Traveling with food allergies — and epinephrine

For millions of people with food allergies, every trip seems like adventure travel. Like mountain climbers and trekkers, they must have their own gear and rely on themselves to cope with risks that could prove life-threatening.

"It's like Russian roulette," said Jamie Hintzke of Pleasanton, Calif. "You've got to be super-careful."

The challenges can be formidable, but they needn't keep sufferers from leaving home, doctors and travelers say. They just have to prepare.

Hintzke's 12-year-old son, Max, is severely allergic to peanuts and tree nuts. So she wipes down armrests, tray tables and audio-control buttons before Max takes his seat on a plane.

She quizzes restaurants about ingredients and food preparation. At hotels, mother and son take their own soaps (some brands are made with nut oils), and Max skips the chocolate on the pillow, which might contain nuts.

"We don't touch doorknobs," Hintzke said. "We don't touch railings."

Despite these precautions, she said, Max once broke out in hives when fellow passengers opened packages of macadamia nuts on a flight from Hawaii.

Information

Food Allergy & Anaphylaxis Network: It has useful travel tips on its Web site, www.foodallergy.org.

The Hintzkes always carry medications when they travel, including epinephrine, which can counter allergic reactions. And travel they do, to London, Denver and Walt Disney World in Florida.

"It is a lot of work, and I suppose we are tempting fate," Hintzke said. "But we have decided not to live life fearing the 'what if.' "

Catherine Watson, of Minneapolis, who is severely allergic to peanuts, also is not deterred.

She still works as a freelance travel writer despite twice detouring to emergency rooms last year after ingesting unexpected peanut bits in beef stroganoff at a Los Angeles restaurant and in vanilla ice cream on a stop while driving home from Galena, Ill.

Among Watson's rules of the road:

"I don't eat anything on airplanes, even trans-Atlantic travel," she said.

And in restaurants, she presents the staff with a laminated note card that displays a peanut with an "X" across it that says in several languages: "Do not give me peanuts. I will die."

About 12 million Americans are thought to have food allergies, said Dr. Scott Sicherer, associate professor of pediatrics at Mount Sinai School of Medicine in New York and author of "Understanding and Managing Your Child's Food Allergies."

Although many foods can trigger allergies, Sicherer said, peanuts, tree nuts (such as walnuts and Brazil nuts), fish and shellfish tend to cause the most severe reactions, including anaphylaxis, which disrupts breathing and circulation and can be fatal.

Eating half a peanut kernel can cause potentially life-threatening reactions, Sicherer said; for some people, eating smaller amounts or just breathing peanut dust can cause problems.

The food-allergic traveler has few legal allies.

The notion that airlines must provide "peanut-free" zones is an urban myth. No such federal law exists, said Bill Mosley, spokesman for the U.S. Department of Transportation.

In 1998, the agency proposed that U.S. airlines refrain from serving peanuts in the row where an allergic passenger sits, plus the row in front and the row behind, he said, but later that year Congress prohibited the DOT from enforcing such zones.

Federal law requires airlines to include epinephrine in onboard emergency medical kits, although doctors say patients with severe allergies should always travel with the loaded syringes.

Today, several airlines, most citing allergy concerns, say they don't serve peanuts, among them American, JetBlue, Northwest, United and US Airways. But Continental, Delta and Southwest still do; policies vary.

If you notify Southwest of an allergy, for instance, it will serve pretzels instead of peanuts on your flight, spokeswoman Marilee McInnis said.

Continental does not do this.

"We do not set up a peanut-free zone," said Continental's Mary Clark. Such an action, she explained, would mislead customers into thinking the cabin is free of allergens, which the airline cannot guarantee.