travelling asia with a nut allergy

What it’s like travelling in South East Asia with food allergies

South East Asia’s relaxed food regulations, combined with language barriers, can make it a daunting destination for those who suffer food allergies.

The idea that a trace of peanut or cashew is enough to kill an allergy sufferer is absurd to some people, but believe me,  it can. I know this from personal experience; if I ingest an allergen, I’ll go into anaphylactic shock within minutes, requiring an Epi-Pen and immediate medical attention. If I don’t receive help in time, I could die.

Traveling with severe allergies presents unique and stressful challenges. There have been times when I’ve skipped meals while traveling, because I didn’t feel certain that something is safe. I’ve relied on others to explain – in a foreign language – my allergies. And I’ve picked through meals before eating them to check for peanuts.

A local who understands your allergies can help with what you can eat.

None of these challenges mean you shouldn’t travel, or limit where you go. If South East Asia is calling to you, go for it! When you do, keep the following tips in mind.

1. Do some research before you travel

Before you head to South East Asia, read up on the region’s local cuisine and food practices. You will want to research the specific country you’re visiting, as food culture varies across this region of the world. Look up the primary dishes and ingredients used to see how prevalent your specific allergen is. This will give you an idea of specific dishes to avoid.

South East Asia is known for their use of nuts, making it a challenging destination for nut-allergy sufferers. The good news is that nuts are typically used as a garnish, so they can usually be omitted from dishes. In Vietnam , I was often able to eat pho, as long as I ensured they left off the peanut garnish! In Cambodia , I ate dumplings and noodles, because peanuts weren’t prevalent in those dishes either.

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It’s lucky I’m a big fan of pho!

Another reliable trick is to research what fast food chains and restaurants are available in your destination; when I first arrived in Ho Chi Minh City, I ate McDonalds. At that point, it felt safer to eat dishes that were familiar to me, than to eat street food.

Another element of research before you travel is medical attention. Look up the names of hospitals, emergency phone numbers, and availability of ambulances. In some cases, taking a taxi might get you to a hospital faster than an ambulance. In some regions of South East Asia, private hospitals are available to foreigners, offering English-speaking doctors and faster treatment; it’s wise to look up the names and address of these hospitals before you go. Keep this information close to you – on a piece of paper in your wallet, or in your phone.

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2. Let your fellow travelers know

Finding this egg coffee in Hanoi was a delicious highlight!

Traveling alone with food allergies can be scary. I have found that traveling with other people who know about my allergies helps immensely, which is why my first trips were done through group travel!

A group travel leader can’t take ultimate responsibility for your safety (that’s all on you), but they can generally assist in managing your restrictions while traveling. In my experience, group travel offered a sense of security and mental support that I wouldn’t have had traveling on my own. I’ll never forget one particular day with a group in Northern Thailand . I had ordered a meal, but when it arrived I saw it had peanuts crumbled on top. My new friends saw my dismay and all offered me portions of their food that were peanut-free; with a bit of effort, I was safely fed! It was calming to know that my fellow travelers and leaders were aware of the unique challenges I faced, and would be there should anything go wrong.

Whether traveling with a friend or as part of a group, it’s important to let people know of your specific allergies, the medications you carry, what kind of medical attention you need in the event of a reaction, and how to identify a reaction. Those around you can only help you if you’ve given them the tools to do so.

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3. Prepare yourself for challenges

Before traveling, make sure you have packed everything you might need to make your experience safe and enjoyable. My prep list always includes extra Epi-Pens (in case you lose one); I generally keep one of them on me, and one in my luggage. I always pack antihistamines to ease any minor reactions I might have, and if you have a medic-alert bracelet, wear it throughout your trip as an extra precaution.

It’s also recommended to have your doctor/allergist write you a medical note, in the event that airport security personnel question your medications. I carry translation cards which explain my allergy, and the medical attention required for it (you can buy these online).

Stock up on fruit and you’ll always have an allergen-free snack.

I also try to bring my own food, where possible. While traveling around South East Asia I always carried snacks with me: safe granola bars from home, protein powder, and locally sourced fruit. By arming myself with snacks, I ensured I had something to eat in the event that I wouldn’t be able to find a meal that I felt was safe to eat. Snacks are a must for flights as well, because many airlines still serve allergen foods, and don’t offer safe meal options to allergy sufferers.

Flights can sometimes be an exceptional challenge; I have spent entire flights with a scarf wrapped around my face to avoid inhaling the smell of peanuts. But hey, it gets me to my destination safely!

RELATED: 4 REASONS NOT TO TRAVEL – AND WHY I IGNORED THEM ALL

Lastly, your preparation should include travel insurance. Make sure to inform your insurance company of any allergies ahead of time.

Traveling South East Asia with food allergies can be a bit nerve-wracking and scary, and your experience will be very different to those who travel without restrictions. A food allergy means you may not be able to eat some of the street food, or try a few local delicacies. But when you find something that you can eat, it will be elating!

As frustrating as traveling with allergies might be, remember that South East Asia has so much to offer; food is only one element of that. You’ll also get to experience the culture, nature, history and adventures, and you’ll be so glad you did.

Travelling with a food allergy or intolerance? Let your agent know when you’re booking, and tell your leader when you arrive. Check out our range of small group adventures, led by expert local leaders, in Asia now . 

All images by Erin Hynes. 

Feeling inspired?

When Erin was 19 years old she moved on a whim to Venice, Italy, where she spent several months working in a hostel and running a pub crawl. It was there that she earned the nickname Pina... because “Erin” is hard to pronounce if you speak Italian. The name stuck, and it is now her travel alias. Erin Hynes is a writer (pinatravels.org) and humanitarian worker based in Toronto, Canada. To see where she is today, follow @pinatravels on Instagram.

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10 Tips for Traveling Southeast Asia with a Peanut Allergy

Note: we are not medical professionals. ALWAYS consult your doctor before traveling Southeast Asia with a peanut allergy.

You’ve been dreaming about visiting Southeast Asia for a long time now. Its white-sand beaches, friendly people, tasty food and incredible wildlife have been calling out to you. But one thing is holding you back – an allergy to peanuts and these crunchy morsels happen to be included in a lot of Asian cuisine.

And you’re certainly not alone. According to FARE (Food Allergy Research and Education) allergies to peanuts/tree nuts more than tripled among U.S. children between 1997 and 2008. In the worst cases, sufferers can go into anaphylactic shock where the throat can swell, blocking the airways.

In Asia, to compare, peanut allergies are not much of an issue. Westerners are about twice as likely as East Asians to be allergic to peanuts, according to the Journal of Allergy and Clinical Immunology.

If you suffer from a peanut allergy and have decided to travel to Southeast Asia, we’ve compiled a few tips to help keep you safe.

1. Consult your doctor first

Always seek medical advice from your GP or a travel doctor before traveling Southeast Asia with a peanut allergy. It’s likely you won’t be the first person to ask your doctor about traveling with this particular allergy in Asia, so your GP should be well-prepared with guidance and be able to advise the medication you’ll need to bring with you on your travels. You should also ask your doctor to write you an official note explaining your peanut allergy and your required medication, so that you are prepared if you’re asked any questions at airports or in the places you are traveling.

2. Be careful when eating street food

If your peanut allergy is at the severe end of the spectrum, it may pay to avoid street food altogether, as you can’t be sure of what’s in it. However, experiencing street food is a large part of enjoying and getting the most out of your Asian travel experience and some bloggers allergic to nuts tend to prefer eating street food as you can see the chef and all the ingredients right before your eyes. But if you don’t want to take the risk, often in cities like Bangkok (Thailand) or Hanoi (Vietnam) you can also find tasty street food dishes in restaurants.

Restaurants might be a little pricier but if it’s a tourist-geared restaurant the staff will be more likely to speak English and it should be easier for you to communicate your allergy and find out what does or doesn’t contain nuts. However, even in a restaurant one should always be cautious and inspect food closely before eating it.

See some common dishes that contain peanuts below:

You should also be particularly careful with dipping sauces. Often peanuts can be blended in and combined with another sauce (barbecue sauce in Hue, Central Vietnam, for example) which means the peanuts are far less detectable.

3. Carry a translated note

Bring a translated note with you (otherwise known as an allergy card) in the most common language of the country/countries you’re visiting. The note should explain that you have a peanut allergy, include an image of a peanut for further transparency, describe what could happen to you if you ingest peanuts and instruct on what to do if you should suffer a reaction.

For example, if your allergy is severe and there’s a chance you could go into anaphylactic shock and require a jab from an Epi Pen – make it clear that you carry a pen on you. If you have a number to call or a hospital address, include it on the back of the note, along with the phone number of your country’s embassy.

Brokerfish.com offers free, printable allergy cards in Chinese and Thailand Foodallergytranslate.com offers an app allowing you to store digital allergy cards on your phone, or create printable cards; and you can select from a range of Asian languages including: Chinese, Indonesian, Malaysian, Korean, Japanese, Thai and Vietnamese.

4. Find your closest hospital

Spend some time researching hospitals in the locations you are visiting when traveling Southeast Asia with a peanut allergy. You could ask your travel insurance provider to recommend some safe hospitals with high-quality medical care. Keep a note with the address and telephone number of the closest hospital to you in your wallet or purse in case you should need it.

5. If your allergy is severe, consider traveling with someone

Having a travel companion is a good idea if you suffer from a peanut allergy. This way if anything should happen, you’ll have someone to help you find treatment as soon as possible. The companion should be briefed on the warning signs for if you have a reaction and told what to do if one occurs.

6. Visit local markets and cook your own food, or try a cooking class

Asia is a place full of bustling markets and visiting them is a great way to get a taste of culture . Why not head to the local market and pick up some fresh produce. There are Airbnb’s all over Asia, many of which include their own kitchens for cooking. And many hostels also have kitchens and cooking appliances for guests to use.

Otherwise, why not try a cooking class? You can easily find classes in destinations all over Asia, run by English-speaking chefs. This way you can be 100 percent sure what you’re preparing doesn’t contain nuts and learn some new cooking skills to take back home with you.

7. Notify your airline in advance

When traveling to Southeast Asia with a peanut allergy, always notify your airline in advance about your allergy so when booking meals they can ensure you aren’t served any food containing nuts. If you want to be extra safe, bring your own food with you to eat on-board and wipe down your seat and tray table before sitting down. Even if you’ve notified your airline about your allergy in advance, remind them again when you get on the plane. And if you have an allergy card or doctor’s note, present it to them.

8. Carry medication with you at all times

This might sound like an obvious pointer, but always make sure you carry any required medication at all times. Stay in the habit of putting it in the same place and always check you have it before leaving your room. You should also bring more medication than you need and store it in different places in case you happen to lose any.

9. Bring some food with you

It’s a wise idea to have a back-up plan. So, bring some non-perishable food with you. This will be especially useful if you want to travel further out from the city where there are fewer hospitals and reliable medical treatment.

It may not be as tasty as Asian cuisine, but you can rest assured knowing you’ll be safe while eating it and you won’t go hungry. You can find non-perishables easily at supermarkets in the capital cities of Thailand, Vietnam, Laos and Cambodia. Try to look for food with English labels so you can be sure there are no traces of nuts.

10. Follow travel bloggers with nut allergies

Of course, one of the best ways to ensure safe travels with your allergy is to hear first-hand from someone in the same position as you. There are many bloggers online who have traveled Southeast Asia with a peanut allergy.

We suggest the bloggers below:

• Earthtrekkers

A blogger who travels the world with her family and has a son who suffers from a peanut allergy. Together they’ve traveled through Thailand, Cambodia, China, Myanmar, Vietnam, Taiwan and India.

• Young Adventuress

An American blogger who travels the world despite suffering from a severe peanut allergy.

• Erin Morawetz

Morawetz has written about her experience staying a month in Thailand with a peanut allergy and offers advice to fellow sufferers.

We hope our 10 tips have been helpful. But, once again, always seek medical advice from your doctor before traveling to Asia with a peanut allergy.

Happy and safe travels every body!

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Travel in Southeast Asia with a Nut Allergy: My Experience

Megan Greenhalgh in Lifestyle Travel on 18 November, 2018.

Should a food allergy prevent you travelling around the world? Surely not.

This was my assumption when signing up for a trip to Cambodia this summer; my peanut allergy did not cross my mind, rarely thinking twice about what I’m eating in the UK where I simply avoid anything that explicitly contains peanuts. In fact, it was rather close to my departure that I began to really consider how difficult managing my allergy would be whilst travelling within Asia. I turned to the internet for advice.

Big mistake. Scrolling through countless websites, blogs and articles about travelling within South East Asia with a nut allergy I was faced with almost blanket negativity. Some sites emphasised how incredibly careful you would have to be, others warned people to abandon their plans altogether. Naturally, this filled me with anxiety. With the trip coming I quickly began to pick apart why exactly the perceived risk was so high

Certainly, travel in general with any type of allergy can be a challenge. The risk of travelling abroad for severe and fatal food allergic reactions hasn’t gone unnoticed. The tragic case of a girl dying after eating a Pret Sandwich on a British Airways flight to Nice occurred just earlier this year.

From my online research, I received the impression that South East Asia, in particular is a difficult area of the world to travel to with a nut allergy:

The prevalence of peanut allergies within Asia is found to be much lower than countries like the UK, for example with much speculation as to the reason for this. Some website claimed that because of the climate of tropical destinations such as Cambodia, the protein found within peanuts that results in allergy acquisition is broken down and thus rates are much lower, whilst others attribute this to their increased exposure to people at an early age. Owing to these stats, there was a general consensus amongst the online community that people are much less likely to understand what a peanut allergy was. It seemed important to be careful when reporting to restaurant staff as they may not comprehend what you mean, let alone prepare food in a way that would cater for your needs.

