The car, the kids and food allergies
Every summer, my family vacations on Oak Island, North Carolina, where we soak up the sun and surf and make happy memories. My 10-year-old son has multiple allergies to peanuts, tree nuts, wheat, milk, egg, soy, sesame and mustard, along with asthma. So before we ever hop in the car, I pull out my "road map," a regimen I use for traveling with food allergies. I want our trip to be about having fun, not about our son getting an anaphylactic reaction or feeling deprived.
For families like mine, special dietary needs and asthma dictate trip choices. A 2009 study found, not surprisingly, that food allergies limit travel plans. About 75 percent of study participants said they chose vacation destinations based on available medical care. More than 90 percent packed their own food, 86 percent arranged for special meals at restaurants and 67 percent obtained extra epinephrine injectors before leaving home.
"When away from home, it’s natural to feel more vulnerable because there’s more dependence on others to provide a safe meal. One can also feel more uneasy being away from medical care," says Scott H. Sicherer, MD, professor of pediatrics at Mount Sinai School of Medicine in New York, researcher at the Jaffe Food Allergy Institute and co-author of the study.
But that doesn’t mean that families living with food allergies should forego travel.
"Families managing food allergies can enjoy road trips and vacations with careful planning," said Veronica Brown, a spokeswoman for Food Allergy Research & Education (FARE).
Proper preparation paves the way for a safe and enjoyable trip, as does effective communication. These are the trip essentials for families with food allergies.
Prepare at Home
About five years ago, Melissa "Lissa" Critz and her husband were en route to Florida from their home in Grapevine, Texas, with their 18-month-old daughter Caroline strapped in her car seat. Turning to check on her daughter, Critz saw the toddler breaking out in hives and vomiting—an allergic reaction to inadvertent contact with egg. Thankfully, Caroline responded to the medication they gave her. The symptoms eased and eventually disappeared.
"That was really scary. It’s that feeling of being on the side of the highway in the middle of nowhere and not knowing what we were going to do if her reaction didn’t stop," Critz says. They had no idea where they were to inform emergency services or where they would have found the closest hospital. Caroline, now 6, has outgrown her egg allergy.
Estimating the distance between exits and knowing the distance to local hospitals should the need to call 911 arise is part of the pre-trip routine for Jessica Brown of Lawrenceburg, Kentucky. Before Brown and her family embark on a road trip, she logs some time online and on the phone, researching safe options for her 5-year-old son, Isaac, who is allergic to milk, along with having asthma and eczema. Brown, who is a volunteer with the nonprofit online support group, Kids with Food Allergies Foundation (KFA), a division of the Asthma and Allergy Foundation of America (AAFA), also turns to KFA’s online forum for recommendations about hotels in the area she plans to visit. Connecting with other families living with food allergies and learning about their experiences is a helpful resource.
"It doesn’t replace research but it gives me a starting point," Brown says.
When Brown books her hotel room, she ensures it’s away from any block of smoking rooms so as not to trigger her son’s asthma. She also scouts out restaurants and grocery stores near the hotel to see what’s available, looking online to check out menus for milk ingredients.
Critz, a Disney-authorized vacation planner for My Magic Journeys, recommends that travelers call ahead to talk to the manager of a hotel or restaurant to find out whether they have policies in place for handling food allergies. In addition, ask about the training instituted for frontline staff, she advises.
"You can have all the policies in the world but if you’re not training the guy with the ice cream scoop, it’s not going to be implemented," she says.
After researching whether her daughter could safely enjoy Walt Disney World in Orlando, Florida, Critz wanted to help other families communicate their special dietary needs while on vacation.
"There’s nothing like being able to give kids this traditional, magical childhood experience and have it be like everyone else’s." says Critz, who partners with the Kids with Food Allergies Foundation to help families plan Disney trips. She donates a percentage of each trip booked to KFA.
"A big part of what I do is help manage anxiety. I want to make sure I understand each person’s anxiety so we can talk about what controls are in place, what we can do to mitigate those anxieties, mitigate the risks," she says.
Critz then books all of the family’s dining, ensuring that the reservation is flagged as a food allergy in Disney’s online system. As the trip nears, she gives Disney’s special-diet team a form with more details about the guest’s allergy. This means chefs at each location have sufficient time to prepare.
Families also need time to prepare for a visit.
"If you're staying with relatives, have a conversation in advance to ensure that they understand your food allergy safety rules," advises FARE’s Veronica Brown.
About a month before a trip to Philadelphia, Stephanie Smith, of Garner, North Carolina, calls the relatives she plans to visit, setting into motion the preparations that make the trip safe for her 4-year-old daughter Zoey, who is allergic to peanuts, tree nuts, milk, egg, wheat and sesame, along with having environmental allergies and asthma. Smith’s dad, Steve Campbell, thoroughly cleans his home, which is pet-free, and removes any food that could potentially cause a problem for his granddaughter. This accommodation paves the way for Zoey to safely spend time with her extended family, which is important to Smith, who has five sisters and a brother in the Philadelphia area.
"My family is really great about Zoey’s allergies—they are beyond accepting," Smith says. "It's a good experience for her to be with the family."
During a recent trip, relatives met Zoey at Sweet Freedom Bakery, an allergy-friendly shop in Philadelphia. It was the first time the little girl was allowed to select whatever she wanted from the sweet selection of cupcakes, brownies and cookies—all safe for her.
"That’s the coolest thing, going up to the glass counter, knowing you can have anything you want—and being able to eat it," says Smith. "It was the highlight of the trip."
