Food Allergies - On Traveling

Home may be your safe haven when it comes to food allergies, but life outside the confines of your abode is just too tempting to pass up. You gotta get out and enjoy yourself, let your hair down, relax. When you have food allergies, however, wandering far from the safety of home may bring more anxiety than relaxation, and that’s perfectly understandable.

A safe, anxiety-free outing requires some advanced preparation, especially if you’re venturing out to an area where you’re not so sure the natives have an abundant supply of foods and beverages you can safely consume. When you properly equip your home and educate family members about food allergies, your food allergy becomes a less intrusive part of your life at home.

You know that everyone knows the drill and that your emergency kit is readily available at a moment’s notice. Although you may not be able to establish the same comfort level for times when you leave the house, you can establish a good level of safety by planning and packing for emergencies. Make it a habit:

  • Pack a travel bag with your emergency medications.
  • Before you leave the house, grab your bag just as habitually as you put on your shoes.

You can toss your emergency medical kit in your car, but make sure you don’t expose the medicines to extreme heat or cold, which could make them less effective. Also make sure that if you park your car and then wander some distance from it, that you take the medical kit with you. Any time you leave the house, even if you’re not planning to eat out, always bring your emergency medicines with you.

In the old days, people ate three meals a day, generally at scheduled times. Nowadays, food is readily available at any time of day or night . . . even in the wee hours of the morning. Eating — and a possible reaction — can happen anytime. Of course, you don’t even have to be eating for a reaction to occur — airborne or contact exposure can trigger a reaction, so always be prepared.

Travel and eating out, however, clearly add risk to the equation so it is even more important that you prepare for the worst in these situations. Many of the reported food-induced anaphylactic events and even fatalities have occurred in individuals with food allergy who did not have their emergency medications with them at the time of the allergic reaction or the medication treatment plan was not followed appropriately.

When wandering off to uncharted territory, you never know what the natives of that region eat . . . or which fast food restaurants are readily available, so pack some safe provisions just in case. Safe foods to pack depend primarily on the food allergies you have and where you’re going.

If you have multiple food allergies, especially to common foods such as milk or egg, eating out can be a huge challenge and you may need to pack lots of food. For more isolated food allergies — even severe allergies like peanut or tree nuts — you can usually find plenty of safe foods no matter where you go, so you can pack light.

Medical ID Bracelet or Necklace

Venturing out on your own always increases the risk that you won’t receive proper emergency treatment if needed. When traveling with others, always let your travel companions know about your food allergies and what to do in the event of a reaction. When traveling solo, wear a medical ID bracelet or necklace.

If you have a severe reaction and can’t tell others what’s happening, they can quickly tell from the bracelet or necklace what’s happening. The best feature of the bracelet is that it contains a toll-free (800) number that’s accessible from just about anywhere.

I recommend that you wear your medical ID bracelet or necklace at all times, so you don’t forget to put it on before stepping out. If you prefer to wear it only in situations in which you may be taking on some added risk, eating out and traveling are at the top of the list. You can order food allergy ID bracelets on FAAN’s Web site at

ID bracelets and necklaces are available in a variety of styles and designs to satisfy the requirements of the most style-conscious patients. If you just can’t bear the thought of wearing an ID bracelet or necklace, carry an emergency ID card in your purse or wallet.

Out To Dinner

Eating out is a little risky whether or not you have a food allergy. In most restaurants, all the food preparation occurs in the back room. You never really know what the cooks and other staff are doing back there. You don’t know where the food came from, how it was stored, or how it was handled.

All you know is that when the server sets the plate in front of you or hands you your to-go bag, the food looks and smells yummy. When you have a food allergy, you place even more trust in the restaurant.

Cooks and other kitchen staff must be particularly careful to avoid any ingredients that contain the allergenic food and to prevent cross-contamination via unclean cooking surfaces or utensils. Even a splatter or airborne particles of an allergenic food can land in your dinner dish if the cooks and servers aren’t careful.

The risks of eating out vary with your food allergy. If you have a severe milk allergy, even the most allergy-friendly restaurant may not be safe enough — it’s just too easy during the hustle and bustle of a lunch or dinner rush for someone back in the kitchen to slip up.

If, however, you can find a restaurant where the personnel take special care — down to using separate pans and utensils — you may be relatively safe. I know of a few restaurants that have mastered allergy-free cooking, so I know that running such an establishment is possible.

It just takes more time and work than most restaurants are willing to commit. Even when you’re eating out at a restaurant where you are completely confident that the chef is following all necessary precautions, keep your emergency medications close at hand.

If you own or work in a restaurant or the owner of your favorite eatery wants to learn more about allergy-free cooking, the Food Allergy and Anaphylaxis Network, the Food Allergy Initiative, and the National Restaurant Association have worked together to develop an excellent education program called Food Allergy Training Guide for Restaurants and Food Services.