Another risk factor identified was the fact that peanut oil was used frequently to cook food within countries like Thailand, Vietnam and Cambodia. Often used in various dressings and sauces, I read warnings that even simple foods such as fries may be cooked in a way that could trigger an allergic reaction. Furthermore, further research seemed to detail that refined peanut oil is suitable for most peanut allergy sufferers, whilst the unrefined kind is more likely to cause reaction (informative, but not at all helpful since it is unlikely I’d be able to ask what type of oil they use in Cambodia’s native language Khmer!)

Rice with Morning Glory

Essentially, this research made me incredibly nervous about both the journey to Cambodia and my 6 weeks spent in the country so I aimed to prepare myself as much as possible. I thought that I’d share my advice so that others don’t travel unprepared.

Contact the Airline: As I wasn’t the one who booked my flights to Cambodia, I had little knowledge of Cathay Pacific’s allergy policy and left it rather late to research (the day before, when they request 72 hours notice is NOT ideal.) Turns out I had to sign a form stating to bring my own food onto the flight since they could not guarantee any of their food was peanut free AND gave out peanuts as snacks on the flight. Personally, I think there are airlines with much better policies, since they refuse to make an announcement to other passengers like many others without a letter form a doctor. (I could have protected myself better if I had acted earlier.)

Research Local Dishes: I carried out rather extensive research into Cambodia’s local cuisine in the lead up to my trip as well as getting in contact with local eateries enquiring as to whether they could cater for nut allergy sufferers – this I think was an over-preparation, done more for my own peace of mind than anything else: whilst there I did not have a single problem.

Purchase Allergy Translation Cards: I ordered these from Allergy UK, something that also seemed rather excessive since they translated “If I eat peanuts, I will die” into Khmer. They were rather pricy, yet a useful safety net if it ever becomes difficult to communicate your allergy to restaurant staff.

Bring an Extra EpiPen: I went from often forgetting to take my Epipen anywhere in the UK to taking 10 with me for the trip just in case – this was really important as I may not have had access to one abroad I needed one. I also got a letter from the doctor stating why I was carrying them in case they were questioned at the airport.

Know your Allergy: This is the most important factor and something I definitely did not have covered before my trip – I had little clue about how severe my allergy was or what may trigger it (although having not had a reaction since aged 7 I had a pretty good idea it wasn’t too severe.) I was actually incredibly lucky that my allergy isn’t triggered by airborne particles as that would have been a problem on the plane.

Whilst I was extremely nervous towards the beginning of the 6 weeks, none of the problems I read about ever materialised and as the trip went on, I began to behave just as I did in the UK. In fact, it has made me wonder if all the negativity I found online was simply speculation and non-reputable – it was certainly outdated and perhaps stemmed from a fear of places far away, differences to the West and simply a fear of the unknown. The notion that allergy sufferers should abandon their trips abroad is one I definitely don’t agree with, yet I understand that there the severity of allergic conditions vary massively and preventative measures are hugely important.

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The truth about travelling to Thailand with a peanut allergy

Escape's Doc Holiday, Dilvin Yasa, answers your travel-related questions.

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Nut-free dining in phuket, do you know of any resorts in phuket that cater specifically for a peanut allergy.

My sources on the ground in Thailand (huge shout-out to the Tourism Authority of Thailand) have done quite a bit of digging and unfortunately none of the hotels have strict protocols in place when it comes to guests and nut allergies. Instead, they recommend zeroing in on the properties you’re interested in and contacting them directly to ask them how they can help you to have a happy and healthy stay. 

Each property will have a different take on how best to manage such allergies. At Club Med Phuket, for example, guests can speak with the restaurant manager or a head chef to discuss their needs and be walked through the buffet each day to learn what can and can’t be eaten. The only real problem here is that unless you’re one of the first in the restaurant, there’s the risk of cross-contamination by other guests, so you’d have to stick to the dishes served up by the staff rather than the self-service options. Note too, that although kids with allergies can enjoy meals within the kids’ clubs programs, they will have to be accompanied and monitored by a parent. 

Meanwhile, Minor Hotels’ Phuket area director of sales Danat Thanooslip told me their hotels – which include Anantara and Avani – are quite particular with dietary restrictions and food allergies, and that all that needs to be done is for you to alert them ahead of your stay and this information will be passed onto the entire team, from villa operation to the kitchen.

No matter the hotel or resort you go with, make a point of sticking to cuisines where nuts and oils derived from nuts are easily avoided, such as Italian or contemporary Western, and be sure to have the hotel write the details of the nut allergy in Thai on a card you can give to waiters and chefs if you dine anywhere outside the hotel. 

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Do any 2023 castles and palaces group tours in the uk cover windsor castle, st james’s palace, westminster palace, st george’s chapel, dover castle, highclere and downton abbey locations .

It might sound unbelievable but there actually isn’t a single tour that takes in all of the castles and palaces you’ve listed. “To allow for flexibility, the London palaces such as Westminster tend to be individual products with day trips available to nearby castles like Windsor and Highclere,” says Kristen Angus of VisitBritain . “Day trips are usually grouped geographically to maximise time visitors can spend experiencing the castles, and minimise transfer times.” 

Kristen adds that it’s best to wait until September-October when 2023 product packaging is released, but in the meantime, they’ve suggested knitting together some Evan Evans Tours or London Private Tours (london-private-tours.co.uk) which offer trips taking in some of the palace and castle combinations. 

The Big Journey Company , too, has a 10-day tour that takes in some of the top castles and palaces and you could team this with a tour or two through Get Your Guide which has a wide range of smaller tours, including quite a few Downton Abbey filming locations. 

If you can’t find anything that quite fits the bill, Kristen recommends contacting operators directly. “If you’re travelling with a couple of people, you always have the option of contacting them to see what options exist for creating a private tour taking in all of your preferences,” she says. “Often it’s not as expensive as readers may imagine and this option allows them to maximise their holiday time by focusing only on the locations they’re interested in.” 

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14 Helpful Tips for Traveling With a Peanut Allergy

Last Updated on October 10, 2023

Traveling with a peanut allergy is daunting, but it isn’t impossible. I know because I’ve done it!

I was born with a severe allergy to peanuts and all peanut derivatives. Around 10 years old, I developed a severe allergy to kiwi, too. In my early 20s, I was diagnosed with exercise induced anaphylaxis, and a sensitivity to cashew. 

Although I have a couple allergies, my peanut allergy is the most stressful of them. Peanuts are way more present in kitchens and food manufacturing than people outside the allergic community realize. This is why so many items in grocery stores today have warnings that they “may contain peanuts.” 

If I ingest an allergen I will go into anaphylactic shock within minutes. I always carry two epinephrine autoinjectors with me, wherever I go. In the event of a reaction, I need to take 1 to 2 doses of epinephrine, and then get immediate medical attention. 

Living with these allergies has totally shaped my relationship with food, and it’s a source of a lot of anxiety and fear in my life. But, I have never wanted to feel held back by my allergies. 

The good news is, it’s absolutely possible to travel with an allergy! With some preparation and safety precautions, traveling with a peanut allergy is totally doable. 

Should You Travel With a Peanut Allergy?

What is it like to travel with a peanut allergy, canada, us, uk, australia, nz, turkey & morocco, central america, southeast asia, choose peanut-friendly airlines. , inquire about in-flight meals. , pack a meal for your flight., notify the flight crew. , wipe down your seating area. , 1. let your physician know , 2. request a medical necessity letter, 3. don’t travel for food, 4. choose your destination with care, 5. research local cuisine and food culture, 6. pack more medications than you expect you’ll need, 7. bring allergy translation cards, 8. use google translate (or other translation apps), 9. have a back-up plan for meals, 10. navigate menus abroad carefully, 11. be careful explaining your allergies in restaurants , 12. stick to “western” dining options, 13. book cooking classes to experience local cuisine, 14. purchase comprehensive travel insurance, final thoughts: travel with a peanut allergy.

It’s definitely important to acknowledge the risk involved when traveling with food allergies internationally. The risk presents itself daily because, well, we have to eat. 

Should you travel with food allergies is a very personal question, and so I’ll say it: There’s no right answer. Every allergic traveler should decide what their personal boundaries and comfort levels are when it comes to travel.

I myself have never wanted to feel inhibited by my allergies, and so I’ve found ways to make travel work, as safely as possible. Before traveling to high risk places, I do intensive research and prepare for every scenario. And, I make compromises.

For example, when I opted to go to Myanmar, a high risk destination for travelers allergic to peanuts, I knew it would be tough to manage my allergies, so I decided to keep the trip short.

Ideally, I’d have gone for 2-3 weeks, but because I knew it was going to be tough to safely feed myself there, I minimized the trip and went just for 8 days, with food packed. I preferred to have a short experience over no experience there at all, and in the end, the trip was worth it.

Traveling with a peanut allergy can come with unique and stressful challenges. When you’re in a country that has food culture and customs you aren’t familiar with, it’s much harder to figure out what is safe to eat. 

In my travels to 40+ countries across 4 different continents, I’ve sometimes needed to go to extremes to feed myself safely. 

In some cases, communication is difficult, and so I don’t feel assured that the severity of my allergy is understood. In other cases, I’m on edge because the nearest hospital is miles and miles away. 

To stay safe, I once spent a week on a rural Cambodian island eating only bananas and instant noodles. And one time I cried in the middle of a street in Kaohsiung, Taiwan, because the language barrier was making it difficult to explain my allergy to local restaurants.

Despite the frustration, insecurity, and fear that my allergies present, I have always found ways to accommodate them, even when this means taking extreme measures. 

For me, it’s worth the preparation and stress to be able to travel, because I get so much joy out of my travel experiences. If you want to go traveling with a peanut allergy but are nervous – Just know that it can be done safely, and it doesn’t have to be scary! 

Low-Risk Regions for Traveling With a Peanut Allergy 

Based on my personal travel experiences, these are the regions and countries where I’ve had the easiest time, and felt the safest, traveling with a peanut allergy. 

For obvious reasons, English speaking countries are stress-free to travel with a peanut allergy. Canada, the United States, the United Kingdom, Australia, and New Zealand are where it’s easiest to communicate the nature of your allergy to others. 

I have found that use of peanut oil is common in some parts of the US, and so it’s worth asking if it’s used in the kitchen when eating out in the US. 

Europe is also quite safe. Peanuts aren’t a staple in most European cooking, and peanut oil is rarely used. In many parts of Europe, people do speak some English, but in the event of a language barrier you can use a translation card or app to communicate. 

Although you’ll face a language barrier in Japan, peanuts aren’t widely used. I managed to find plenty of safe meal options, and restaurant staff were always receptive when I explained my allergy to them. Peanut oil is used in some restaurants, so it’s good to ask about that while in Japan. 

There’s a language barrier in both Turkey and Morocco, but luckily, peanuts aren’t widely used. I managed to find plenty of safe meal options, and restaurant staff were always receptive when I explained my allergy to them. 

In traveling around Guatemala, Nicaragua, Costa Rica, Belize, and Mexico, I’ve found that peanuts don’t appear in many popular dishes. For most meals across Central America, I stay away from the sauces that are placed on the table.

It’s still important to ask about peanuts before dining, though. There is a language barrier throughout Central America, but translation cards and Google Translate can help with that. When in doubt, it’s usually possible to order something “western.”

Higher-Risk Regions for Traveling With a Peanut Allergy 

Based on my personal travel experiences, these are the regions and countries where I’ve had the easiest time, and felt the safest, traveling with a peanut allergy.

This region of the world definitely has a reputation of being tough to travel with a peanut allergy. This is because peanuts are indeed used quite a lot in Southeast Asian dishes. 

While there are more peanuts around, there’s also plenty of safe eating options available. There are food chain joints like McDonald’s in many cities (always safe!) and lots of restaurants that serve Western-style meals like pizza and sandwiches.  

Traveling with a peanut allergy in Southeast Asia means you likely won’t get to try local fare, but you can still travel there safely!

Peanuts are used in many Taiwanese dishes, and so it’s important to be cautious when traveling Taiwan with an allergy. The good news is, you’ll find plenty of safe chain restaurants as well as Western-style restaurants, so safe options are accessible throughout Taiwan. 

Peanuts are used in many Chinese dishes, and so it’s important to be cautious when visiting Hong Kong with an allergy. The good news is, you’ll find plenty of safe chain restaurants as well as Western-style restaurants, so safe options are accessible throughout the city.

** The above notes about lower and higher risk destinations for people with peanut allergies is based on my own experiences. As I travel to more places, I will keep these 2 lists updated with my perceptions. 

Flying With a Peanut Allergy

One of the scariest parts of traveling with a peanut allergy is actually getting to your destination. Being stuck inside an airplane for hours, far from a hospital, is stressful. Especially when peanuts are served on the flight. 

Below are some tips for tackling flights with a peanut allergy.

Many airlines are moving away from serving peanuts, but it does still happen. When possible, you can opt to book airlines that no longer serve them. You can see an up-to-date list of airline peanut policies, here . 

I myself have yet to come across an airline that provides guaranteed peanut-free meals, but it’s worth asking! What I have found is that some flights stock snacks that are labeled, and often safe. 

I always play it safe with a meal I’ve packed myself, because I don’t think it’s worth it to risk eating airline meals. Just be sure to pack foods that can go through security (stay away from liquids, like yogurt).

