Tips for Travelling Safely with Anaphylaxis Risks

The Guardian reported that there were 25,721 admissions to English hospitals for allergies and anaphylaxis in 2022–2023, more than double the 12,361 recorded two decades before. For food-related anaphylaxis and other adverse reactions, the figures increased from 1,971 admissions in 2002–03 to 5,013 last year (2022). Their data was obtained from the drugs regulator the Medicines and Healthcare products Regulatory Agency (MHRA). 

Anaphylaxis is a life-threatening allergic reaction caused by food, medicine or insect stings, and it appears to be on the increase. Symptoms of anaphylaxis, which is also known as anaphylactic shock, come on rapidly and include:

• Blue, grey or pale skin, lips or tongue
• Difficulty breathing or very fast breathing
• Difficulty swallowing
• Feeling confused, dizzy or faint
• Swelling of the throat and tongue
• Swollen, raised or itchy rash
• Wheezing, coughing or noisy breathing

It is a medical emergency, and requires immediate treatment, so it is not surprising that those with an allergy, or those who are the parent/carer of an allergic child, will feel anxious about the thought of travel, especially abroad. Travelling with an allergy could be a worrying notion and there are extra questions and things to consider when choosing a location, booking a flight or other form of travel, or selecting accommodation. 

In addition, travelling overseas may mean that language(s) can be a barrier, and foods can be unfamiliar; however, allergies don’t have to stop you from travelling. Careful preparation and communication will help make your trip safe and enjoyable, whether you are travelling for business or for pleasure.

Planning

The planning stage is the most important. Before booking a holiday or making any travel arrangements, you should gather all the information needed to make informed decisions based on your needs if you are the person with the allergy, or based on the individual needs of the person or child with the allergy. This is because an allergy is individual to the person and is influenced by many different factors including the age of the person, other medical conditions, and severity of previous allergic reactions.

Research and information gathering should include such things as:

• Choice(s) of transport
• Destination(s) of your travel
• Accommodation
• Languages spoken at destination(s) (if appropriate)
• The availability and access to medical treatment locally at your destination(s). You can also check the Government’s healthcare advice for all countries that you are visiting
• The availability of foods suitable for a food allergic person, if a food is the allergy
• Check the food labelling laws in the country that you are visiting. Labelling laws will vary around the world, so familiarise yourself with these, if a food is the allergy

This initial research can help you to minimise and mitigate risks.

Timing your travel

When booking your trip, it can be advisable to schedule your travel times taking into account your individual allergy. For example, anyone with food allergies such as dairy or eggs may want to avoid early morning travel when it is more likely that these foods will be readily available, and served, whether this is on your mode of transport, or at departure terminals. 

Anyone who has a nut allergy or even a dust allergy, may benefit from early morning travel as the majority of airlines, ferry operators, coach operators and train operators clean their fleets overnight. Most carriers should also clean between journeys; however, this may not be thorough cleaning. Pillows and blankets supplied on flights may not be cleaned between flights, only repackaged, so wherever possible take your own.

It can be useful to check with the travel provider about their cleaning schedules, and also whether you are able to pre-board in order to clean/wipe down the seating area. Although dust mite allergens are not generally associated with an IgE systemic anaphylaxis reaction, dust mite allergic asthma is considered a major risk factor for the condition, so it is probably wise to take the cleaning schedules of your chosen travel carrier into account. Speak to your carrier’s customer services for information, and explain that you need to know this information because of your allergies. 

Many airlines now have allergy policies such as, but not limited to:

• British Airways
• EasyJet
• Ryanair
• Virgin Atlantic

However, it is advisable to check whether your chosen travel provider has an allergy policy and/or provisions for passengers with allergies, as there is no legislation to date that determines best practice for managing the needs of allergic travellers. Also, check whether staff and crew have had first aid training that covers recognising allergic reactions and providing appropriate help.

Most carriers request that people with allergies inform them at the time of booking and when checking in at the airport or port, and also that they make staff and crew aware of the allergy when boarding, so that they can alert other passengers and request them not to open or consume foods that cause the allergy. Whilst carriers can request this of other passengers, they can not stop them from bringing foods with them, or from consuming them during travel. It is particularly important that you inform staff and crew every time a snack or meal is offered and served during travel, as it may be served by a different person to the person that you have already informed. 

Check documentation and medical ID  

In the event that you do have an allergic reaction, ensuring that first responders and paramedics are aware of what allergen you have reacted to, and any medication you may be taking, can save your life, particularly if you were to have a severe allergic reaction. 

Many people may elect to wear allergy medical ID jewellery which holds your most vital medical information, making it easily accessible to first responders and paramedics when you cannot speak for yourself in an emergency. They are most commonly in the form of necklaces or bracelets, worn on your pulse points for easy identification by first responders taking care of you.

You can also complete your medical ID on your mobile phone. Whether you have an Android or an iPhone, here’s how to do it:

First, open Medical ID. There are three ways to get there:

• Long press the Apple Health app and choose Medical ID.
• Open the Health app, it is preinstalled on all devices running iOS 8 and later. Tap on your profile image at the top right. Select Medical ID.
• Go to Settings > Health > Medical ID.

