Travel poses a challenge for everyone. You have to plan ahead, reserve accommodations at your destination, pack all the stuff you need, and, if you’re flying, make sure you get to the airport in plenty of time to check in and weave your way through security. For those with food allergy, travel is far more challenging, and the more severe and complicated the allergy, the more challenging it becomes.

Whenever you travel, consider carrying a signed medical release giving people permission to administer emergency medications, including epinephrine. Some people are so afraid of being sued if something goes wrong, that they refuse to intervene, even when someone is at risk of dying. You can pick up a sample release at FoodallergyInitiative.org (the Food Allergy Initiative provides medical releases in several languages).

When you’re traveling on a tight schedule to a distant destination, flying may be the only mode of travel that makes sense. When driving is an option, consider the benefits — you can pack more of your own food, choose your restaurants more carefully, and you don’t have to risk sitting elbow-to-elbow with someone who decides to snack on a food that you’re sensitive to in the middle of the trip.

If you decide to fly, be prepared for airline regulations that govern medications and foods you need to carry with you. Prior to your flight, ask your doctor to write a letter explaining why you need the items you’ve packed. Some baggage inspectors are sticklers, and they may require an official letter.

With my own epinephrine, in all the flights I’ve taken (and I’m a frequent flyer), I’ve only been questioned five or six times. Only once would I have been unable to carry the medicine on board without a letter. Still, you should always carry a letter to the airport, just in case.

I’ve had to fax or email letters to patients all around the world to get them past security. Make sure your medications are in their original packaging. Be particularly careful that prescription medications are in their prescription bottles.

When you’re traveling to see relatives, family accommodations are usually best . . . assuming, of course, that the family you’re visiting understands food allergies and is supportive. With family, you have kitchen privileges for preparing your own meals and plenty of storage space for special foods.

On the other hand, some families just don’t get it when it comes to food allergy. If you’re family just doesn’t get it, when every trip to their home is like navigating a mine field, you may be better off staying elsewhere (while you, of course, try to gently instruct them about food allergy).

When you’re going on vacation, you may have several destinations from which to choose. Some people enjoy the hustle and bustle of big cities, major attractions, and locations that attract tourists — places where emergency medical treatment is readily available.

Others prefer the solitude of remote areas — some so remote that you’d need to aerial-drop emergency medications to the site. Which do I recommend? It’s pretty much a toss-up. You may think that populous areas are safer because of their better access to emergency medical care, but remote locations offer some benefits.

Every year, I have a number of teenagers in my practice who want to go on camping or canoeing or outward bound trips. While this often causes outright panic for their parents, I remind them that if all their teenagers can eat is what their parents put in their backpack, they are much less likely to have a reaction than eating out at local restaurants.

You may be dealing with other allergic conditions along with food allergy, such as asthma or eczema. If you have found that one climate or environment is particularly good or bad for your health, be mindful of this as you draw up your plans.

I have several patients who travel to the same, family-favorite vacation spot year after year and call me every year to report a severe asthma attack. I wonder how this destination manages to remain a family favorite when they visit the local emergency room almost as often as they see me.

Planning Your Meals

When you’re on vacation, one of your primary goals is to leave drab daily routines behind. With food allergies, however, your daily routines are often your best protection. Although I don’t want to ruin your trip by suggesting that you click back into your daily eating routine, some careful planning can enable you to vary your diet while remaining reaction free.

Staying safe requires a combination of packing safe foods, reading labels when you go shopping, and carefully reviewing and choosing restaurants.When traveling to an unknown place that isn’t exactly a thriving metropolis, you may have trouble finding a grocery store that carries the allergen-free foods to which you’ve become accustomed. Consider scoping out such areas prior to departure.

If you have a computer with Internet access, search Google for “grocery store” followed by the destination city and state or zip code to view a list of grocery stores in the area. You can also search online phone books, such as YellowPages.com.

If you’re traveling to a remote destination that has limited access to grocery stores, you may have to stock up on your own food supplies before departing. Most families with food allergy, especially if milk, egg, wheat, or soy are involved, prefer to prepare most, if not all, of their own meals.

If you cannot stay with friends or family, this is going to be much easier to accomplish if you can stay in a hotel or motel with a kitchenette. Thankfully, these have become more and more common in recent years and generally a whole lot nicer.

When you arrive, take a close look at the facilities and inspect for cleanliness. Food residue may be present on pots and pans, dishes, cutting boards, and so on. If the kitchen or the cooking equipment appears suspect, ask the hotel or motel personnel to clean it up prior to the time you plan on cooking your first meal.

Researching a few safer local restaurants before departing on your journey is a good idea. Using a combination of guide books and the Internet, you can draw up a list of restaurants that sound good to you and then start calling the restaurants to get a feel for which ones would be most accommodating.

Follow the same guidelines for choosing restaurants at your destination that I provide earlier for selecting local eateries. When you arrive, take the usual steps described previously. By preparing in advance, you’re much more likely to start your trip right, rather than having a total meltdown before you’ve even had your first meal.

Healthcare Providers

I have one family that travels everywhere they go with a map noting every emergency room on the route they are taking. While this is a bit extreme, and more than is necessary, having some knowledge of available healthcare facilities is not a bad idea. Thankfully, in the United States, most hospitals are very capable of dealing with an allergic reaction.

The biggest issue is having some idea of how far away from help you are so that you and your doctor can plan accordingly. For example, if you’re far from medical attention, you may need to have additional doses of medicine available so that you can deal with a reaction as you wait for help to arrive.

When traveling in your own country, you’re well-schooled in what you have to deal with and how to deal with it. Food labels, although they may be a little cryptic, are fairly standard. You’re familiar with the protocol of communicating your needs to restaurant servers and chefs. You know who to call and how to call in the event of an emergency.