Before boarding, head to the gate of your flight to let the crew know about your peanut allergy. They’ll often let you pre-board to clean your seat, and they’ll make an announcement informing other passengers to please avoid eating any peanuts they may have brought themselves. 

Give your seat, tray, armrests, and the general area around you on the plane a wipe-down with sanitizing wipes. This way, any residual peanut traces from meals eaten on prior flights is cleaned up. 

Essential Tips for Traveling With a Peanut Allergy

It’s always a good idea to let your physician or allergist know that you will be traveling with a peanut allergy. Sometimes, they’ll have tips or advice specific to the country or region you’re visiting, or they may be able to point you toward helpful resources. 

When you check in with your physician, ask for a letter of medical necessity. These are usually written by your family doctor or allergist. 

The letter explains that your epipens (or whichever autoinjector you carry) is for medical purposes. I carry one on all my travels to show flight attendants and security personnel in airports, just in case. To date, I’ve never been asked to provide the letter, but better safe than sorry. 

Can you bring epipens on flights?

Yes, you can bring epipens on planes because they are personal medical devices. You can bring your epipens in your carry-on luggage, and do not need documentation. Just be sure that the prescription label on your epipen is clearly visible. If it isn’t, consider bringing a medical necessity letter, just in case.

Understandably, eating local cuisine is a highlight for most travelers. As an allergic traveler, I have often felt pangs of jealousy in watching my partner eat delicious street food, or in hearing backpackers rave about a specific local dish.

Because eating local cuisine in many regions of the world comes with allergy risks, I actively do not travel for food. As much as I wish it could be a central part of my travel experiences, it just can’t. 

And this is ok, because travel is just as rewarding without being able to try local food. The fun part is that on those occasions when trying local dishes is safe, it feels like an extra special experience!

Traveling with a peanut allergy is easier in some regions of the world than others. Factoring this into choosing a destination will help you prepare for your travels, and guide your pre-trip research.

At the top of this guide, I shared a breakdown of which regions of the world I’ve personally found to be low-risk, and which have been higher-risk.

Just because a country or region of the world might be “harder” to travel with a peanut allergy because of lack of awareness, use of peanuts, or language barriers, doesn’t mean you shouldn’t travel there. 

But, understanding the challenges you’ll face in some destinations versus others might impact where you choose to travel. Choosing a destination will depend a bit on your personal boundaries and anxieties when it comes to your peanut allergy.

Before traveling to a new country, research the local cuisine to give yourself a sense of what ingredients are predominantly used.

This helps to familiarize myself with the degree of danger that eating in a local restaurant might present, and helps me to figure out which allergens are used in specific dishes.

For example, because peanuts are rarely used in cooking in Japan, I felt quite safe eating Japanese food. In Myanmar, I ate almost exclusively canned food that I had brought with me, because I knew that peanuts are a common ingredient in local fare.

Packing more medication than you’ll need ensures you have extras, just in case. Traveling with a peanut allergy, I always carry 4 auto-injectors. 

I typically bring 2 with me out for the day, and leave the other 2 in my hotel or hostel room. This way, if I need to use one, or for some reason lose the ones I have on me, I have back-ups available. 

I also recommend carrying two packages of diphenhydramine in tablet form. This antihistamine is extremely effective, and I often take it before a meal if I’m worried about cross-contamination.

Make sure to also research the local emergency phone numbers, availability of emergency transport, and the closest hospital,  so you’re prepared should anything go wrong. In some cases, I’ve decided not to travel to certain regions of the world because I know that hospitals aren’t within reach.

A translation card is a card with a message written in the language of the country you are visiting, that explains your peanut allergy. It typically describes the allergy, and the severity of a reaction. 

Translation cards can be shown to your waiter before ordering a meal. You can do translations online and write out a card yourself, ask hotel staff or a local to write a card for you, or you can go to Allergy Translation to buy printed, laminated cards. 

Another option is to ask someone you know, or hotel staff, to record a voice note explaining your allergy. I have done this for a few destinations, and it worked beautifully. I just played the voice note for the server to listen to. 

I mix the use of translation cards with my own judgment. When I eat somewhere, I scrutinize the menu, decide on my safest food option, and then carefully survey and smell the food before eating it. 

I often will opt for western- style meals such as pizza and pasta rather than local dishes, just because I’m familiar with what ingredients are in those dishes.

In some cases a server might have questions after reading a translation card. In those situations, having Google Translate (or another translation app) on your phone  is super helpful. 

You might even opt to skip the translation cards and just show a translation on the app, instead. 

Either way, be sure to purchase a local sim card with mobile data, or buy international data through your carrier, so that you’re able to get online when abroad. 

Traveling with a peanut allergy means I always travel carrying food. I typically devote a quarter of my pack to snacks and meals that I can rely on if I do not find an allergy safe food option. Every day, I bring some of these snacks with me in my daypack.

The best items I have found to carry include: Clif Bars (the only peanut-safe Clif Bar currently is the coconut chocolate bar), protein powder, oatmeal, instant noodles, broccoli, carrots, fruit. I typically bring the processed foods from home and buy the fruits and vegetables locally.

When I was in India , for example, I probably ate three bananas a day because they were always easy to find, fresh, they filled me up, and most of all – were safe to eat!

I am often asked if it is possible to bring food on planes. Yes, but avoid liquids (yogurt, pudding, etc.) because they may be confiscated for exceeding the carry-on limits of liquids. 

When you’re traveling with a peanut allergy, menus can be a huge source of anxiety. Don’t worry though, there are some steps you can take to minimize the anxiety (and risk!).

Ask if English menus are available. More often than not, restaurants in touristy areas all around the world will have some translated menus available. If they don’t offer it when you sit down, it’s still worth asking about – just in case.

Know your stuff ahead of time. I find that doing research on local cuisine before heading to a new country is super valuable: Learn the names of dishes, and figure out which ones are safest for you to eat. 

Use technology. For allergic travelers, smartphones and internet data are key to keeping safe. Always invest in some data when you travel so that you can access Google and Google Translate no matter where you are. If you don’t understand a menu, you can use Google Translate to take a photo of the menu, and the app will translate it for you.

Ask for help. Don’t underestimate the willingness of local people to help you. While traveling in The Netherlands , for example, I’ve found Dutch people to be very helpful in sorting out what is safe for me on a menu. You can ask your server, or ask someone sitting nearby.

Traveling in countries with a language barrier, I’ve found that sometimes there’s miscommunication. I’ve had situations where a person mishears what I’m explaining, and thinks I’m asking for peanuts. 

In some restaurants it may be better to stick to translation cards, or not mention your peanut allergy at all, to avoid confusion.

Another strategy is to order your meal, and once it’s arrived, ask about peanuts. This way, you know peanut hasn’t accidentally been added to the dish because the allergy was lost in translation. 

In traveling with a peanut allergy, I’ve found that choosing “western” style dining options is usually the safest. 

I know, it’s not thrilling to travel abroad just to eat things you have at home, like pizza, pasta, or sandwiches. But those foods are choices that are extremely unlikely to contain peanuts, or a trace of peanuts. 

Cooking classes are a fantastic way to experience local cuisine in a safe way. These experiences are usually led by staff who speak English, and because of their work with tourists, they’re typically aware of allergies. 

Since you’re doing all the cooking, you’re able to ensure your meal will be safe. A cooking class gives you the opportunity to taste local dishes, and you learn how to make something delicious, too!

I can’t emphasize enough how important it is to always purchase travel insurance if you’re traveling with a peanut allergy. An anaphylactic attack abroad could put you in hospital, and result in costly hospital bills. This is why nut allergy travel insurance is essential.

To save yourself the stress of hospital bills, and ensure you have support if something goes wrong, it is always worth it to invest in travel insurance for allergies. The cost of travel insurance is nothing when compared to the cost of a hospital visit abroad.

If you travel with a peanut allergy internationally, you’re likely aware of how difficult it is to find travel insurance that covers anaphylaxis.

This is because a severe food allergy is considered a pre-existing condition. Before buying insurance, call the insurance company to ask about their policy on allergic travelers. You’ll want to ask:

• If their policies include coverage of severe food allergies.
• If food allergies must be declared in advance for the policy to cover reactions.
• If they require a stability period to cover you – This is a period, which is typically 90 days, in which you’ve not suffered an anaphylactic reaction.
• If you can pay extra to be covered for your food allergies.

The main point is that when shopping for travel insurance, read the fine print and call the company to clarify before purchasing. Travel insurance for allergies is tricky, and so you’ll want to cover all your bases in advance.

If you have severe allergies and are nervous to travel, I totally understand. It can be overwhelming to leave your safe routine at home, and navigating food allergies while traveling isn’t always easy.

If you’re nervous, but travel is something you want to experience, I recommend easing into it. Start with short trips that are closer to home or around regions that are lower risk. When you start feeling more confident and comfortable, move on to higher-risk destinations.

Erin has been traveling for over a decade, both solo, and with her partner. She’s now traveled to countries across 6 continents, and has lived in 2 countries abroad. Erin also hosts the travel podcast, Curious Tourism , where she interviews travel industry thought leaders and experts about responsible tourism. Learn more about Erin, and get in touch with her, here .

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I never experienced this so far (hopefully I never will). It could be a real problem and can ruin your vacation especially if this happens to your kids! Thanks for the useful tips so we can know if we face with this 🙂

Milica – <a href=" https://beautifulwanderlustlifestyle.blogspot.com/">Wanderlust Lifestyle/text</a>

I don’t have food allergies and have never thought of this, so thank you so much for the insight. Thanks so much for sharing this with all of us!

Though I don’t have food allergies, its important for those who have the problem. Very good post, it would really benefit those suffering the same as the travel may be hampered to a great extent. Hence it is essential to take proper care to avoid any issues.

This is such great advice. I don’t have anu food allergies but I have diabetes so I have to always travel with my medication and insulin.

Gosh…this must be so scary. I’m so glad that I don’t have any food allergies. These are great tips. Being smart and doing research is a great way to be able travel even if you have food allergies. I guess worst case scenario would be just to bring your own food..I guess that would be cheaper too!

Thanks for the advice and useful tips on food allergies. I know someone who having this problem I am sharing with him. Hope this will help him

These are great tips! I’m so lucky I don’t have allergies x

I’m glad I’m only allergic to a certain kind of fish. It must have been quite a struggle initially for you but I’m glad you figured a work around to things and now able to share tips for others. This could actually save lives.

This was great advice and information as a mom to someone with a food allergy. My daughter is allergic to peanuts and tree nuts. We have 2 epi pens for her as well. We haven’t traveled out of the United States yet, but we do travel across our state. We try to eat at restaurants we know are allergy friendly. We always have an epi pen with us. I cannot imagine the struggle of traveling abroad with an allergy. I am sure it isn’t easy to have to pack your own food just in case.

Allergies can be the worst problem we can have during travel. It’s great to be prepared alway.

I know how hard it must be for you and you’ve really come up with some nice tips here! Btw, love your natural smile!

I have a good friend that is allergic to peanuts so we always have to be mindful of that when we travel! Thank you for shedding light on this topic!

This is really great advice. I’m fortunate not to have any seriously fatal allergies, but my niece is allergic to eggs and I always worry when I take her anywhere or even buy her food gifts from my travels which she loves. I read every label twice

Food is such a huge part of travel for us, and we’re lucky enough not to have any severe allergies…just some sensitivities to certain things. Important advice!

Great information, luckily my allergies are relatively easy to avoid (I just cannot eat seafood) but without this post, I would never know about the nut allergy insurance

This really useful information! Thank you a lot for sharing this!! https://goavilla.in/

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Nattie on the Road

Everything you need to know about traveling thailand with a peanut allergy.

I am allergic to peanuts, yep, I’m one of those people.

So when we were going to be traveling to Thailand I was a little nervous about what I was going to be able to eat. In my experience here in the US, almost all Thai food has peanuts on it. I’ve had more than one experience where I’ve ordered Thai food at home and forgotten to specifically ask for no peanuts and then have to send it back for a new dish. It’s a bummer.

So if you are like me and have a peanut allergy and want to visit Thailand, don’t hesitate, here’s what you need to know.

Traditional Thai food doesn’t use a lot of peanuts

• Aside from a few dishes most food doesn’t have peanuts in it. So you will be able to enjoy tons of rice, curry, and noodle dishes without fear of anaphylactic shock.

Dishes to avoid

• Pad Thai contains crushed peanuts on top as a garnish. Since it is a popular dish and there is the issue of allergies some restaurants will not add the peanuts, rather they will be in a condiment dish on the table.
• Massaman Curry contains peanuts in the curry sauce, sorry, you just don’t get to try it.
• Papaya Salad contains peanuts as a garnish on top. A lot of times it’s easy to just ask for this dish without the peanuts. I did have one occasion where I asked for it sans peanuts and they told me it wouldn’t taste good and recommended trying something else, which was a little strange, but I wasn’t going to fight the server on it, so I just went with a different salad.
• Satay Skewers will come with peanut sauce either drizzled on top or on the side for dipping. You can definitely ask for no peanut sauce when ordering, but it’s also a good idea to make sure that the meat hasn’t been marinated in the sauce either just to be safe.

Learn to some Thai

• I’m allergic to peanuts = chawn/pom-pay too-eh lee-song
• I’m allergic to nuts = chawn/pom-pay too-a
• Could you prepare a meal without peanuts = tam ah-hahn mai sai too-eh lee-song dai mai
• A lot of people do understand English, especially in big touristy cities, and most restaurant workers will understand “no peanuts” but it’s always good to know how to say it in their language too.

