When Diane, a 22-year-old graduate student at the University of Maryland, packed for a three-week study abroad course in Morocco in winter 2013, she never thought she would need her epinephrine auto-injector.

Diane figured she had long outgrown her food allergies. She hadn’t had an allergic reaction to peanut since 2000 – when she was 9 years old.

Two weeks into the trip, Diane was shocked to find her body covered in hives. What caused the allergic reaction?

Could have been a noodle dish she ate for lunch at a Thai restaurant earlier that afternoon, even though the waiter assured her it was cooked without nuts. Maybe there was peanut in the chocolate gelato she ordered afterward?

It was a mystery, but she knew she needed medical help. Her lips felt tingly and she briefly felt tightening in her throat. “I could feel my whole body reacting,” she said.

In the following 48 hours, Diane went to hospitals in Rabat, Casablanca and Marrakesh, once in the middle of night. She was given multiple shots of cortisone, an intravenous (IV) corticosteroid and antihistamine pills similar to Benadryl – but not epinephrine, the first line of treatment for a severe allergic reaction including hives. The doctors declined to give her epinephrine because they believed her breathing was not distressed.

Diane followed her doctor’s instructions at each hospital, and her symptoms improved. A few hours later, though, the hives would return worse than before.

On the last day of the trip, Diane’s hives finally cleared up. She feels fortunate that her allergic reaction did not progress into life-threatening anaphylaxis. And she regrets not packing her epinephrine auto-injector.

“I learned you should never underestimate your allergies or past allergies,” Diane says. “Take every precaution necessary, even if you think it’s unnecessary, and always be prepared. I’m never going to travel without my epinephrine auto-injector again.”

Before You Go…

Allergy and asthma don’t have to keep you and your family from enjoying a trip, whether it’s domestic or to a foreign country. Safe travel starts with sound planning.

Schedule a checkup with your primary care physician or allergist prior to a trip. You can’t expect to stay healthy away from home if your asthma or allergies are acting up at home.

  • Discuss where you’re going and what you plan to do. Is it a different climate that might affect your asthma, such as a higher altitude with cold, dry air? Is it pollen season? Smog or pollution?
  • Ask your doctor if there are steps you can take to prevent symptoms during your trip, and request prescription refills.
  • Check with your insurance provider and confirm you’re covered for any health care costs incurred during travel. You may need to pay out of pocket and then file later with your insurance company. For overseas trips, consider purchasing additional temporary travel insurance.
  • Research the area you’re visiting and map out directions to the nearest hospital or emergency care clinic. Find out the name and telephone number of a local allergist.

When traveling by plane, check Transportation Security Administration regulations for carrying medications or medical equipment. (Call 855.787.2227 or visit www.tsa.gov/travel.) Airports outside the United States sometimes have their own regulations, so check before you leave.

Pack Your Bags

Andrea Jensen of Salt Lake City, Utah, and her three children each have asthma and they pack extra medication when traveling.

“Peak flow meters, nebulizers, inhalers, allergy medication – they’ve gone with us to Disneyland, the Grand Canyon, everywhere,” she says. “Plus, my son is allergic to tree nuts and I’m allergic to seafood, so we carry our epinephrine auto-injectors.”

Peak flow meters, which monitor breathing, are typically electric or battery-operated handheld units. Nebulizers, which deliver medication to lungs in fine mist, require power but are also available as battery-operated units. Purchase a power adapter separately to fit your car or use in overseas electrical outlets.

Always pack your medications in carry-on luggage and keep emergency medications you might need during the flight at hand rather than the overhead luggage bin. If you’re at risk for anaphylaxis, carry two epinephrine auto-injectors because a second dose is sometimes needed. And don’t forget to seek immediate medical treatment after administering epinephrine.

Keep your medications in their original containers and include a signed letter from your doctor explaining your need for medication.

Leavin’ On a Jet Plane

Dreaming of a vacation in a faraway land? To get there, airplane travel is likely the best mode of transportation, but it presents challenges for people with food allergies, pet allergies or asthma.

Call the airline ahead of time or visit its website to find out policies for in-flight snacks and meals, pets, and allergy and anaphylaxis. Information on websites can usually be found under “Special Travel Needs.”

Some airlines continue to offer in-flight bags of peanuts, exposing nut-allergic passengers to allergens. A recent international study by Matthew Greenhawt, MD, director of research at the University of Michigan Food Allergy Center, revealed that 1 out of every 10 airline passengers with nut allergies reported an allergic reaction during flights.

Nut-allergic passengers were less likely to experience a reaction if they informed the flight crew of their allergies and requested special accommodations, Greenhawt says. These measures included:

  • Requesting a peanut/tree nut-free meal
  • Avoiding airline-provided food
  • Requesting a peanut/tree nut-free buffer zone
  • Requesting other passengers not eat nut-containing products
  • Cleaning the tray table with a sanitary wipe
  • Avoiding the use of airline pillows or blankets

During a flight, you could find yourself sharing the passenger cabin with dogs, cats and other furry animals. If you have pet allergies, the presence of animal dander could cause symptoms to flare up.

Airlines allow a few pets or trained service animals to travel in the cabin each flight. Most require pets to stay in carriers under the seat in front of the passenger bringing the pet aboard – but there may be no such restriction for a trained service dog.

When you make your reservation, request to sit as far away as possible from pets; some airlines require at least 24 hours notice for a seating accommodation. Also, pre-medicating may help.

Some people with severe asthma may need oxygen to adapt to reduced air pressure in airplane cabins. Discuss with your doctor whether you’ll need in-flight oxygen. Some airlines do make oxygen available to passengers – you cannot bring your own on board – but it’s best to make this request at booking.

A Side Trip Gone Awry

Nicole was up for an adventure.

The 21-year-old college student from Danbury, Conn., traveled with a friend to Cairo, Egypt during 2013 winter break. On a whim, they decided to take a 16-hour, overnight train ride to Aswan in the southern part of the country.

Nicole packed lightly but inadvertently left her albuterol inhaler at a youth hostel in Cairo. Her train car was filled with cigarette smoke and by the time she arrived in Aswan, she was coughing and wheezing and it hurt to breathe.

Nicole first went to a pharmacy to find out if she could get a bronchodilator inhaler over-the-counter, as is common in Egypt. She asked for the medication using its chemical name – albuterol.

“The pharmacist just gave me a blank stare,” she said. “The language barrier was just too difficult and I felt like I was getting nowhere.”

Nicole took a taxi to a nearby clinic where she received treatment. When the doctor handed her an inhaler, she saw the chemical name was salbutamol. Turns out that’s the international name for albuterol. (The international name for levalbuterol tartrat­e inhalers is levosalbutamol.)

“Lesson learned – always bring your inhaler,” Nicole said upon returning to the United States. “Write down the chemical and brand names of the drugs you use, especially when traveling to a foreign country, just so there’s no confusion.”


Reviewed by Stanley Fineman, MD, Tera Crisalida, PA-C, and Andrea Holka