year-old local woman cooking for you in an Airbnb by the sea in Crete…” A mere breadcrumb drowned in a bowl of soup and she’ll be chained to the bathroom with stomach pain and lethargy.
But slowly, the world is catching up to the spectrum of dietary needs. Regulations enacted a decade ago in the UK and EU compel restaurateurs to inform diners about dishes containing any of 14 allergens. In North America it’s about protecting themselves from litigious diners as much as protecting the diners themselves. I’ve had waiters in Casablanca and Beijing preemptively ask “any allergies?” while a Parisian one will wearily point to the salade mixte.
Nevertheless, forewarned is forearmed. Bear the below in mind, and being that allergy-addled traveller becomes just a little easier.
The allergic traveller’s pre-trip checklist
Consider a food-desensitisation treatmentProfessor Adam Fox of the clinic Allergy London offers a multi-month course that involves administering incremental amounts of, say, peanuts, eggs or milk to increase tolerance. That way, accidental exposure to the allergen will result in a less severe reaction, if any at all. This is, of course, only something to be attempted under skilled professional supervision, and won’t work for everyone.
Be aware: if you have one food allergy, you’re likely to have another. Shellfish fall in the same category as some dust mites, for example. Raw apples, stone fruits and pears can cause “pollen food syndrome”, a tingly sensation in the mouth. Some 40 per cent of those allergic to peanuts are also sensitive to cashews and pistachios, 25 per cent will react to sesame and 4 per cent to lupin flour, a ground legume used in some European pizza bases.
Pack wisely. Bring non-perishable snacks and Tupperware for packing buffet leftovers. If you suffer from potential anaphylaxis, bring an up-to-date EpiPen and a prescription. “They can get funny at security if you don’t have a prescription for your meds,” says Fox. Dr Claudia Gore, a consultant in paediatric allergy at the Imperial College Healthcare NHS Trust, recommends a food allergy management plan with proof of prescribed medications from your GP or allergist. BSACI has one for children. An adult version is due out later this year.
“Never put your medication in the hold,” warns Gore. It’s no good to you if you have a reaction in the air or your checked bag disappears.
If you don’t speak the language in your destination, carry translation cards with phrases like “I am allergic to…” and “I am having an allergic reaction – please call an ambulance”. The brilliant resource AllergyUK offers customised cards in 35 languages.
Learn the emergency number in your destination. In North America and many other countries it’s 9-1-1. In Japan it’s 1-1-9.
Find your online tribe. Anaphalaxis UK is a handy site. Fox rates the blogger and podcaster Daniel Kelly, who goes by @maycontain. There’s also Coeliac UK, a support network posting research, recipes and case studies.
Make sure your medical insurance covers accidents and hospital treatments in your destination. Gore suggests applying for a GHIC (global health insurance card) covering emergency services abroad.
If you plan to party, says Gore, “remember alcohol and drugs decrease risk perception and change reaction thresholds, so you’re likely to react earlier to a smaller amount of your allergen.”