Go ahead and try some street food

• A lot of people and forums seem to say to avoid the street food if you have an allergy, but I would beg to differ. If you are ordering from a cart you can watch them make your food, and if you see them going for the nuts you can stop them. Although, if you have a severe allergy, like you could have a reaction from your food being in the same vicinity of peanuts, you will want to go for a cart that doesn’t sell anything containing peanuts.

Bring an EpiPen or two, or ten.

• Fun fact, I never had an EpiPen until I traveled to Thailand. In my everyday life it never seemed necessary, my allergy isn’t severe and I’m really good at not eating things that have peanuts in them. So it never seemed reasonable to spend an exorbitant amount of money on one. However going to a foreign country where I don’t speak the language you never know what can happen. So I figured between a $500 EpiPen pack and death, I’d fork over the cash.

Know your body and your allergy level, and be smart.

• This might be the most important thing because allergies can have different levels of severity. For me, I actually have to consume, like put in my mouth, chew, and swallow a peanut to go into anaphylactic shock. While other people can have a reaction just by smelling it, or eating something cooked in peanut oil. Knowing yourself and what your body can handle will be the first defence against having an allergic reaction. And lastly be smart, if something looks or smells suspicious either ask, or don’t eat it. I’d rather go buy something else to eat than have to break out my EpiPen 100% of the time.

Avoiding peanuts in Thailand is so much easier than a lot of people expect, which is awesome because they have some really great food there. And chances are if you have made it this far with your peanut allergy you know how to be smart, careful, and pay attention to what you are eating. So don’t let an allergy hold you back from experiencing some amazing food and culture in Thailand!

Do you travel with an allergy? What are your tip and tricks, and how do you deal with it? Let me know in the comments.

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9 thoughts on “ Everything You Need to Know about Traveling Thailand with a Peanut Allergy ”

Excellent post on traveling with an allergy! Did you feel like you were putting a lot of blind faith in the eatery to not put peanuts in your food?

Thanks so much! No more blind faith than I put in a kitchen to leave out the peanuts here in the states honestly. I think I only ever had one instance where I got food with peanuts on it whenI’d asked not too, and my boyfriend and I just switched dishes, I didn’t feel like causing a fuss.

That’s such an interesting and much needed post for those with allergies! I never even thought of that; this is genius! Thanks for sharing such important tips! Thanks for joining #FlyAwayFriday, hope to see you again this week! xo

Thanks so much!!!

Wow this is so informative!! My cousin also has a peanut allergy and he travels a lot for work so this would be something I’m sure he’d be interested in. I’ll have to share this with him!! Great post!

Thanks so much! If he’s ever in Thailand it’s good to know there are still things you can eat!

Hello.This post was extremely fascinating, particularly because I was browsing for thoughts on this subject last Friday.

The title should be everything you need to know about travelling to Thailand with a MILD peanut allergy. Someone with a severe allergy also has to consider cross contamination.

I use a Nima Sensor. Bought one recently after I saw a segment on the Today Show. Here is the link

https://www.today.com/video/rossen-reports-can-new-device-detect-peanuts-in-food-1422539843742

It is a small device that lets you test your food and signals if it is safe to eat. – Very cool.

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A Peanut-Free Paradise: Navigating Bali with a Peanut Allergy

Bali, an Indonesian island located in the westernmost end of the Lesser Sunda Islands, is a popular tourist destination known for its beautiful beaches, lush jungles, and rich culture. However, for individuals with a peanut allergy, travelling to Bali may seem daunting and even dangerous. Peanuts are commonly used in Balinese cuisine, and it can be difficult to communicate the severity of the allergy to locals. With the right planning and preparation, however, it is possible to visit Bali with a peanut allergy and enjoy all that the island has to offer.

Before travelling to Bali, it’s important to do some research on the local food and the most common dishes that use peanuts. Some of the most popular dishes that contain peanuts include Nasi Goreng, Gado-Gado, and the traditional Indonesian satay, which are skewers of grilled meat served with peanut sauce. However, many dishes can be made without peanuts, so it’s important to ask for dishes to be made without peanuts or to find alternative options. Being able to communicate about your allergies in the local language can be helpful, and learning some basic phrases can be very useful.

When dining out, it’s important to be clear and specific about your allergy and to ask questions about the ingredients in the food you are ordering. Many restaurants in Bali can accommodate peanut-free requests and may have alternative options that are safe for you to eat. Some restaurants may even have separate kitchens or utensils dedicated to preparing nut-free meals. It’s also a good idea to carry a translation card that clearly states your allergy, as well as ingredients and dishes to avoid. This way, it could be easier to communicate with the staff and increase your chances of getting a safe meal.

When booking accommodations, it’s a good idea to communicate your allergy to the hotel staff and request a peanut-free room. This can ensure that the room is cleaned with peanut-free cleaning products and that no peanuts were present in the room previously. You can also ask for a peanut-free floor or request a room with a kitchenette so you can store and prepare your own food.

When travelling, it’s also important to always carry your epinephrine auto-injector, as well as any other medications that you may need in case of an allergic reaction. You should also inform people you are travelling with or those who are taking care of you about your peanut allergy and how to use the auto-injector in case of emergency. It’s also a good idea to wear a medical alert bracelet or necklace with information about your allergy.

In conclusion, visiting Bali with a peanut allergy may require some extra planning and preparation, but it is still possible to enjoy all that the island has to offer. By researching local dishes and food, communicating your allergy clearly, being prepared for emergencies, and being vigilant about food labels and ingredients, you can reduce your risk of a reaction and have a successful trip. With a little bit of extra care, you’ll be able to experience the beautiful beaches, rich culture, and delicious cuisine that Bali has to offer.

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How to Travel to Bali With a Peanut Allergy Safely – tips from someone who lives there with a life-threatening nut allergy

When I first told my parents I wanted to visit Southeast Asia, they were extremely nervous. 

Not because of how far away it was, how long of a flight it was, or how I’d be traveling abroad with my friends, but because I’m not like any traveling millennial – I’m a lot more fragile.

I’m deathly allergic to peanuts.

Not the I-sneeze-or-my-face-swells-a-little-allergic, but rather my-throat-closes and if-I-don’t-get-to-a-hospital-within-minutes-of-anaphylaxis-setting-in-can-DIE allergic. And anyone who’s been to Southeast Asia, has eaten in a Thai, Vietnamese, or Indonesian restaurant knows that peanuts are just about EVERYWHERE in their cuisine. So how do I survive living in Bali now as a travel blogger with a serious peanut allergy? Very, very carefully.

I wanted to write this post because I know how scary it can be as someone traveling to a new country with a food allergy , but also for their loved ones back home. Luckily, it is possible to travel to Bali and eat in Bali with a nut allergy, and I would hate if your allergy stopped you from seeing the incredible island that is Bali .  There are many western restaurants available and food that is safe to eat for nut allergy sufferers – and actually, recently, most places in Bali have gotten really good at dealing with food allergies and sensitivities – they get it now, but that being said you can’t be nonchalant about it in Bali, either.

Here are my tips of what I do to survive living in Bali with a peanut allergy , and what I recommend anyone traveling to Bali with a nut allergy do to stay safe abroad

1. carefully explain, at every single meal, and before you touch any food in bali, that you have a serious nut allergy, and make sure they understand.

In Balinese culture, they will sometimes nod their heads and say yes even if they don’t quite understand, so make sure they FULLY get it. 

2. Eat at safe restaurants

I wrote a blog post here about 10 Restaurants I Eat Safely in Bali With a Peanut Allergy (and the 1 that almost killed me), and I recommend checking that out if you also have an allergy – I have been pleasantly surprised over the years to find out some of the best restaurants in Bali don’t use peanuts.

3. Don’t eat at the local Indonesian warungs

Why risk it?? They often put peanuts in food here, and even if it’s not in what you’re ordering, the cross contamination in local warungs is very dangerous for those with nut allergies in Bali.

4. Bring an allergy card with you

You can buy an Indonesian one on Amazon here ), and show it to your waiter when you sit down and order.

5. If you don’t feel 100% like the place you’re eating is clean, understands your allergy, etc. DO NOT EAT THERE!!!!

6. know where the nearest hospitals or clinics are.

Ask your hotel and be aware, just in case. 

7. Don’t eat too adventurously

I like eating the food I can trust in Bali – like pizza, mexican, sushi, club sandwiches, eggs, bacon, etc. I don’t get anything too complicated. 

8. Bring your own snacks

When in doubt, eat your own food! On my first trip to Bali, I barely ate anything and lived off of safe snacks I brought from home. It was fine! I’ve now gotten more comfortable since I know the restaurants to trust with a peanut allergy in Bali, and the foods I can rely on – but on that first trip, my snacks were everything!! It’s important to always bring snacks when you’re flying or traveling anyway, whether or not you have a food allergy! It’s easy to bring a supply of healthy snacks just in case you don’t feel comfortable eating at certain restaurants.

9. Bring an epi pen with you everywhere you go – of course!!

And bring multiple in your suitcase when you pack for Bali !!!!

10. And, finally, do not go to Kynd Community for a smoothie bowl .

This is the cafe that nearly killed me when they didn’t list on their menu peanut butter as an ingredient in a smoothie I ordered, and, despite knowing about my allergy, they put a spoonful of peanut butter in my smoothie. I took not even a sip when I realized what had happened. They claimed they were “really busy” and it got lost in translation with the kitchen. But peanut butter wasn’t listed as an ingredient. I was so confused. Just goes to show though – you have to be careful who you trust, and maybe avoid overly busy or peak hours. I don’t tell that story to scare anyone – because, seriously, I feel SO safe eating in Bali now- but only in the places I can trust – and I think it’s important to know the ones you can’t trust, as well. 

This was the ‘death sip’ – taken seconds before I realized what had happened!!! It is a very cute cafe though!! But there are other smoothie bowl spots in Bali that I trust much more (Nalu bowls has always understood me and made me feel very safe, for instance, but I never get granola)

Check out these other Bali blog posts:

The best restaurants for peanut allergies in Bali

The best hotels in bali

How to prevent Bali belly

The Biggest Mistakes People Make Traveling to Bali for the First Time : Mistakes to avoid in Bali for first-time travelers .

The Ultimate Gili Air Travel Guide

The most overrated things to do in Bali, and where to go instead

The Ultimate Ubud Travel Guide

The Ultimate Travel Guide to Canggu, Bali

The ultimate bali honeymoon guide,   the most instagrammable places in bali, the 5 best smoothie bowls in bali, bali’s newest sunset spot: la brisa bali in canggu, the best bali day trip: rice fields and waterfalls in ubud, jetset christina’s guide to the gili islands, what to wear in bali.

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WRITTEN BY: Christina

Christina is a leading luxury lifestyle and travel blogger with over 2 million readers. Follow her on instagram @jetsetchristina.

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Christina, Thank for this guide. We are looking to go Bali in October.

Pingback: The Best Bali Bucket List - JetsetChristina

I’m reading this and FREAKING out so much lol. I have a severe allergy to all nuts and even coconut and we’re planning on going to Bali next year but I’m scared food wise. Didn’t really want to be stuck eating burgers and fries the entire trip but this makes me feel so much better! Thank you for putting the info about KYND as well because that was a bucket-list place, not anymore.

Thank you! My daughter and I both have a nut allergy. I’ve been to Bali before and it’s always so stressful! Do you have any tip on Bali with kids?

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Travelling Without a Passport

Traveling with a Nut Allergy: Everything You Need to Know

Travelling is an exciting opportunity to grow as a person and experience new things you may never have otherwise experienced. Travel is known to improve communication skills, increase confidence and tolerance, and make memories that last a lifetime. Of course, that means travel should be accessible to everyone. However, traveling with a nut allergy means extra considerations and can make things a little more complicated.

With a bit of extra planning, traveling with a nut allergy is definitely possible, no matter how severe. If you’re about to set out on a new adventure, or if you’re traveling with someone who has a nut allergy, read on for our guide to traveling with a nut allergy!

Travel to: Asia

Flying with a nut allergy

Most of the time, flying with a nut allergy is perfectly safe: generally speaking, one person eating nuts on the plane won’t cause a reaction. However, if your allergy is especially severe, it may be a good idea to call ahead to the airline and inform them of your allergy.

While there’s no guarantee about what the airline will do (as all of them will have different policies), it’s always a good idea to let the crew know beforehand. Occasionally, they will make an announcement to the other passengers, requesting they not bring nuts on board with them.

If you do have a reaction on board, don’t panic: if you use an adrenaline injector such as an EpiPen, it will be allowed with you on the plane, and you can use it. Flight attendants may also move you to a different area of the plane and, if needed, provide extra oxygen.

Tips for traveling with a nut allergy

When you’ve arrived safely, you may feel like your stress is only beginning. However, there are many ways you can make your travel experience safe, fun, and comfortable. As with any traveling, the best way to avoid error is through planning ahead and communicating your needs.

See Also: Everything Your Tour Guide Wants You to Know Before You Travel

Call ahead and ask about food policies

If you’re joining a tour, make contact with your tour leader and advise them of your allergy. You likely won’t be the first person with an allergy they’ve led, and they’ll have plenty of tips and tricks for you.

If you’re traveling solo, it may be a good idea to look up restaurants beforehand and check out menus. If they seem like a good place or make reference to nut-free practices, make a note of it and consider visiting on your trip.