When you travel to a foreign land, however, you’re journeying to unfamiliar territory. You’re unfamiliar with the way they do things, and they’re unfamiliar with you. Even more challenging is the fact that the food they eat may be entirely different from what you’re accustomed to.

The following items can make you more aware of the issues you face when traveling to foreign lands and bring you up to speed on some possible solutions:

• The problem food is in everything! In Asian countries, you’re going to be dealing with a lot of peanut. In Israel, sesame permeates the menu. In Japan, fish is the staple. You may not need to cross a destination off the list, but you may need to pack a lot of your own food. Just make sure you can get through the customs check with the food you bring.

• You don’t speak the language. Eating out safely requires an ability to communicate your allergy and your needs to the server and chef. If you don’t speak their language, you may not be safe eating out at the local establishments. Sometimes, a chef’s card in the local language can help — check out the cards at FoodallergyInitiative.org. To further complicate matters, the locals may speak different languages or dialects.

• You don’t read the language. Ever try grocery shopping in China, Japan, Germany, France, Russia? Those people have the gall to label their foods in something other than English! Well, that’s obviously a problem, but even English-speaking countries can pose a problem with their food labeling. Food labeling in Canada, Western Europe, Australia, and New Zealand is typically excellent and in some instances better than in the U.S. Elsewhere, labeling may be limited at best. Stick with basic fresh foods.

• Emergency medical care may not be very accessible. Before you depart, meet with your doctor, tell her where you’re going, and discuss your concerns. Stock up on special medications, if needed, and obtain a letter from your doctor stating that you need to carry these specific medications. Makes sure all medications are labeled appropriately.

If you’re traveling outside the country or to a remote location in your country of residence, adjust your plan to treat reactions more aggressively:

• Pack lots of epinephrine. You should have at least three doses and maybe more depending on the length of your stay and your ability to obtain more. Prior to leaving on your trip, ask your doctor under what conditions you should administer a second or third dose.

• Pack lots of antihistamines. Benedryl is usually the antihistamine of choice.

• Pack a steroid, such as prednisone. In most cases, you don’t get the steroid until you’re in the emergency room. When traveling to a place where the emergency room is inaccessible, you should have your own supply ready to go. Consult your doctor about the use of the steroid — when to take it and how much to take.

• Respond immediately to reactions. Don’t even think of taking the waitand- see approach. Administer epinephrine immediately.

A two or three-hour flight can be a little uncomfortable, but when you’re airborne in close quarters for 12 hours a more, the discomfort seems to rise exponentially. When you have a food allergy, the risk of reaction also tends to increase. When you’re going to be on a long flight, take a few extra precautions:

• Pack food. I’m not about to bash airline food, but when you have food allergies, you can’t trust it, particularly on international flights.

• Carry on your medications. Don’t check the bags that contain your medications. Carry them on with you, so you have them on the flight, and, if your bags are lost in transit, you have the medications when you reach your destination.

• Inform the flight crew. The flight attendants should know that you have a food allergy, and they should be aware of what to do if you experience a reaction in flight. Often, the flight crew will ask if a doctor or other type of medical professional is on board the flight who would be willing to respond to your needs. This is another situation in which you should be prepared with extra doses of medicine and an appropriate action plan.

Peanuts used to be as common on airplanes as they are at baseball games, making flying especially nerve wracking for people with peanut allergy. When passengers are packed tighter than sardines on a flight for several hours, and the attendant starts handing out bags of peanuts, you may start eying that emergency door and hoping you had a parachute handy.

In most cases, peanut on flights does not pose a significant risk. I fly often, frequently on international flights, and I’ve never had an in-flight reaction. Others have, however. Most of these reactions are caused by eating something that contains peanut on the flight. Far fewer reactions are caused by contact, and inhalation reactions are rare.

I’ve personally flown hundreds of times without any difficulty, and I have a very severe peanut allergy. To remain safe, however, always have emergency medication available. Although policies are forever changing, most airlines are willing to make some accommodations for those with peanut allergy, either by offering peanut-free flights or peanut-free buffer zones.

Visit the FAAN for up-to-date information on specific airline policies. Even though I personally do not take these precautions, I think that peanut-free accommodations are a reasonable request for most families. If, however, you cannot find such a flight, or you find out at the last minute that the promised flight is unavailable, the reality is that airborne reactions on airlines are very rare in the spectrum of things and do not expose a major risk to most patients.

Cruising For A Reaction

The cruise is becoming a more and more popular vacation choice, but if you’ve ever been on a cruise, you realize that the middle of the ocean is not the best place to experience a severe food reaction. Like most vacation options, however, cruises have their pros and cons:

• Cons: Most cruises have a doctor on board but the quality of the doctor, and the depth of the doctor’s experience in treating food allergies, cannot be guaranteed. Have a detailed emergency action plan in place, and share it with the doctor and other personnel on board.

Make sure they know where your emergency medications are stored and that they can get to them in a hurry. You should also tweak your emergency plan to treat reactions more aggressively. Also, make sure that you can contact your doctors, no matter where in the middle of the ocean you are. Fortunately, the development of satellite phones has made this much easier.

• Pros: Some cruises have a well-trained staff that’s very willing and able to prepare special food just for you and is quite capable of responding effectively in the event of an emergency. Eating on a cruise ship with experienced chefs may certainly be much safer than dealing with a dozen new restaurants in a less controlled environment.

I have a large number of patients who have had great luck with cruises. It makes me a bit nervous, but if you do your homework and can identify a safe cruise line, your trip may be as safe as it is enjoyable. Plan ahead and talk with the right people. Ask other people you know with food allergy if they’ve taken a cruise, and see what they recommend.