The sad state of allergy awareness in modern travel – and how to protect yourself

I recently took my mother to a famous farm-to-table restaurant in Athens. It’s not particularly focused on seafood, but when I visited, it seems their ship had arrived. When I told the hostess, as she was sitting us, that I had a shellfish allergy, she looked at me like I told her I was. shellfish. She went out to find a copy of the prix fixe, spinning with unlimited ingredients. A sea pole? It wouldn’t be a chance. Octopus? Squid? Not difficult from me.

While mom sucked at langoustin, I ate six way fungi. But I’m used to having mushrooms and table bread thrown at me for free. There are worse things – anaphylactic shock, for example – than a hastily defrosted burger at a wedding in Mallorca, after the chef has removed the mollusks from a long-simmering paella. (A few hours before, I had begged him to put aside a vegetarian portion; that was obviously absurd.)

I’ve been side-eyeing spring rolls and sniffing out oyster sauce since I first traveled alone as a teenager. Living in Shanghai in the 2010s, I used my allergy to avoid sea cucumber and all. But I have also paid the price of inattention: rushing to the hut to “exorcise” a hidden crab, or avoiding the nearest hospital on a road trip.

I saw a different side of Mumbai from Gurana hospitals, then I toured a stretch of roadside chemists to fill my prescription. In one emergency room in Canada, I was denied the usual adrenaline shot and instead forced to drink a liter of activated charcoal.

Seafood allergies can be serious, but they’re easy to manage—despite the fact that a few major airlines serve shrimp salad in coach. During the past week in Japan, a real Squid Game for sensitive eaters, the restaurant staff were very careful, sending me and my peanut allergic friend Ben into the kitchen for a stilted consultation 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&M’s are an airplane snack staple still sold at Duty Free.

Another friend, Hannah, an executive coach and celiac, fills bags with gluten-free bread and cereal because, despite assurances to the contrary, a chef in Mexico won’t always touch the high stakes. Others assume that “celiac” in Western parlance is a “lifestyle choice”.

“Restaurants get more attention,” she says, “but an 80-year-old local woman cooking for you in an Airbnb by the sea in Crete…” One break of bread drowned in a bowl of soup and she’ll be chained to the room bath with stomach pain and lethargy.

But slowly, the world is catching up with the spectrum of dietary needs. Regulations enacted ten years ago in the UK and EU oblige restaurants to notify diners of dishes containing any of 14 allergens. In North America it is about protecting themselves from litigious diners as well as the diners protecting themselves. I had servers in Casablanca and Beijing preemptively ask “any allergies?” and the Parisian one will be devotedly focused on the salade mixte.

However, forewarned is forearmed. Remember the following, and be that the allergy-addled travelers are just a little easier.

The allergic traveler’s pre-trip checklist

• Consider food desensitization treatment Professor Adam Fox from the Allergy London clinic offers a multi-month course that involves administering additional 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. This, of course, is only something to do under the supervision of a trained professional, and it won’t work for everyone.

• Be aware: if you have one food allergy, you probably have another. Shellfish fall into 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. About 40 percent of those allergic to peanuts are also sensitive to cashews and pistachios, 25 percent react to sesame and 4 percent to lupine flour, a ground legume used in some European pizza bases.

• Pack wisely. Bring non-perishable snacks and Tupperware to pack away buffet leftovers. If you are suffering from possible anaphylaxis, bring an up-to-date EpiPen and a prescription. “They can be funny in security if you don’t have a prescription for your meds,” says Fox. Dr Claudia Gore, consultant in pediatric allergy at Imperial College Healthcare NHS Trust, recommends a food allergy management plan with proof of prescribed medication from your GP or allergist. BSCI has one for children. An adult version is due out later this year.

• “Never put your medicine in the womb,” says Gore. It’s not good for you if you have a reaction in the air or if your checked bag disappears.

• If you don’t speak the language in your destination, bring translation cards with phrases like “I’m allergic to…” and “I’m having an allergic reaction – call an ambulance”. The fantastic resource AllergyUK offers personalized cards in 35 languages.

• Learn the emergency number in your destination. In North America and many other countries it is 9-1-1. In Japan it is 1-1-9.

• Find your tribe online. Anaphalaxis UK is a handy site. Fox rates blogger and podcaster Daniel Kelly, who goes by @maycontain. There is also Celiac UK, a support network that provides research, recipes and case studies.

• Make sure your medical insurance covers accidents and hospital treatments in your destination. Gore recommends a GHIC (global health insurance card) that covers emergency services abroad.

• If you plan to party, says Gore, “remember that alcohol and drugs reduce the perception of risk and alter reaction thresholds, so you’re likely to react sooner to a smaller amount of your allergen.”