Pack safe snacks

If it’s possible, bringing along your favorite snacks is a great idea. When you’re in a country where you may not know where to find snacks that are safe for you to eat, it can be helpful to have some available. Stick some sealed, non-perishable snacks into your checked baggage, and carry a couple with you while you’re out exploring. Just remember not to litter and be courteous of food policies at certain national parks and monuments.

Make sure you travel with your adrenaline injector

Whether it’s an Epi-Pen or another form of adrenaline injector, make sure you always have it on hand. Emergency medications aren’t generally subject to the same regulations as other liquids or sharps, so don’t worry about flying with one. If you can, bring an extra in case one is lost, stolen, or, in the worst-case scenario, used.

If you’re traveling with someone, make sure they understand the signs of anaphylaxis and know how to administer an adrenaline injection if you need it. It’s a good idea to know that you’re traveling with someone who will remain calm in case of emergency: talk before you leave about what to do if the worst happens, and you have a severe reaction.

Practice saying, “I have a nut allergy” in different languages

Language barriers could pose a big risk for travelers with severe nut allergies: if you can’t tell someone about your allergy, how can they help you? Practise phrases such as “I have a nut allergy” or “I need medical assistance.”

Here’s how to say “I have a nut allergy” in a few languages.

• “J’ai une allergie aux noix.” (French)
• “Tengo una alergia a las nueces.” (Spanish)
• “Ho un’allergia alle noci.” (Italian)
• “Eu tenho alergia.” (Brazilian Portuguese)
• “Wǒ yǒu jiānguǒ guòmǐn” (Chinese pinyin)
• “ Ich habe eine Nussallergie” (German)

See Also: Ordering Coffee While Travelling

If you aren’t comfortable attempting to speak the language (or if you’re having a reaction and can’t), it also may be a good idea to carry translation cards.

• Justhungry.com has a selection of allergy cards you can show to people to make sure everyone knows the situation.
• The phrase is also 我有堅果過敏 in Chinese traditional writing and 我有坚果过敏 in simplified Chinese.

The most important thing to remember when traveling with any allergy is that it’s entirely possible to enjoy yourself abroad. With a little extra planning and communication between you and your travel partner, or you and your tour operator, you can have a stress-free trip.

What are your top tips for traveling with a nut allergy? Let us know!

Maggie Soares

Maggie is a life-long traveller with a special affinity for the United Kingdom. When she's not reading, writing, or dreaming about her next trip, you can find her talking at length about her dog to anyone who'll listen.

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Southeast Asia with a nut allergy - my experience and advice - Vietnam Forum

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Southeast Asia with a nut allergy - my experience and advice

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I feel compelled to share my positive recent experience of travelling in Southeast Asia with a fairly serious nut allergy. While I am not trying to encourage complacency and my allergy is not as perilous as some, I want to reassure fellow sufferers that travel in this region is very feasible with sensible precautions.

MY OVERALL EXPERIENCE

With an allergy card translated into each of the local languages (see below for translations), I was able to clearly communicate my allergy to staff, who ALWAYS took my concerns seriously. When I was unable to have a dish because it contained nuts, they would recommend a safe alternative. This includes street food stalls, which I was strongly advised to avoid prior to my trip. From my experience, the majority of dishes in this region DO NOT contain nuts and you can often see exactly what a street food vendor is putting in your dish as they prepare it.

COUNTRY-SPECIFIC ADVICE

Fairly low risk if you are careful. Levels of English were the lowest I encountered on my travels, so an allergy translation card was vital. Locals were ALWAYS helpful and only on two occasions in our two week stay could I not have the food. Both occasions occurred in local street food hangouts and the staff understood my concerns and communicated clearly what I could have as a safe alternative.

Pho, Vietnam’s national dish, was a dependable and safe option for breakfast, lunch or dinner. I also had fried noodles or rice with chicken, beef or seafood virtually every day across the region, with no issues at all. Hot pots, spring rolls and stir fries were also fine and I do not believe nut oil was ever used. Do not be deterred by the street food - stalls or small restaurants often serve just two or three meals, so you can see the ingredients and preparations in front of you. It is also often the tastiest food!

English was spoken surprisingly widely here and communication was rarely an issue. However, due to the remoteness of our homestays and relatively low standards of medical care, I played it fairly safe here. Fish amok is definitely one to avoid – it always had nuts when I enquired. Beef loc lac was one of my favourites and was a dependable option, as well as the standard fried noodles and rice.

The most nut-infested country from my research, but I had no major issues. I advise you to avoid pad thai, which typically contains nuts, though I did enjoy this dish twice including at a street food stall where nuts were not used. English was widely spoken.

RECOMMENDATIONS

Nut allergy translation cards – I strongly advise you to carry an allergy translation card at all times – this was typically the only means of communicating my allergy and I would have been at far greater risk without it. It was virtually impossible to explain my concerns without use of this card. Below I copy the translations that I used. Though these worked reliably for me, I cannot guarantee accuracy and advise that you print these next to a picture of nuts with a big red cross through it, in case the translation fails!

English: I have a life-threatening allergy to nuts, nut oil, peanuts and peanut oil. If I eat the above foods or have food cooked in nut oil, I could die. Does this food contain nuts, nut oil, peanuts or peanut oil?

Vietnamese: Tôi bị dị ứng đe dọa nghiêm trọng đến tính mạng với các loại hạt , dầu hạt , đậu phộng và dầu đậu phộng. Nếu như tôi ăn phải các loại thức ăn trên hoặc trong nấu trong các món ăn , tôi sẽ mất mạng. Thực phẩm này có chứa các loại hạt, đậu phộng hoặc dầu đậu phộng?

Khmer: ខ្ញុំ មាន ប្រតិកម្ម ទៅ នឹង គ្រាប់ និង សណ្តែកដី ទាំងអស់ ។ សូម កុំ ដាក់ គ្រាប់ ឬ សណ្តែកដី នៅក្នុង អាហារ របស់ខ្ញុំ ។ គ្រាប់ និង សណ្តែកដី នឹង សម្លាប់ ខ្ញុំ ។ សូមអរគុណ

Thai: ฉันมีอาการแพ้ชีวิตที่คุกคามต่อถั่วน้ำมันถั่วถั่วลิสงและน้ำมันถั่ว. ถ้าฉันกินอาหารนี้หรืออาหารใด ๆ ที่ปรุงด้วยมันฉันอาจตายได้. อาหารนี้มีถั่วน้ำมันถั่วถั่วลิสงหรือน้ำมันถั่วหรือไม่

Research – I’ve outlined some safe and risky dishes above, but research key ingredients used in common dishes before you travel. Keep to dishes that you know are typically safe and choose the right locations to be adventurous with your choices, e.g. where you can see the food being prepared and staff speak good English. I never saw a menu that details which dishes contain nuts.

Street food tour – I planned to do this on my arrival, but never got around to it. Consider a street food tour with an English-speaking local, who will be able to advise which dishes are typically safe for you to eat.

I hope the above is of some help to those wishing to travel in Southeast Asia with a nut allergy. While sensible precautions must be taken - the most important being an allergy translation card - your allergy should be no obstacle to travelling across this wonderful region and exploring the superb food that it has to offer.

Print and remind: Tôi dị ứng với đậu (Đậu phộng...) - Nut allergy!

Hope it is helpful to the others.

Thanks for taking the time to share that with us. I'm sure it will be helpful to many others. I will save this as many people do ask about this quite often on here. Good one.

Thank you so much for this. We are looking for a family holiday and had been put off taking my son to Asia due to his nut allergy. This gives me a reassurance that we could travel fairly safely.

Thank you so much for all the information and tips you’ve given, my girlfriend and I are embarking on a 3 month trip around South East Asia in 2 weeks for 3 months, she has a severe peanut allergy but is fine with all other nuts.

I’d really appreciate it if someone had the translations but without the mention of nuts and nut oil, only peanut and peanut only. Any help would be hugely appreciated!

My hero, thanks so much. That helps a lot :)

FYI, you can order allergy cards via this website: http://www.selectwisely.com/catalog/Nut_Allergies

Happy traveling!

This topic has been closed to new posts due to inactivity.

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Travel to Indonesia with a Nut Allergy Safely

Yes, it is possible to visit Indonesia, with a nut allergy. However, it requires extreme diligence, precaution, and pre-planning in order to stay safe.

In this post, we’ll provide information about traveling to Indonesia with a severe nut allergy as well as an English-Bahasa Indonesian allergy card translation that you can carry with you in restaurants. We worked on remote biological stations in the jungles of Sulawesi, Indonesia for several summers with a conservation organization that hosted visiting high school biology students and university volunteers. During this time, one of our biggest challenges was managing pervasive nut allergies.

It is recommended that travelers with nut allergies visit more populated, touristy islands (such as Bali) when traveling in Indonesia, where they will have easier access to dietary alternatives and medical assistance (if needed). And of course, travelers should always speak with their doctor about this concern before traveling.

Quick tips for travelers with a nut allergy going to Indonesia:

• Always carry EpiPens on your person and let your travel companion(s) know where you keep them
• Train your travel companion(s) how to use your EpiPen
• Do research on the airline you’ll be flying with beforehand and use best practices on the plane
• Create and always carry with you an “allergy card” written in the Indonesian language
• In a restaurant or café, never assume you’ve been understood when ordering, and always double check
• Speak to the chef in the kitchen and examine the products and utensils being used to cook
• Buy and make your own food when possible

We attended training and looked after many students who had nut allergies and/or other strict, life-threatening dietary restrictions on a remote island in Indonesia, however we do not claim to have medical expertise when it comes to nut allergies. If you are traveling with a nut allergy to any region of the world, you should first consult your doctor.

We’ll be directing the tips in this article at the person who has a nut allergy (or any severe food allergy) traveling to Indonesia, but this information can also be used by parents or guardians looking after young people with severe nut allergies.

Most Indonesians are not familiar with severe nut allergies

It’s important to know that nut allergies are not common in Indonesia or other parts of Southeast Asia, so many local people will not be familiar with the severity of this issue. Additionally, nuts and nut oils are used in a lot of Indonesian cooking, so you’ll definitely have to be careful and repeat, repeat, repeat your message so that it is clear (Indonesians are very friendly and will tell you what they think you want to hear—which can be very problematic in this case).  

Travel to Touristy Places

You’ll have less of a language and cultural barrier issue in places such as Bali , because there are so many millions of tourists who visit every year. Just like in Thailand, Bali is very used to dealing with the needs of foreign guests.

You’ll have easier access to people who can understand your food requests, and access to medical care should you need it.

Our students and volunteers with nut allergies came to very remote parts of Sulawesi, but we had a network of people working for the organization to help keep them safe. If you are traveling on your own, especially with limited Indonesian language skills, it will be more difficult in remote places to stay safe with a severe allergy.

Pack and carry multiple EpiPens (easily accessible)

Make sure that you’re packing several EpiPens in your bag and planning on carrying one with you (on your person) at all times during your travels. If you have a travel companion, give that person a step-by-step lesson on how to use the EpiPen in case you are not able to use it on yourself.

If you’re traveling alone, let people you meet along the way (in hotels, hostels, etc.) know that you have a severe allergy and tell them where they can locate your EpiPen in an emergency. If an emergency does happen, you’ll only have a small fraction of time to react and so it’s better to be prepared beforehand.

Carry EpiPens on the airplane with you as well, in your carry-on luggage (not checked bags). Some travelers carry a letter from their doctor stating that they have an allergy and require an EpiPen, just in case they have trouble getting their EpiPens through security in their carry-ons—but this doesn’t appear to be an issue for most people.

On the Plane and in Airports

Remember to have your EpiPens easily accessible on the plane. Also, let your travel companions on the plane know where they are and how to use them.

Before you leave, do research on the airline you’ll be flying. You can go to this website to find out specifics about each airline’s nut policy and try to book a flight with a stricter “no-nut” stance.

Take your own food on the plane. This is the safest route to go. Pack yourself enough food for the long journey.

Let the gate agents know that you have a nut allergy. They should let you board the plane early so that you can wipe down the seat you’ll be using on the plane. This is a good idea because planes aren’t exactly left squeaky clean from flight to flight. Some parents of children with nut allergies recommend avoiding the seat pocket, as wrappers from contaminated products may be left in there.

Let the flight attendants know that you have a nut allergy , so that they can avoid giving you nut products and can be aware that you may need help in an emergency.

Prepare an “Allergy Card” in Bahasa Indonesia (Indonesian language)

This is a card that you should print, laminate, and carry around with you at all times. Please note that this card is not a guarantee at all that the restaurant staff will follow your request. Indonesians are very kind and hospitable and so they may just tell you what you want to hear (such as, that they understood your request).

To be safe, ask to speak with the chef as well and ask to examine the oils and utensils being used to prepare your meal in the kitchen. This may seem like overkill, but a life or death situation is worth it.

Below is a translation for an allergy card from English to Bahasa Indonesia made in 2010 (translation by the Bali International Medical Centre – BIMC, which is accredited by the Australian Council on Healthcare Standard International – ACHSI). We contacted the BIMC for an update and they say that they no longer provide bilingual translation.

However, they did want to say that they are open 24 hours and suggest that allergy-sufferers come have a consultation with one of their GPs and can provide a letter if necessary. If this is of interest to anyone, you can make an appointment by contacting:

☎️ +62 361 3000 911 🖥 [email protected] 📳 +62 811-3896-113 (WhatsApp only)

Here’s an allergy card you can print:

Or you can make your own with the text provided below:

To Whom It May Concern

This is to certify that the holder of this card is allergic to nuts, and their products. Digestion of any of these products may lead to death.

