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PRACTICAL TRAVELER; Coping With Food Allergies

By SUSAN CATTO

FOR the Tedesco family of Bergenfield, N.J., carefree holidays ended five years ago when their daughter Annie, then 15, had a severe reaction after eating shellfish. On their next trip to Florida, said Mike Tedesco, Annie's father, ''we had to keep an eye on her at all times and watch what she ate.'' Even french fries prepared in the same oil used to fry shrimp could have sent Annie into life-threatening anaphylactic shock again. ''One minute she could be fine and the next she could be in respiratory distress.''

To many people, sampling foreign flavors is one of travel's greatest attractions. But six million to seven million Americans are estimated to have serious food allergies, according to the Food Allergy and Anaphylaxis Network, a nonprofit advocacy group in Fairfax, Va., and for them travel can be a minefield. As I know from traveling with my husband, Andrew, who is allergic to peanuts, the usual concerns about restaurant and airline meals are compounded by language and cultural differences.
Trouble-Causing Foods
 

According to Dr. James Li, a professor and consultant in allergic diseases at the Mayo Clinic in Rochester, Minn., a diagnosis from your doctor is essential to determining the exact nature of an adverse reaction to food. On one end of the spectrum is anaphylaxis, a life-threatening immune-system response that can result in hives, swelling of the lips, hands and throat, difficulty breathing and cardiovascular distress. Just eight foods are responsible for 90 percent of adverse reactions to foods, according to the Virginia group: peanuts (responsible for 50 to 100 deaths a year in the United States), tree nuts (e.g., almonds), eggs, fish, shellfish, soy, wheat or milk. Gastrointestinal symptoms are far more common than allergies, said Dr. Li, and are usually called food sensitivities or food intolerance.

While food sensitivities are a concern for travelers, a potentially fatal food allergy obviously requires greater cautionary measures. With tightened airline security, some people have reported difficulties boarding with EpiPens, needles containing epinephrine, which can buy you enough time to get to a hospital. Travel with a letter from your doctor stating that the medication must be carried with you at all times. Leave your prescription in its original packaging, and make sure the paperwork includes the telephone numbers of your doctor and pharmacist. Your doctor may suggest carrying an antihistamine like Benadryl as well. Ask for a letter outlining the treatment you should receive and have it translated if necessary.

Obviously, avoiding exposure is the best way to deal with a food allergy. As a first step, Anne Muñoz-Furlong, founder of the Food Allergy and Anaphylaxis Network, suggests being realistic about where you go. ''It's going to be nearly impossible to get a non-shellfish-contaminated meal in Japan,'' she points out. Some vacationers mail food in advance. But the odds are long that Andrew and I will ever go to, say, Thailand.

Ms. Muñoz-Furlong also suggests printing up (and translating if necessary) laminated sheets or business cards explaining your allergy and listing the food or foods that will cause a reaction. The cards can be used in English-speaking restaurants -- you can ask the server to deliver them to the chef.

Reading labels and talking to waiters and chefs are useful, but they are not guarantees. ''The quality of the information you get is sometimes quite variable,'' said Dr. Li. Desserts and breads may come from outside suppliers; sauces and flavoring pastes may have dozens of ingredients; cooking equipment or serving utensils may have come into contact with allergens. For a recent trip to Mexico, Andrew and I chose a resort with buffet meals so that he could see the food and pick items likely to be peanut-free. He subsisted on fruit, cheese, grilled fish and bread, but Ms. Muñoz-Furlong pointed out that he might have been better off at a traditional restaurant. Buffet dishes are subject to cross-contamination, not only by servers but also by diners who use their utensils in more than one dish. She also said that international chains might prepare food differently. Just because you can eat the United States product, don't assume the Russian version is safe for you.

If your sundae arrives covered with nuts or your burger smothered with cheese, Ms. Muñoz-Furlong suggests keeping the offending dish at your table to make sure you get a new, uncontaminated serving. ''I've heard of cases where nuts are just scraped off the top of a sundae and more whipped cream put on,'' out of pure ignorance.

Ultimately you have to look out for yourself. Andrew's motto is ''When in doubt, don't eat it.'' He's never handed out a card, but he warns waiters of his allergy, orders conservatively -- steak and potatoes, for example -- and refuses to sample anyone else's food.

It's not a bad idea to consider the availability of medical services while planning your trip. ''If you're going on a long bus trip to a rural area hours from medical care and if you're eating indigenous food, there's a chance that someone will have a reaction and that it will be harder to treat,'' said Dr. Li. Experts recommend finding out how to call an ambulance, where the major medical centers are, how the health system works and even whether paramedics routinely carry ephedrine. Make sure you have adequate insurance and enough cash to cover any emergency. Your doctor, the local American embassy or some of the organizations listed below may be able to help you find a doctor or clinic familiar with your condition.

Useful Resources

Established in 1991, the Food Allergy and Anaphylaxis Network, 10400 Eaton Place, Suite 107, Fairfax, Va. 22030, (800) 929-4040, fax (703) 691-2713, offers a wealth of information, including a bulletin at www.foodallergy.org outlining food and allergy policies at various airlines. An associated group, the Food Allergy and Anaphylaxis Alliance, www.foodallergyalliance.org, links allergists in Australia, Canada, the Netherlands, New Zealand, Britain and the United States.

The MedicAlert Foundation, 2323 Colorado Avenue, Turlock, Calif. 95382, (888) 633-4298, www.medic alert.org, provides members with an easily recognized emblem (bracelet or necklace) engraved with their conditions and a collect call number -- accessible from anywhere in the world, with interpreters available in more than 100 languages -- that a doctor can call to get their files. Membership is $35 for the first year, $20 after that.

The American Academy of Allergy, Asthma and Immunology, (414) 272-6071, an organization of health professionals, offers a searchable database of member allergists at www.aaaai.org.

Bob and Ruth's Gluten-Free Dining and Travel, 22 Breton Hill Road, Suite 1B, Pikesville, Md. 21208 (410) 486-0292, is designed for people with celiac disease, a genetic disorder in which the immune system reacts to the proteins found in certain grains. Trips include cruises to Mexico, the Western Caribbean and Alaska and, still on the schedule as of early last week, a grand tour of Hong Kong, China and Japan.

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