Aside from her visit to the allergy-friendly bakery, Zoey only eats food her mom has packed beforehand or prepares during their stay. When a trip is approaching, Smith orders a double supply of Gerbs seeds, a snack she relies on. She also bakes extra batches of bread, such as pumpkin and sandwich bread, slicing and freezing individual slices so they’re ready to pack for the trip.
Like Smith, the activity in my kitchen ramps up a few weeks before my family’s trip to the beach. I freeze cupcakes and slices from birthday cakes and make several double batches of muffins. A loaf of bread, sliced and frozen, along with Daiya dairy-free cheese and my George Foreman grill, mean I can make grilled cheese for a nice lunch break from the sun. My children help me plan the menu for the week, so I know what tools I need for the meals I make there, as well as which entrees I can cook ahead and freeze, such as allergy-friendly baked ziti, pizza and turkey. Because my son doesn’t eat at restaurants, this preparation ensures he has plenty of the food he likes.
Having grocery stores nearby means we can replenish the refrigerator while there. Medicine and medical supplies, however, are not as easy to come by. So before a trip, I make sure we have up-to-date prescriptions, any safe over-the-counter medications, current emergency plans and a nebulizer.
We fill bags and coolers with food and supplies as I check items off my list. The food I prepared ahead is transported from the freezer to a cooler. Dry goods, such as pasta and cereal, and essential cooking tools are put into bags. Then I fill up a snack bag for the car—fresh fruit, safe chips and other favorite munchies. When the medicine bag is put in back next to the beach toys and the safe sun block, it’s almost time to go.
Smith packs her car with Zoey’s medical supplies, food and cooking pans. She also brings a few mini-bottles of CeraVe cleanser so that Zoey can wash her hands at rest stops. (Standard hand wipes tend to make Zoey’s skin burn, Smith explains.) She throws in extra clothes so Zoey can change outfits should she be exposed to one of her allergens, such as pet hair.
"Obviously, I can’t douse her in the tub while on the road. The quick change makes it feel like a little Vegas show," she says with a smile.
On the Road
Ready for the long drive from Kentucky to New Orleans, Jessica Brown climbed in the car with her husband, son Isaac and a huge tote bag filled with snacks—Enjoy Life bars, fruit strips, dried fruit, cereal, small fruit cups and juice boxes. Isaac’s medication was packed, including four sets of EpiPens, and Brown’s backpack carried a supply of wipes.
The family was in Alabama when it was time to stop for dinner. Brown checked the AllergyEats app for restaurant recommendations. There were no eateries listed in that area so they settled on a familiar restaurant chain that had served them safely at home. When Brown asked for the allergy-friendly menu, she was met with confusion. Finally, the hostess returned with a menu.
"It was a Braille menu,’" Brown says.
Leaving her table to search for a manager, Brown got a peek inside the kitchen and decided the level of potential cross-contact was unsafe for her son—regardless of the type of menu. They left a tip and headed for the highway, counting on the snacks in the car to stave off hunger until they reached their destination.
"The Braille menu experience was scary," Brown says. "But it reinforced my policy to follow my gut feeling about whether a restaurant is safe."
"Most families with food allergies have had this type of experience," says Critz of My Magical Journeys. "If you’re not comfortable, you should get up and leave."
Tarah Jakubiak of Greensboro, North Carolina, who has traveled since the age of two, has had her share of restaurant visits that end without eating. (Jakubiak is allergic to eggs, nuts, peanuts, mushrooms, garlic, sesame, soy, shellfish, most fruits, chicken and pork, along with having asthma.) In these instances, she tries a different restaurant or falls back on the food she carries with her.
"I've learned during my years of traveling to always have food on me," says Jakubiak, who is president of Allergic Traveler, an online supplier of dining cards for those with food allergies. "I’ve been in situations where I haven’t been able to eat for 8 to 10 hours because nothing was open or whatever was open served food I couldn’t eat," she says. "That’s why I always have food on me."
Jakubiak started Allergic Traveler after asking friends to translate a dining card she had created for herself so that she could travel abroad more safely. She now works with over 17 translators to produce dining cards in various languages.
"Since it is prepared by others, each meal when traveling carries the concern of a hidden allergen," says food allergy researcher Scott H. Sicherer. "It is vital to have a good line of communication with those preparing the meals."
A study that Sicherer co-authored in 2007 revealed that restaurant personnel can have misconceptions about preparing a safe meal. They might erroneously think it’s okay to remove shrimp from pasta or nuts from a salad or that fryer heat destroys fish allergens, he says.
"Describe the foods you need to avoid and alert the staff to issues of food allergy and cross-contact," he advises.
Jakubiak uses the wallet-size dining cards every time she visits a restaurant, whether at home or during a trip. At a restaurant, she first hands the card to a server. If she’s not satisfied with the server’s response, she asks to speak to the chef. She also uses her knowledge of ingredients to make suggestions and inquire about what menu items might work.
"Having allergies has turned me into a foodie," Jakubiak says. "I’ve educated myself about what items I can substitute, what will and won’t work."
Jakubiak’s ability to effectively communicate about her dietary needs has literally opened up the world to her. She travels extensively throughout the United States and around the globe.
"I’ve always had this sense of freedom, despite food allergies," she says. "I get to see all of this history and culture. I find it very awakening."
Upon reaching our destination, I inspect the beach rental for any food residue and dust. A cleaning service has gone over the place but they weren’t cleaning with a food-allergic child in mind. I wipe down all surfaces, alleviating my concerns about cross-contact. We then unload the car and get settled into our home-away-from-home for the week.
The sun is starting to set over the ocean when we walk down to the beach to join other family members who arrived earlier. My children join in with their cousins, chasing a football across the sand. I’m sitting at the water’s edge when I hear my son’s laughter floating above that of his cousins’. It makes all the preparation worth it.