Thank you for your attention.

Bahasa Indonesia:

SURAT KETERANGAN

Surat ini menerangkan bahwa pemegang kartu ini memiliki alergi terhadap kacang, dan produk-produk olahannya. Mengkonsumsi bahan-bahan tersebut, sengaja maupun tidak, dapat menyebabkan kematian.

Terima kasih atas perhatiannya.

Here is another translation that our Indonesian friend did for us:

“Saya alergi kacang-kacangan dan semua produk dari kacang. Jika termakan, saya akan mati. Tolong jangan gunakan minyak yang mengandung bahan kacang, atau peralatan masak yang sudah menyentuh produk kacang-kacangan ketika memasak makanan saya. Terima kasih.”

Which translates roughly to: “I am allergic to nuts and all products from beans. If I eat them, I will die. Please do not use oils containing peanut ingredients, or cooking utensils that have touched nuts products when cooking my food. Thank you.”

At the bottom of this article, we provide more, extensive phrases in Indonesian that may be helpful for you (or your travel companions) to print out and carry with you during your trip.

Additionally, you can visit this website which offers allergy cards for sale in all different languages.

At Restaurants

You can try to only eat at “Western-style” restaurants or upscale restaurants owned by foreigners but that is still no guarantee that your food won’t accidently be contaminated by nuts.

For every meal that you don’t prepare yourself, you should show your allergy card to the waiter and the kitchen staff, and check the kitchen. It’s better that they see how serious you are and that you try to convey the severity of the consequences.

Talk to people in hotels and hostels and get advice from other travelers. Many people have travelled in Indonesia, especially in Bali, with nut allergies and can offer you recommendations of restaurants that will be more understanding.

The safest thing to do is to visit grocery stores and make your own food if you’re staying in an Airbnb.

Avoid packaged snacks and wear a mask at the market

Packaged snacks like cookies and candy bars tend to have nuts or nut traces in them. The labels will be in Bahasa Indonesia. So, it’s best to skip the packaged products and opt instead for some fresh (UN-CUT) fruit in the markets such as rambutans:

Make sure that the fruit you buy has a peel and is un-cut.

Wear a face mask – Some tourists with nut allergies recommend wearing a face mask in the marketplaces as the stalls cooking with nut oils and nut powders throwing residue into the air may be an issue, depending on the severity of your allergy.

Many tourists report having an amazing time in Indonesia despite food allergies. Don’t let a food allergy keep you from visiting Indonesia—you’ll just have to prepare a bit more and be cautious throughout your trip. But people with food allergies are used to doing this when eating out in their own countries anyway! Get out there and enjoy 🙂

READ NEXT: Our 25 Essential Things to Know Before Visiting Indonesia

Additional Indonesian Phrases for Allergies

Here is a PDF of some additional Indonesian phrases that might be useful for traveling in Indonesia with an allergy. These are the phrases that we carried around with us in Indonesia when looking after our students and volunteers with severe allergies.

Brittany is a Wayfaring Human who loves to adventure with her husband and son. When she's not having adventures, she's taking pictures of them and writing about them.

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How to travel Southeast Asia with an allergy

No one should miss out on a chance to visit far-flung tropical destinations. Though, having a serious allergy can really inhibit you. You are anxious about what you can eat, the language barrier and what you can do if something does happen.

Southeast Asia is a dream destination for many, but with the heavy influence of seafood and peanuts in their cuisine, it can be a real worry for anyone with these allergies. Your safety and happiness is our greatest concern, so we have created a guide to travelling to Southeast Asia with an allergy to help you understand the risks and the steps you can take to have the amazing holiday that you deserve.

Shellfish allergy

An allergy to shellfish is a response by the body’s immune system to the proteins found in particular marine animals. This can range from octopus, squid and scallops to marine animals with a shell, like shrimp, crab and oysters.

Southeast Asia does have a diet that relies heavily on seafood. In our previous post, a taste of Vietnam , we looked at how the different regions of the country offer different types of food. If you are visiting northern Vietnam you will find that many dishes contain seafood and crab in particular, but there is a great deal of beef and chicken on offer too.

If you do suffer from a shellfish allergy and are visiting the south on a Cambodia holiday then you should be cautious when eating out, or trying the street food. The south is blessed with the largest stretch of the coastline, and the people here really make the most of it. You will find a great deal of squid, shrimp, prawns and crab throughout the region.

Cross-contamination is a risk when there is such an abundance of shellfish in Southeast Asia. You may not necessarily be allergic to all seafood, but there is a chance that it has come into contact with shellfish. Be cautious of soups and stocks. Your dish may not include shrimp or some crab, for example, but may have come from something containing it in the kitchen.

Peanut allergy

An allergy to peanuts is among the most common food allergies, as well as one of the most severe. The reaction – anaphylaxis – can be caused from even the slightest contact with a peanut, for those who are most seriously affected.

Helpline Assistant at the Anaphylaxis Campaign , Grace, was kind enough to speak to us about traveling with a peanut allergy:

“It’s not uncommon for people with allergies to be anxious about travelling. However, by following the top tips available on our website and making sure you’re prepared, travel can be a lot less frightening. Ingredients common to many cultures in Southeast Asia include fish, tree nuts, peanuts, sesame seeds, soya and tofu.”

“The Anaphylaxis Campaign is the only UK wide charity focused on supporting those at risk of severe allergies. Our ultimate aim is to create a safe environment for all people with allergies by working with and educating the food industry, schools, pre-schools, colleges, health professionals and other key audiences. Our focus is on medical facts, food labelling, risk reduction and allergen management. We actively campaign to raise awareness of anaphylaxis with the general public and with the relevant authorities for better allergy care and treatments.” “If you have a food allergy we would recommend picking up a free printable translation card online to help to ensure others are made aware of your allergy despite any language barriers. Most importantly, make sure you have your medication with you at all times and ensure you take a note from your doctor explaining that your medication is needed with you on the flight. If you have any concerns or further questions, our helpline team will be happy to take your call.”

Such is the severity of peanut allergies, that many experts and allergists advice that the best way to prevent a reaction is by complete avoidance. However, this is almost impossible, particularly abroad. After all, allergies are not restricted to one type of person, or one country. So while there may be a higher proportion of peanuts in Southeast Asian diets, there is still going to be people who are allergic.

Traces of peanuts can be found in the following:

• Almond and hazelnut paste
• Baked goods
• Sweets, chocolate
• Desserts – cookies, puddings, pies, pancakes
• Enchilada sauce
• Sauces, glazes and marinades – pesto, gravy, mole sauce, chilli, salad dressing
• Snack foods
• Vegetarian foods/products – peanuts can be used as an alternative to meat

Travelling with allergies

No matter how many precautions you take before you go, travelling with allergies is never easy. Rarely are you ever truly comfortable. We were fortunate enough to speak to Tullia Marcolongo, the Executive Director of IAMAT – International Association for Medical Assistance to Travellers who offers some advice:

“If you are travelling with a food allergy, we recommend the following:

• Research the common foods of your destination country. Find out what common ingredients are used in cooking that could cause an allergic reaction.
• Pack the medications you need to prevent an adverse reaction like antihistamines or epinephrine injectors with refills. Always have these available on your purse or handbag.
• If you are buying groceries abroad, read the labels and be aware of packaging that does not list ingredients. Note that in many countries there are weak or no food labelling regulations and some products may be partially labelled.
• Tell others about your food allergy. Carry a personalised translated card detailing your allergies to show restaurant waiters, grocery store clerks, or food vendors. Don’t rely on your tour guide to do this for you. SelectWisely and Allergy Translation offer a wide range of professionally translated cards.
• Wear a Medic Alert bracelet mentioning your allergy.
• Find a reputable doctor or hospital prior to your trip in case of an emergency. Tell your tour guide or travel companions so they know where to take you.
• Carry a traveler clinical record outlining your food allergies so that healthcare providers abroad are aware of your condition.
• Ask your tour guide what their role is during a medical emergency so you know what to expect.”

Preparation and research are very important to holiday, understanding where to go, what to see, when is best to visit and more. But this planning is emphasised when you are travelling with an allergy. As Tullia said, understanding the foods of the country you are visiting is vital.

It is also important to make people aware of your allergy. You are not making a fuss or making anyone go out of their way for you. Perhaps it is your child who has an allergy. One tip we have, which could relate to yourself if you are the one who suffers, is to bring your own snacks. Or even better, make your own before you go on holiday. By bringing snacks that you know you, your child or partner can eat means that when hunger strikes you can just reach into your bag and pull something out with confidence, rather than gambling on a range of foreign snacks.

Be sure to keep your medication with you throughout your trip. If you or a loved one does suffer with a serious allergy then you probably do this anyway, but just remember to have it in your hand luggage for the flight and at hand throughout the duration of your holiday or tour.

But for some, the biggest worry can come long before you step foot in your destination. The confined restraints of the aeroplane mixed with dozens of people in close proximity probably not suffering from an allergy themselves can cause a few problems. Before you book your Cambodia holiday you can contact the airline and make them aware of your allergy. They will be able to inform you about the food provided and you can even ask to pre-board to sterilise your seats.

Helpful translations

C̄hạn phæ̂ t̄hạ̀w lis̄ng – I am allergic to peanuts

C̄hạn phæ̂ H̄xy – I am allergic to seafood

Tôi dị ứng với đậu phộng – I am allergic to peanuts

Tôi dị ứng với Động vật có vỏ – I am allergic to shellfish

Khony mioakanaeph to thouadin – I am allergic to peanuts

Khony mioakanaeph to shellfish – I am allergic to shellfish

Khnhom mean a le sai cheamuoy sa nte k dei – I am allergic to peanuts

Khnhom​ a​ le​ sai​ tow​ nung​ saambaur – I am allergic to shellfish

Helpful apps

One of the best tools to those who suffer from allergies but have the insatiable appetite for travel is to download a food translator app. Allergy FT is a brilliant app that you lists over 86 food allergies ranging from egg and shellfish to peanuts and wheat.

It will translate your allergy into a range of languages in 57 countries across the world, with all of the translations build into the app, so you are not being charged extortionate prices for your roaming internet rates.

If you have a shellfish allergy the app can translate clams, crab, lobster, mussels, oysters, scallops and shrimp into the local language for you.

Allergy FT is available on the app store for £1.99. However there are other options for you.

Food allergy stats for the UK

• 44% of British adults suffer from at least one allergy, with numbers rising year-on-year.
• Between 1992 and 2012, there was a 615% increase in hospital admissions for anaphylaxis in the United Kingdom
• Up to one per cent of the population has an allergy to shellfish, while this can grow in countries with significant consumptions of shellfish
• Up to 20 per cent of those with allergies to fish can consume fish which is canned , for example tuna. However, this is still a very sensitive area, as four in five people could still have a reaction. So do take caution or consult an allergy specialist.

Ask the right questions

Eating out with an allergy goes beyond asking “does this contain any peanuts//shellfish?” You have to ask deeper and more specific questions.

For example, if you are allergic to peanuts you will need to enquire about the oil used in the kitchens: “What kind of oil is used to fry the chips?” Sometimes the oil will have been used to fry or cook something that does have traces of nuts, or the oil itself will be nut-based.

This continues with sauces and garnishes. Some are made in bulk at the beginning of service and are transferable for a number of dishes. This means that there could be traces of nuts within. Look deeper than whether there is a visible example of nuts or shellfish being included in your dish. But having lived with the allergy, or someone who has one, you will know this.

No one should feel like they cannot travel because of their allergies or specific dietary requirements. Food is such a massive part of experiencing new cultures that it is really hard to immerse yourself in local customs without trying native dishes. But you have an extremely serious condition, one that cannot be taken lightly.

If you follow our advice and speak to your tour provider and airline, we are sure that you can travel Southeast Asia with an allergy and have an amazing time along the way.

Editor’s Note: This blog was originally posted in August 2017 and has been fully updated.

Book an escorted tour of Southeast Asia with the UK’s leading Asia Experts, Wendy Wu Tours. Our fully inclusive tours visit all the major sights of the region for an unforgettable holiday.

We also have tours to China, Japan, India and South America…

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7 Ways to Cope With a Nut Allergy Abroad

AS ONE OF millions of people around the world with a life-threatening nut allergy I know all too well the trials of eating abroad. I’ve spent an evening in Paris hooked up to an adrenaline ventilator, been in hospital in Peru and starved myself on a Sahara Desert trek thanks to my inability to pronounce ‘cashew nut’ in Arabic.

The risk of travelling with a nut allergy is very real but I’ve learnt the hard way, a few precautions and preventions can make the ride a lot smoother.

1. Know Your Emergency Procedure

Foreign hospitals often do not understand the severity of a reaction or how to treat it so ensure you are aware of what you need. Emphasize that you need to be seen immediately.

Ask your doctor to write down the medication and dosage to be administrated in case of an attack. Note the pharmaceutical names, as brand names can be different abroad.

If you carry an Epi-pen ensure you know when and how to dispense it and are able to do so yourself. Inform your travel partners of their duties should you become unable to help yourself.

2. Remember: You Can Never Carry Enough Drugs!

It goes without saying that you need to carry your prescribed medication, but make sure you have spares and store them in different places in case you lose your luggage.

Modern adrenaline dispensers such as Epi-pens are not available in some parts of the world so take enough for your journey and leave a repeat prescription at home.

Check the use-by dates of all medication if you are on the road for long periods- even recently purchased prescriptions can have short expiration dates.