Tap Edit:

• Fill in as much information as you want to provide. List any medications and/or known allergies. If you are not taking medications, or have no known allergies, it helps first responders if you write None or None known. Otherwise, they may think that you omitted to answer the question.
• For Emergency Contact, you can only choose a name and phone number of someone in your contacts app. So, whoever you want to list, make sure to list them in your contacts.
• Under Emergency Access, make sure Show When Locked and Share During Emergency Call are both toggled on, if you see green on the buttons, they are on.
• At the very top of the page, there is a place for a profile photo. Put in a recent picture of your face. It could help emergency responders to know that they are looking at your information and not someone else’s.

When you are finished, press Done at the top right to save your information:

Medical ID cards are perfect for carrying more detailed information in addition to other forms of medical ID. They usually list important details such as your medical history, emergency contact and NHS number. If you are travelling abroad, you could write this information in the local language, as well as in English. Charities such as Allergy UK can provide translation cards at a small cost; the cards are printed in English on one side and the language of the country you are visiting on the reverse side. 

For flights, it is advisable to get a letter from your allergy consultant or GP stating that due to your allergy, you need to carry antihistamine and your adrenaline auto-injectors in the carry-on luggage. Some adrenaline auto-injector manufacturers such as EpiPen provide Travel Certificates that are available to download from their website. Check whether the manufacturer of your own particular brand of adrenaline auto-injector has a Travel Certificate to download; if not, the letter described above must be obtained. Failing to do so may cause issues taking your medication on board the flight and could cause issues at customs upon arrival.

Other documentation that you should have on your person when you travel include:

• All prescriptions for medicines that you are carrying with you
• Your allergy action plan (more about this later in this article)
• Details for your emergency contact
• Your travel insurer’s emergency contact details

Travel insurance and why it is important to declare an allergy 

Travel insurance policies must meet the needs of the person travelling with an allergy, and/or any other medical conditions they may have. It is really important to ensure that you declare your allergy when purchasing your travel insurance to ensure that you are covered. You will then be asked if you are at risk of anaphylaxis and, if so, when the last incident was, and if you have adrenaline auto-injectors – be truthful. Whilst this may mean that you need to shop around for the best deal on travel insurance, and you may have to pay a little more, not declaring a pre-existing condition could invalidate any policy altogether, leaving you with potentially heavy medical bills and, in extreme cases, repatriation bills should an emergency occur. 

Travel insurance is calculated on risk, so if you have been trouble-free from anaphylaxis for 12 months or more, the risk would probably be considered minimal, and this would be reflected in the travel insurance premium. A comprehensive policy is recommended for anyone with allergies as the severity of an allergic reaction cannot be predicted, and this will ensure that any reaction related to a declared allergy will be covered. Remember to read the small print before purchasing a policy and check that the policy includes at a minimum:

• Emergency treatment
• Ambulance transfers
• Hospital admissions
• Replacement of allergy medications

If you are travelling to an EU country or Switzerland, you can apply for a new Global Health Insurance Card (GHIC), if your GHIC (or EHIC) has expired. An EHIC or GHIC may not cover all health costs and never covers repatriation costs, so it is not a substitute for travel insurance. 

The importance of preparation and a checklist 

Preparation is key before any travel, and this is even more so for anyone with allergies who is travelling. Having a checklist can ensure that you have prepared, and that you have got everything that you need before you travel. Items that should be on your checklist include:

Mode of travel:

• Make sure that you have informed the carrier of your allergy, and that your allergy needs are communicated clearly and consistently; where possible ask the carrier for written confirmation that they are aware of your particular needs and carry a copy of this when you travel.
• Ensure that you arrive early for departure so that you can check that your allergy needs are in place.
• Pack your preferred brand of wet wipes for cleaning the seating in your hand luggage.
• If required, take your own travel pillow and travel blanket.

Documents – all these should be carried on your person: 

• Ensure that you have copies of prescriptions for your medication and Travel Certificates for your adrenaline auto-injectors.
• Ensure that your medical ID is on your mobile phone, wear your medical ID jewellery and, if necessary, carry a paper copy of your medical ID.
• Carry translation cards in the language(s) of the country/countries that you are visiting.
• Ensure that you have a paper copy of your allergy action plan, and if travelling with others, make sure that they understand how to follow the instructions on the allergy action plan, including how to administer the adrenaline auto-injector, if needed.
• Carry details of your travel insurer’s emergency contact details, as they can advise on emergency medical services wherever you are travelling to.

Prepare your medication:

• Consider the length of your trip and how far from medical help you may be when planning how much medication to take.
• Check that the expiry dates of your medicines will be valid for the duration of your trip.
• Carry at least two adrenaline auto-injectors when travelling and ensure that they are easily accessible during travel.
• If travelling with others, teach them how to use adrenaline auto-injectors before you travel so that they are prepared in case of emergency.
• Remember to inform security personnel at airports and ports that you are carrying life-saving medicine in your hand luggage.

