Josh Mandelbaum doesn't just break out in hives if he eats a peanut; the tiniest bit of peanut dust has the potential to kill him.
The 12-year-old suffers from an anaphylactic peanut allergy. If he accidentally ingests the dust—prevalent on airplane surfaces as nuts are commonly served as snacks—it could cause a life-threatening reaction. He doesn't let that keep him from traveling six to eight times a year but it does require planning and diligence, said his mother, Lianne Mandelbaum.
According to James R. Baker Jr., MD, CEO and chief medical officer of Food Allergy Research & Education (FARE), an estimated 15 million Americans live with food allergies. The most common are milk, eggs, peanuts, tree nuts, wheat, soy, shellfish and fish.
Planning is key. Travel Influencer Scott Eddy wrote a blog post about how to eat clean while traveling, and said some of the advice is the same for traveling with allergies.
"You're not going to find any allergy-free restaurants," he said. "Make a list [of potential restaurants] and get prepared before you go."
He recommends reaching out to food bloggers and contacts on social media for recommendations. It also helps to learn about the food in that culture before leaving home. Is the cuisine heavy in peanuts, such as Thai food, for example? Some cuisines don't use nuts at all. Find out what's commonly used in local cuisine and adjust your food plan accordingly.
Also, be sure to pack a written allergy care plan and a letter from your doctor.
"It is important to note that food allergies should be diagnosed by an allergist. Some people needlessly avoid foods when they are not clinically allergic," Baker said. "People with food allergies may not be able to be as adventurous as others when it comes to dining out while traveling, but they can still try new foods, as long as they are cautious and do their research."
By the time Josh Mandelbaum takes his seat, his mother has spoken to at least four airline officials to alert them of his allergy, including the flight attendant who will take care of them during the flight. If the airline is cooperative, she boards the plane early to wipe down the seats, makes sure there are no stray peanuts in or under the seats, and covers his seat with a seat cover. She has packed all of his food in a carry-on bag—they always refuse airline meals, just in case—and his epinephrine pen is close at hand. On a cooperative flight, the attendant will also make an announcement asking that passengers refrain from eating peanuts during the flight to reduce the risk.
Airlines are not always cooperative, so it's important to know an airline's policies before boarding the plane.
"Air travel can be particularly stressful for those managing food allergies, because you don't have access to emergency medical care in the event of an allergic reaction," said Baker. "It can also be stressful if you're traveling to a foreign country if you don't speak the language, and you're relying on others to understand the seriousness of your food allergy."
FARE recommends keeping copies of your food allergy emergency care plan and medications handy at all times, and knowing where the nearest hospitals are within your destination, just in case. “Try to book the first flight of the day and when possible, book a direct flight so you are not dealing with different planes and crews,” Mandelbaum added. “If you get a different crew, you get a different result.”