Keep your prescription on hand when you fly or you’re going anywhere where your luggage might be inspected- taking a syringe into a nightclub can look suspicious to foreign security!

3. Don’t Eat Like A Local

Food trading standards vary drastically between countries and labeling is often done according to different standards. Be extra diligent when trying foreign delicacies as even common foods may contain unlabeled ingredients.

In Brazil, nut traces (especially cashew nuts) are commonly found in chocolate even if it doesn’t state it on the packet. They also serve a cashew nut juice. In France and Italy, almonds and pistachios are common in all cakes and pastries even if staff tell you they are nut-free. Indian and Chinese food is full of peanut oils and kitchens often use the same pans for cooking different dishes so cross-contamination is likely. Mediterranean dishes are often sprinkled with pine nuts.

Exercise caution of ‘home brands’ abroad- Cadbury’s chocolate in South America is actually made in Panama and does not contain the exact ingredients of the British variety.

Be wary of ingredients like sesame, poppy seeds and coconut that can provoke reactions in nut-allergy sufferers. If you’re not sure, this is not the time to find out!

4. Make Yourself Clear

Even if you can’t speak the native language, look up a few words before you go and carry a small dictionary to check food labels. Keep a card with you to show to waiters or shop-owners if you are not sure of pronunciation.

A literal translation may not suffice- in some languages the word ‘nuts’ refers to one type of nut and frequently nuts such as cashews, almonds and pine nuts, as well as items such as peanut butter, are referred to separately. ‘Dried fruits’ is a good catch-all term but try to memorize as many different names as possible.

Sometimes it is best to be dramatic: ‘I will die if I eat this’ avoids the common scenario of the nuts being scraped off and the meal being returned to you. Severe allergies are extremely rare in some parts of the world so the average waiter is likely to put you down as another ‘fussy tourist’ unless you state your case very clearly (and with a smile).

5. Plan Ahead

Problems arise when you entrust your food intake to strangers but it’s difficult to avoid these situations on holiday. Many hotels, hostels and tour operators will accommodate your requests if you explain the situation but always double check. Ask to see the packets wherever possible or to speak to the person preparing the food. Take a packed lunch if you are worried.

Contact airlines and bus companies before traveling with them and confirm that a nut-free option is available. Many airlines (British Airways, American Airlines) have banned nut products on-board but consider buying some sandwiches before you board the plane just in case.

Ensure your allergy is covered by your travel insurance – always declare it and shop around for a company that provides full cover. Many companies will cover you if you haven’t been in the hospital in the past year.

6. Eating Out

Experimenting with local cuisine is a vital part of experiencing a new culture so don’t let your allergies put you off eating out. However, it’s best to accept that you will never be able to have a carefree ‘try-anything’ approach to food.

Ask before you eat, even when pressured by locals to ‘just try it’.

Request to speak to the chef if the waiter seems less than knowledgeable about food content- calmly explain the importance that you know exactly what is in it.

Pass on spicy food as this can mask the tingling sensations of a reaction and it’s a good idea not to drink a lot whilst you are eating too- save the wine till you are safely past dessert!

7. Be Paranoid

Different symptoms to what you have previously experienced can occur so monitor any changes and if you experience any of the following, seek medical attention:

Tingling/ itching in the mouth or lips.

An itchy, blotchy rash

Swelling, particularly around the face and throat.

Wheezing/ difficulty breathing

Vomiting/ Diarreaoh

Stomach aches/ cramps

Faintness/ dizziness

There’s no reason to let a nut allergy put an end to your travel fantasies. You need to be warier than other travelers, but don’t let that force you into giving up and staying home.

Community Connection

Even if you don’t have to worry about something as serious as a nut allergy, it’s still important to stay healthy on the road. Try these five useful remedies from easily found ingredients when you’re really far out there. And it can’t hurt to pack these medical books for the road, or to brush up on some tips for staying healthy abroad.

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Having a Peanut Allergy in China: What Should I Look Out For?

August 29, 2020.

Is it possible to survive with a peanut allergy in China? How can I travel with a peanut allergy in China? Should I even bother…?

Having a peanut allergy, or any allergy for that matter, definitely sucks. Worse still when you have to travel with an allergy - and even worse when you’re travelling to a country full of the things you’re allergic to!

Well, I hate to break it to you, but Chinese cooking contains a fair amount of peanuts in comparison to a lot of western foods.

So should you even bother travelling to China? Of course!

Chinese food is awesome, and even as a peanut allergy sufferer you can enjoy lots of it. But, you will need to be careful about what you’re eating. 

Peanut Allergy in China: Understanding Chinese Food

Above all else, it is important to understand Chinese food and Chinese people. There are many different varieties of Chinese food- often named after the region. Just like in the West we may say “Let’s have Italian” or “Let’s go for Japanese tonight”, in China, you will find yourself saying “Let’s have Yunnan food tonight”. Each region of China has its own special type of cuisine , each unique and awesome in its own way.

Like spicy? Sichuan is your place. Love meat on a big sword? Go for Xinjiang! Is hotpot your thing? Chongqing is famous for the spicy one.

This differentiation is important for allergy sufferers since different locations use different ingredients. If you’re are avoiding a peanut allergy in China, you should ideally stay away from southern food, such as Guangxi or Yunnan cuisine. These places are hardcore peanut lovers and use nuts often in their dishes (no matter where in China you’re dining).

If you’re eating in these locations you should be particularly careful since in the south, peanut oil is one of the cheapest oils. It is used in many restaurants. You should be wary of street BBQ and ask every time you eat somewhere. In the north, peanuts are more expensive. If you eat in a fancy restaurant they may use peanut oil since it is seen as a better oil.

Peanut Allergy in China: What the locals think

When asking (see the “key phrases” below) you should also be aware that Chinese people don't understand why you are asking. Having a peanut allergy in China is not common. In fact, many people find it strange as it is generally unheard of.

If you ask them directly whether or not the dish has peanuts, or if they use peanut oil or not, they will most likely say yes. They will presume you want to have peanuts or peanut oil so will either lie (if they don’t use peanut oil) and tell you that they do, or they’ll add peanuts to a dish that otherwise doesn’t have peanuts. So, you need to make it clear that you do not want peanuts - and why.

After explaining you have an allergy, you should also explain what effects the allergy has, i.e. “If I eat peanuts, I will die. Please go and ask your chef”. Often, they will not understand the importance and severity of having an allergy and will answer without actually knowing, or they will presume that having a few peanuts is okay.

Peanut Allergy in China: Key Tips

• Have a set of phrases printed out to carry with you everywhere (see the "key phrases" below for sentences).
• Have your medication with you at all times
• Stay away from southern Chinese food if possible
• Go back to the same place regularly if you know it is ok - but still ask every time. Things change often!
• Bring a Chinese speaker with you if you are unsure
• Eat in western food places if you are unsure

Peanut Allergy China: Dishes to Watch Out For

• Kung Pao Chicken - always has peanuts
• Kung Pao Shrimp
• 5 spice peanuts
• Stir-fried chicken, stir-fried vegetables

Peanut Allergy in China: Key Phrases

Having an allergy was actually one of the reasons why I began learning Chinese . It's definitely an investment that paid off!

Here are some phrases to get you started.

Having lived in China for over 2 years, I eat peanuts pretty regularly - despite having a severe allergy. No matter how decent my Chinese is and how careful I am, it happens about once every month or two.

This has multiple reasons: sometimes I’m too careless. Sometimes they don’t really ask the chef. Sometimes it’s cross-contamination. Sometimes the oil they use is mixed oil.

The important thing is that you know and understand your own peanut allergy, and you are always prepared in case you do accidentally eat peanuts. If cross-contamination causes a big issue for you, I would suggest finding a couple of restaurants that you know are safe and sticking to them - or just doing some of your own home-cooking.

Don’t listen to people if they say having a peanut allergy in China is impossible - it’s not. You just have a little more to think about.

Most importantly… Have fun enjoying all the awesome food of China . And be safe!

Post contributed by Zoe

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Southeast Asia with a nut allergy - my experience and advice - Vietnam Forum

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Southeast Asia with a nut allergy - my experience and advice

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I feel compelled to share my positive recent experience of travelling in Southeast Asia with a fairly serious nut allergy. While I am not trying to encourage complacency and my allergy is not as perilous as some, I want to reassure fellow sufferers that travel in this region is very feasible with sensible precautions.

MY OVERALL EXPERIENCE

With an allergy card translated into each of the local languages (see below for translations), I was able to clearly communicate my allergy to staff, who ALWAYS took my concerns seriously. When I was unable to have a dish because it contained nuts, they would recommend a safe alternative. This includes street food stalls, which I was strongly advised to avoid prior to my trip. From my experience, the majority of dishes in this region DO NOT contain nuts and you can often see exactly what a street food vendor is putting in your dish as they prepare it.

COUNTRY-SPECIFIC ADVICE

Fairly low risk if you are careful. Levels of English were the lowest I encountered on my travels, so an allergy translation card was vital. Locals were ALWAYS helpful and only on two occasions in our two week stay could I not have the food. Both occasions occurred in local street food hangouts and the staff understood my concerns and communicated clearly what I could have as a safe alternative.

Pho, Vietnam’s national dish, was a dependable and safe option for breakfast, lunch or dinner. I also had fried noodles or rice with chicken, beef or seafood virtually every day across the region, with no issues at all. Hot pots, spring rolls and stir fries were also fine and I do not believe nut oil was ever used. Do not be deterred by the street food - stalls or small restaurants often serve just two or three meals, so you can see the ingredients and preparations in front of you. It is also often the tastiest food!

English was spoken surprisingly widely here and communication was rarely an issue. However, due to the remoteness of our homestays and relatively low standards of medical care, I played it fairly safe here. Fish amok is definitely one to avoid – it always had nuts when I enquired. Beef loc lac was one of my favourites and was a dependable option, as well as the standard fried noodles and rice.

The most nut-infested country from my research, but I had no major issues. I advise you to avoid pad thai, which typically contains nuts, though I did enjoy this dish twice including at a street food stall where nuts were not used. English was widely spoken.

RECOMMENDATIONS

Nut allergy translation cards – I strongly advise you to carry an allergy translation card at all times – this was typically the only means of communicating my allergy and I would have been at far greater risk without it. It was virtually impossible to explain my concerns without use of this card. Below I copy the translations that I used. Though these worked reliably for me, I cannot guarantee accuracy and advise that you print these next to a picture of nuts with a big red cross through it, in case the translation fails!

English: I have a life-threatening allergy to nuts, nut oil, peanuts and peanut oil. If I eat the above foods or have food cooked in nut oil, I could die. Does this food contain nuts, nut oil, peanuts or peanut oil?

Vietnamese: Tôi bị dị ứng đe dọa nghiêm trọng đến tính mạng với các loại hạt , dầu hạt , đậu phộng và dầu đậu phộng. Nếu như tôi ăn phải các loại thức ăn trên hoặc trong nấu trong các món ăn , tôi sẽ mất mạng. Thực phẩm này có chứa các loại hạt, đậu phộng hoặc dầu đậu phộng?

Khmer: ខ្ញុំ មាន ប្រតិកម្ម ទៅ នឹង គ្រាប់ និង សណ្តែកដី ទាំងអស់ ។ សូម កុំ ដាក់ គ្រាប់ ឬ សណ្តែកដី នៅក្នុង អាហារ របស់ខ្ញុំ ។ គ្រាប់ និង សណ្តែកដី នឹង សម្លាប់ ខ្ញុំ ។ សូមអរគុណ

Thai: ฉันมีอาการแพ้ชีวิตที่คุกคามต่อถั่วน้ำมันถั่วถั่วลิสงและน้ำมันถั่ว. ถ้าฉันกินอาหารนี้หรืออาหารใด ๆ ที่ปรุงด้วยมันฉันอาจตายได้. อาหารนี้มีถั่วน้ำมันถั่วถั่วลิสงหรือน้ำมันถั่วหรือไม่

Research – I’ve outlined some safe and risky dishes above, but research key ingredients used in common dishes before you travel. Keep to dishes that you know are typically safe and choose the right locations to be adventurous with your choices, e.g. where you can see the food being prepared and staff speak good English. I never saw a menu that details which dishes contain nuts.

Street food tour – I planned to do this on my arrival, but never got around to it. Consider a street food tour with an English-speaking local, who will be able to advise which dishes are typically safe for you to eat.

I hope the above is of some help to those wishing to travel in Southeast Asia with a nut allergy. While sensible precautions must be taken - the most important being an allergy translation card - your allergy should be no obstacle to travelling across this wonderful region and exploring the superb food that it has to offer.

Print and remind: Tôi dị ứng với đậu (Đậu phộng...) - Nut allergy!

Hope it is helpful to the others.

Thanks for taking the time to share that with us. I'm sure it will be helpful to many others. I will save this as many people do ask about this quite often on here. Good one.

Thank you so much for this. We are looking for a family holiday and had been put off taking my son to Asia due to his nut allergy. This gives me a reassurance that we could travel fairly safely.

Thank you so much for all the information and tips you’ve given, my girlfriend and I are embarking on a 3 month trip around South East Asia in 2 weeks for 3 months, she has a severe peanut allergy but is fine with all other nuts.

I’d really appreciate it if someone had the translations but without the mention of nuts and nut oil, only peanut and peanut only. Any help would be hugely appreciated!

My hero, thanks so much. That helps a lot :)

FYI, you can order allergy cards via this website: http://www.selectwisely.com/catalog/Nut_Allergies

Happy traveling!