You can order it online at or call the Food Allergy and Anaphylaxis Network at 800-929-4040. I believe that the rising prevalence of food allergies along with programs such as these and the growing willingness of restaurants to cooperate will lead to restaurants with increased allergy awareness where those with food allergies can dine more safely.

Allergy-Friendly Restaurants

Locating an allergy-friendly restaurant is often mainly a process of elimination. Allergic to fish or shellfish? Cross seafood restaurants off your list. Even if you’re ordering off the Turf side of the menu, the chances of cross-contamination from the Surf foods is just too great.

Allergic to peanuts or tree nuts? Avoid Asian restaurants. Nuts are all too common in Asian dishes. Don’t let temptation overrule your natural avoidance instincts. When it comes to food allergies, restaurant personnel have attitudes, either good or bad.

Ideally, when you inquire about allergen-free foods, the server, cook, and manager are receptive, knowledgeable, caring, and sensitive. Many of the restaurants that fit this description are run by managers who have food allergies or have a close family member with food allergies.

Unfortunately, you may not be so lucky to find such a restaurant. Many restaurants would prefer that you never showed up. The servers and cooks may even act ignorant, rude, and otherwise uncooperative. When you find yourself in such a situation, the best response is usually to go elsewhere.

You may be able to whip the restaurant into shape but, in the meantime, you may be taking unnecessary risks. Some restaurants and other eateries are simply not conducive to allergenfree dining. Following are several types of establishments that may pose a higher risk:

  • Buffets: Observe a buffet for about two minutes, and you immediately know why buffets are high-risk areas for patrons with food allergies. The foods in the buffet line rub elbows. People can’t find the spoon for the potatoes, so they serve up their spuds with a spoon that was sitting in the egg noodles. Messy patrons fling the food around as though they were having a food fight.
  • Bakeries: In addition to the risk of airborne allergens, particularly for people with wheat allergy, bakeries are notorious for cross-contamination. Baked goods often sit next to or on top of each other in large display cases. Tongs and other serving utensils are often shared and reused. In such an enclosed environment, allergens easily spread from one food to another.
  • Restaurants that serve pre-made foods: Restaurants that cook meals from scratch are best. You tell the chef which ingredients to use and which ingredients not to use, and that’s what you get. Some restaurants get pre-made entrees that they slap together to create your meal. Call ahead and ask if the chef cooks the meals from scratch or uses prepackaged meals.

Fast-food and franchise restaurants have gotten somewhat of a bad reputation lately, but they offer some advantages for those with food allergies:

  • Standardized food preparation and cooking procedures ensure that meals are likely to be the same at all locations.
  • Most larger restaurants have Web sites where you can study the ingredients in detail before you go.
  • Larger restaurants often share less equipment. While most restaurants use the same deep fryer for multiple foods, many fast food joints use dedicated oils, at least for their French fries. So while another restaurant might be frying shrimp or mozzarella sticks in the same oil as the fries, at a fast-food or chain restaurant, your fries are more likely to be fried in fries-only oil, but ask to make sure.

With all the activity and the variety of foods at most restaurants, airborne allergens also pose a possible risk, particularly if you’re sensitive to airborne allergens. To limit the risk, take the following precautions:

  • Be on the lookout as soon as you walk through the door. The waiting area may have allergy-unfriendly snacks, such as peanuts in their shells.
  • Ask to be seated at a table far from the kitchen, especially if the kitchen is open to the dining room. Sitting close to the kitchen exposes you to a higher concentration of airborne allergens, including milk, egg, peanut, wheat flour, fish, shellfish, and meats. Cooking launches most airborne allergens, but food preparation accounts for its fair share — chopping nuts, beating flour in a mixing bowl, kneading bread, or rolling pie crusts.
  • For those with milk allergies, steer clear of the cappuccino maker. Patients can have airborne reactions in areas where milk is being frothed.

Allergen-free dinners out start not with the food but with the restaurant’s staff. When you book a table at a restaurant, tell the person who’s reserving the table about your food allergy. Ask the person to ask the chef whether she can provide you with a meal that doesn’t contain the food you’re allergic to.

If the person is not sure, consider eating at a more accommodating restaurant. When you arrive at a restaurant, make sure the waiter or waitress knows about your allergy and how serious it is. If you are not confident that they understand how important it is for you to avoid a particular food, then look for another restaurant.

Despite careful planning, not all the pertinent information you provide may be accurately relayed to the chef. One way to ensure that the chef is made aware of your food allergy is to prepare a chef card.

A chef card is a personalized card on which you list the foods you’re allergic to and related ingredients, as well as ways to avoid cross-contamination from utensils, surfaces, and other dishes in the kitchen. Use the sample chef card shown in Figure below as your guide.

Make copies and keep the chef cards in your wallet or purse. You can personalize your chef cards by using bright colored paper, designing your own cards, or laminating the chef cards. When you go to a restaurant, give a chef card to your server and ask him or her to share it with the chef.