Food:

• Always check ingredients and be cautious of any dishes with sauces or dressings, unless you are certain of what they contain.
• Make sure any person preparing and serving the food knows about your allergies.
• When your food arrives, check that it is what you have ordered and check again with the server that it doesn’t contain your allergen(s).
• Take some safe, non-perishable foods with you, just in case; check with your carrier what is allowed on board.
• Ensure that you tell the hotel/accommodation catering (if applicable) about your allergies.

Accommodation:

• Many hotels and accommodation understand the needs of travellers with allergies. Call ahead to enquire about non-smoking and allergy-friendly rooms, hypoallergenic bedding, and other necessary arrangements.
• Ask for recommendations for restaurants, hotels, activities and so on; for example, does your allergist or doctor have other patients with good experiences at certain places?
• Check out sites such as Trip Advisor for recommendations of allergy-friendly hotels, accommodation and restaurants in their forums.
• Ensure that you tell the holiday representative, if there is one, and accommodation staff about your allergies.

Allergy action plan 

It is recommended that you prepare and carry an allergy action plan. This is a written emergency treatment plan. Carry it whenever you travel – in fact, carrying one at all times is sensible for anyone with allergies. 

Adrenaline auto-injector manufacturers such as Jext, have produced downloadable allergy action plan templates. Check whether the manufacturer of your own particular brand of adrenaline auto-injector has a downloadable template. If not, you can create your own based on the Jext version; however, take care to specify on the plan the brand of adrenaline auto-injector that you have been prescribed to avoid any confusion. The British Society for Clinical Immunology and Allergy (BSACI) have downloadable action plans available for children.

Medication and emergency contacts

If you need prescribed medicine for your health condition, talk to your GP or practice nurse about your travel plans at least two months before your departure date. They can tell you if you need to make any special arrangements. 

Different countries have different rules and regulations about the types of medicine they allow to be taken into the country, and also the maximum quantity that you can take in, so you will need to check the rules for all the countries that you are going to, including any countries that you are just passing through. International rules on medications vary, so if you are concerned, contact the embassy of the country that you are visiting. GOV.UK has a full list of foreign embassies in the UK.

Always carry medicines and medical equipment such as your adrenaline auto-injectors in their original, correctly labelled packages. They should also include the respective passenger’s name on the original labels. When travelling by air, make sure that you carry your medicines in your hand luggage with a copy of your prescription and either the adrenaline auto-injectors’ Travel Certificates or your doctor’s letter. The British Society for Clinical Immunology and Allergy (BSACI) has a template letter for children travelling with allergies, which should be signed by a health professional only.

It is important that the security staff at ports and airports are made aware that any medication that you are carrying in your hand luggage may be in liquid form (antihistamine) and that the adrenaline auto-injector contains a sharp needle. The 100ml liquid rule for hand luggage does not apply to medication in liquid form, for example antihistamine in syrup form, but a copy of your prescription or letter from your doctor as proof of need will be required. These documents will help you to avoid any problems at security and customs, and will also be useful if you need medical help while you are away.

All allergy medication should be easily accessible for use at any time during travel, so don’t put it in overhead lockers on planes. Talk to staff or crew about the best place to keep them so that they are within reach during travel if needed. If safe and appropriate, the seat pocket in front of you may be ideal.

When storing your adrenaline auto-injectors, remember that they should be kept away from extremes of temperature, and should be kept at room temperature, in line with manufacturer’s guidelines. They should not be stored in a refrigerator and should be kept away from direct sunlight.

Whenever you travel you should ensure that your emergency contact’s details are up to date and that the person knows that they are your emergency contact. Check that they will be available when you are away and if not, choose another emergency contact. Make sure that their details are easily accessible to first responders and/or medical personnel should an emergency occur. Details of how to include an emergency contact in your medical ID are set out above; however, you may also want to include an emergency contact in your phone’s directory under ICE, which stands for in case of emergency; many first responders will look for this.

How to enjoy your travels safely with allergies

The key to enjoying your travels safely when you have allergies is to start planning early. It is useful to carry out a risk assessment to identify and mitigate any risks. If you know in advance what the issues might be and are confident that you have strategies in place to overcome them if needed, then you will be more relaxed to enjoy your travels.

Whilst translation cards are incredibly useful, it is also beneficial to learn some key phrases in the local language of your destination. To prepare, write down in English, key phrases that you know you will need to use, then use either a phrase book or an online tool such as Google Translate to translate them into the local language(s) of your destination(s). Once translated, note these down in a notebook and keep it handy at all times. It can be fun learning and trying out a new language. Practise pronouncing these key phrases to ensure clear communication, and even if you stumble a bit, locals will appreciate your efforts and be more likely to accommodate your needs.

Take some time to research the local cuisine. Each country has its own unique dishes and culinary traditions, so familiarise yourself with the typical ingredients used and food labelling. Research online to get an idea of what to expect and to identify any potential allergens that may be commonly used, then you will know what to avoid.

Final thoughts

For anyone who has lived with allergies for years, it can be easy to forget that not everyone will be as informed as you, and they may not understand the significance or seriousness of a potential reaction. Communicate the severity of your allergies and of anaphylaxis to each and every relevant person throughout your travels, and be prepared with medication, documentation, snacks, plans and backup plans. Then you will be able to relax and enjoy your time away.