Your chef card doesn’t take the place of asking questions or careful planning when you’re ordering at a restaurant. Chef cards can’t guarantee an allergenfree dining experience, but they can help make your meal safer. A few Web sites have chef cards already made up. The Food Allergy Initiative offers several food allergy cards in several languages for eating out at more exotic restaurants.

Most of these pre-fab cards are useful, but they often contain a list of the top allergenic foods — you place a check mark next to the foods you’re allergic to. With so many foods listed on the card, this can be a little confusing. I prefer creating a custom card that shows only the foods you’re allergic to.

Studying Menu

A menu is not a cookbook. A menu usually tells you the name of the dish, a brief list of the main ingredients, and the price. Rarely can you tell from the brief menu description what the chef’s secret ingredients really are. To safely order, be as selective when choosing an entrĂ©e as you are when choosing a restaurant, ask plenty of questions, and watch out for hidden ingredients:

  • Read the menu carefully. If the food you’re allergic to appears in the name of the dish, cross it off your list. Remember that the food might not be mentioned in the dish’s name or description, so always check with the waiter or waitress.
  • Ask what’s in it. Tell your server what you’re allergic to and then ask which items on the menu do not contain the problem food. Ask about the specific ingredients used to prepare a particular dish. If your server doesn’t sound sure, ask to speak to a manager or chef. Ideally, let the restaurant know about your food allergy before you arrive.
  • Ask how the food is prepared. The way the food is prepared often influences how safe it is to eat. Make sure the server and the chef know not to share cooking equipment, including deep fryers, or utensils between your food and other foods being prepared or cooked. Let them know the dangers of cross-contamination from spills or splatters.
  • Keep it simple. Ordering pure, basic foods is best. A flame-broiled steak without sauce and some plain green beans are unlikely to cause a reaction. A casserole or anything else that contains a mix of ingredients is more likely to contain something you don’t want.
  • Pass on the sauce . . . or get it on the side. Sauces are great hiding places for allergens. A sauce is likely to contain peanuts, fish, milk, wheat, or any number of hidden ingredients. Order your sauce on the side. Better yet, forego the sauce altogether.
  • Ask about the dressing. Most dressings contain oils, and many salads contain nuts or seeds, even if you can’t see them. Ask which oils have been used in the dressings. If you have milk or egg allergy, ask if the dressings contain mayonnaise. Ask if the salad contains nuts or seeds. Even if you’re ordering the fruit salad or chicken salad, you still need to ask these questions.

Be particularly careful around anything that contains a mix of ingredients, including sauces, crackers, and breads. These foods often contain hidden ingredients, such as:

  • Almonds (in your marzipan; a sweet paste often used as cake filling or topping)
  • Fish sauce (in Thai dishes)
  • Milk (in some crisps)
  • Oyster sauce (in Chinese food)
  • Peanuts (in Satay sauce; an Indonesian sauce in which you typically dip your meat)
  • Sesame seeds (in hummus)
  • Tree nuts or peanuts (often used in sauces and in dessert toppings or fillings)
  • Wheat flour (in soups or sauces)

Explain to the server the seriousness of your food allergy. The server may not completely understand the potential danger until you stress it. Also, let the server know that allergens often exist in foods as hidden ingredients. Continue to talk with the server until you’re confident that the person understands and is qualified to serve you safe food.

If your server doesn’t seem to “get it,” and you’re not confident that you’re getting through to him, speak with the manager or chef to assure that the meal you are ordering will be safe to eat. You made it through dinner without the slightest hint of a reaction.

Now, you can kick back, relax, and reward your successful vigilance with a sinful dessert. Whoa! Not so fast. That dessert menu may tempt you with some of the riskiest foods in the building, whether you are allergic to milk, egg, wheat, peanut, tree nuts, or even seeds. They are risky for three big reasons:

  • Desserts frequently contain one or more key allergens, often as a hidden ingredient. Very common examples would include finely ground peanuts or tree nuts in a pie crust, a cake the contains a nut extract, or a pastry that has been “washed” with egg whites. These could all produce deadly exposures.
  • Desserts are at high risk for cross-contamination, all the way from the mixing bowl to your plate. Pastry chefs, particularly in small bakeries or restaurants, commonly bake like most people do at home — they use the same mixing bowl, cookie sheet, spatula, and serving utensils for all their desserts, without washing them thoroughly in between. Even if the dessert comes from a larger manufacturer, we see lots of reactions related to the serving utensil or ice cream scoop used at the restaurant.
  • Many restaurants do not actually make their own desserts and therefore often have no knowledge as to what they are really serving. Restaurants often buy their desserts from pastry shops and others who specialize in desserts.

I always save dessert for home, where we can make something that we know will be safe. To some, this may seem unnecessarily cautious, but as a group, desserts count for far more reactions than foods from any other menu category. Why risk ruining a lovely, safe dinner by topping it off with a risky dessert?