This topic has been closed to new posts due to inactivity.

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Tips on Traveling With a Nut Allergy

Traveling with a nut allergy can be stressful. Especially when you or a loved one has a severe food allergy, you’ll need to consider making special arrangements and pre-plan to prevent allergic reactions in new environments. I’m sure there’s a lot you already have on your to-do list. Unfortunately, I’m going to add in a few more things to consider. But, these checklist items are important! It may seem like a lot of prep work now, but you’ll be glad you thought about these things ahead of time once you’re on your trip. Here are five tips to put on your to-do list before traveling with a nut allergy. We hope they’ll make you feel well prepared for your upcoming trip. Safe Travels!

When you buy through our links, Nut Free may earn an affiliate commission. Includes Amazon, Thrive Market, HealthLabs, and Personalabs.

1. Notify Your Physician, if This Is Your First Time Traveling With a Nut Allergy

It's good to create an Emergency Care Plan specific to traveling. You’ll want to set up an appointment to talk to your allergist in order to go over your travel plans. Your allergist can map out any potential problems and then address what to do in case of an emergency while you’re away from the physicians familiar with your medical history.

Your allergist will be the best person to access risk. They’ll have the most valuable advice pertaining to your particular travel plans. And they’ll be able to provide customized medical advice specific to you or your family’s condition. Should any medical care be needed while away from home, they can also create a plan on what to do for emergency medical care and treatment. Talk to your allergist about your preferred method of travel (Bus, plane, or are you driving? And what should you expect in those situations? What is the preventative plan to minimize exposure?). And make sure you also talk about what to do when you dine out if you’re visiting a foreign country. (Should you be traveling abroad as your preferred vacation spot.)

Your allergist will plan out specific steps that you or your child can take if you find yourself in a situation where you’re having a medical emergency. This will be especially helpful if you’re creating a new environment for yourself by visiting a completely new location, or new country. Your allergist will also be able to put their care plan in writing, print it on their medical letterhead or stationary, and then you can take their written plan with you to refer back to. Having a plan set in place, with specific steps, will help alleviate anxiety on what actionable steps should be done if something goes awry. The last thing you’ll want to do while having an allergic reaction, or watching your child have one, is to brainstorm and try to come up with a plan.

It’s also a good idea to carry a copy of your travel emergency medical care plan should someone else be able to help or assist you during a severe allergic reaction, or anaphylaxis attack.

I suggest taking a few printed copies of your care plan and to take them with you on your trip. Make sure a copy is stored nearby in an easy to find location, in a place you can access in the event of an allergic reaction. And don’t forget to wear your medical ID bracelet!

A printed care plan will also help communicate your medical needs for you. Make sure you have a copy translated if that’s something that will be applicable to your travel plans. You’re more likely to be treated with the preventative care you need when time is of the essence. A printed doctor’s note can also ensure that you’ll be able to carry your medications at all times, on the airplane, on a bus, etc.

Get Peace of Mind: Test Your Allergy Levels

HealthLabs.com offers same-day lab allergy testing  for only $160. What you get: 15 allergens tested via IgE levels (true allergy tests), including peanuts, almonds, cashews, hazelnuts, walnuts, cow's milk, egg whites, sesame, wheat, and more.

2. Make Sure Your Travel Insurance Covers Food Allergies

Typically, if you're traveling with a pre-existing condition, your pre-existing condition will need to be considered “stable” in order to be eligible for coverage by travel insurance companies. However, if you’re pre-existing condition is a nut allergy, it’s never really “stable”. A severe allergic reaction can happen at any time. It’s not predictable and neither is the severity of a potential reaction to a known allergen. What has happened in the past isn’t necessarily an indication that your allergic reaction won’t worsen the next time your food allergy is triggered.

Some travel insurance companies will cover your nut allergy, but only if you have proof of “stability”. They’ll do this by insisting coverage is dependent upon a mandatory period of time between the time of travel and the last time you have been hospitalized for your allergic reaction. Meaning, if it’s been 12 months, two years, etc. where you haven’t been admitted to a hospital, your allergy can then be considered “stable”. Each insurance company’s eligibility will be dependent on different time frames to qualify as “stable.”

A pre-existing condition is a condition that you are aware of before traveling. Should someone have an allergic reaction on a trip with absolutely no history of food allergies, the case should be covered by regular travel insurance. But, if someone knows about a pre-existing condition, like a life-long, life-threatening food allergy, it’s important to be honest and upfront about your case history with your travel insurance company. Otherwise, should something happen, the travel insurance company could file a claim and refuse aid.

If your insurance plan doesn’t cover anaphylaxis and you end up having an anaphylaxis attack, any hospital charges will turn into out-of-pocket charges. If there’s proof you knew about your condition and were not honest about it when purchasing travel insurance, your claims could be rejected. So you must declare your food allergy to the insurance company to avoid any sort of claim rejection.

Every policy will be a bit different.

When shopping around for your policy, be sure to look for coverage of anaphylaxis, specifically.

If you live in Ireland, the UK, or Australia, the company Compare Travel Insurance put together an  article comparing five different travel insurance plans  that lists travel insurance companies that do cover pre-existing nut allergies.

3. Learn What Local Dishes Have Your Allergen Inside of Them and Which Dishes to Avoid

Take a moment to research the culture of whatever area you're traveling to. Are there specific dishes that are popular and in every restaurant? Is there a staple dish that you can learn more about that is likely to be completely nut free? Are there certain dishes that are likely to have nuts somewhere inside their recipe that you need to be extra careful around? Are there certain dishes so likely to have nuts inside their recipe that you need to avoid them completely?

Doing a little bit of research can help you better recognize your allergen while dining out. If you do find a nut free dish you enjoy, never assume that the dish will be completely nut free at every restaurant. Even if it is, there’s still a risk of cross-contamination. You must have the allergen talk at every restaurant you visit.

But, it’s true that certain dishes and certain restaurants will be more welcoming than others. If you find a restaurant that made you feel like your concerns were addressed and heard, go back often! If they make you feel comfortable, it’s nice to have familiarity and stability.

Do you have a host that can educate you on the culture or be your advocate when dining out? If you don't have a guide, maybe consider hiring one. Having a translator that speaks your native language and the native language of wherever you're traveling to would be highly beneficial.

Don't forget certain sauces could have nuts grounded up inside of them, even when nut particles aren’t visible. This is true, even if in your native country nuts aren’t used in similar dishes. There are bound to be certain sauces that are new to you, because certain dishes will be completely new to you! Researching the local cuisine of wherever you are visiting ahead of time will help you recognize which dishes are potentially dangerous, in addition to which other red flags you’ll want to avoid while dining out.

4. Order An Allergy Card In A Few Different Languages

If you’re traveling to a foreign country, it’s possible that your native language might not be the primary language. It’s normal to experience anxiety around getting lost in translation. You might be thinking of a worse case scenario like, “Does the waiter know that I said no nuts? Or do they think I said extra nuts?”

There are certain websites that can translate your regular restaurant cards. You can make your own or you can order a template of a pre-translated card, like this one from  Select Wisely . Allergy Cards are great for clear and direct communication regarding your allergen and they are especially handy when you can pass them along to your server.

The Select Wisely brand has a  pre-made card  where you can select a language and have a template translated. Check out the right-hand corner. The actual info that’s listed on the allergy card is pretty straight forward. It saves you from the additional anxiety of wondering whether or not the waiter heard you right or understood exactly what it was that you were saying. It's also really portable. It’s sized like a credit card and can be stored inside your wallet for easy access.

Equal Eats is another brand of allergy cards that offers a  customizable pre-made template , and it’s able to be translated into various languages with a click of a button. This company would be a great option for someone who has multiple food allergies, and not just nuts. It’s really customizable. It’s easy to choose your allergens and then choose whichever language you want your travel card to be written in.

Pre-translated allergy cards are fantastic. They take out a lot of guesswork and can give you some confidence in your ability to translate your needs. But, if you find yourself in a situation where you’re unable to communicate with your allergy card alone, or if something happens and you need to speak up, if you have questions about a specific dish etc, and you aren’t quite sure what to say as the language is a little new to you, do consider using google translate! You type whatever you need to say in your native language inside the google translate browser, and then have it translated to text. Instead of trying to speak the translation, simply show the waiter the translated text from your phone. Don’t forget that pronunciation can also change your intended translation! If in doubt, simply exchange communication exclusively through written text.

5. Stock up on snacks that don’t need to be refrigerated

If you get to a restaurant and are starting to feel uncomfortable, leave. If you’re starting to feel like you’re just unsure, leave. If you start to second guess whether or not the restaurant you and your friends finally found fully understands the urgency of you needing to stay away from nuts, you’ll want to be able to reach into your bag and pull out a snack to tie you over. When thinking of snacks that you can take with you, and keep in mind you’ll want to rely on snacks that won’t need to be refrigerated.

Since you’re traveling to a foreign place and everything around you will be new, consider bringing snacks you’re already familiar with. Focus on your staples items. Pack them in your luggage and keep a few snacks in a backpack so you can bring food with you while you hike, see the city, etc. When everything else is new, it’s nice to stick to some things you’re already familiar with. Especially if this is the first time you’re traveling to a particular area or city. If you have a favorite protein shake — that’s awesome! Bring that. Protein shakes are great because they don’t normally need to be refrigerated until after they’ve been opened. They’re also filled with tons of healthy energy and make for a great meal placement. And that’s ideal. Should a meal replacement suddenly become necessary — boom.

If you can refrigerate your protein shakes, in your hotel room etc., go ahead and do so as they’ll probably taste better cold. I’m not sure how well protein shakes would hold up if they're consistently being taken in and out of the refrigerator. If the shake’s temperature keeps changing dramatically, I would imagine it would decrease the shelf life expectancy or at least the nutritional vitality of the product. So, maybe just put a few shakes in at a time to not waste food, or risk food spoilage.

If you aren’t typically into protein shakes and haven’t given pre-made shakes much of a thought before now, check out the  plant-based protein shakes by OWYN . OWYN makes shakes in four nut free flavors: chocolate, cookies ‘n' cream, strawberry banana, and vanilla. They each have 20 grams of protein and are each free from the top common allergens. So, no dairy, soy, gluten or wheat, egg, peanut, tree nut, fish, or shellfish. If left unopened, they have an 18 month shelf-life. They’re perfect for keeping a few inside your bag or backpack as a backup plan! For more info on nut free protein powders, see our article 10 Great Nut Free Protein Powders for Your Workout .

Summary for These Tips on Traveling With a Nut Allergy

These tips are just the beginning! There’s a lot that goes into creating a safe travel experience when you have a nut allergy. If you're interested in learning more about flying with a nut allergy, please see our article F lying With a Peanut Allergy . We hope our tips will help alleviate some of the stress you’re feeling around your travel plans. If you have any tips of your own in regards to traveling with a nut allergy, please share them with the community! We’d love to connect with you over at Instagram. Tell us: What are a few things you learned while traveling abroad? Are there certain things you would do differently? What would you absolutely do again?

Our IG handle is  @gonutfree .  See you there!

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Tips for International Travel

Get tips for traveling, dining and seeking medical help abroad.

International travel lets us see new places and experience new cultures. But all these new experiences mean new potential risks for someone with a food allergy.

You depend on others to communicate with you about where your food comes from and how it is prepared. You would also need help if you happen to have an allergic reaction. Add in new cuisine and people who speak another language, and your foreign travel could start to feel overwhelming.

Take these steps to ensure your safety when traveling abroad with food allergies.

• Ask for recommendations for restaurants, hotels, activities and so on. Does your allergist have other patients with good experiences at certain places?
• Ask your doctor to write extra prescriptions that you can carry with you. Learn their generic and brand names in the countries you’ll be visiting.
• Start planning early. Language barriers can be tough to deal with, but chances are someone working at the hotel speaks English. With many Internet translation services available, email can be an effective way to correspond leading up to your stay.
• Find out if any local doctors in the area specialize in allergy. Ask: Will they be able to write you a prescription for additional epinephrine auto-injectors or medications if you need them?
• Locate the hospital nearest to where you will be staying, just in case.
• Bring several copies of your  Food Allergy & Anaphylaxis Emergency Care Plan . Make sure this document is with you at all times (along with your medications!).
• Carry  chef cards  in English and in the language of the countries where you will be. Always have them with you.
• Bring non-perishable food that is safe for you to eat. Dried pasta and allergen-free snack bars are good options. Don’t assume that the same products manufactured in other countries will contain the exact same ingredients.
• The International Food Allergy & Anaphylaxis Alliance (IFAAA) has developed a  travel plan document  for international travelers. Use this resource as a complement to your usual  Food Allergy & Anaphylaxis Emergency Care Plan . 

IFAA Tip Sheets

For some of the countries represented by the International Food Allergy & Anaphylaxis Alliance (IFAAA), FARE and our partner organizations have provided helpful travel tip sheets.

• New Zealand
• United Kingdom
• United States

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Flying with nut allergies: What to do to ensure a safe flight

F lying with food allergies can be a harrowing experience. In addition to the planning and preparation before your flight, you may also encounter rude or dismissive behavior from fellow passengers and airline staff. This exact situation happened to Lianne Mandelbaum with her own child, prompting her to take up the mantle of education and advocacy for food-allergic flyers through her nonprofit, The No Nut Traveler .

After returning home from her own negative experience, Mandelbaum searched online and found many stories similar to hers. The rest is, as they say, history. Her website started as a safe space where other travelers could share their experiences, but it has grown into something with the power to affect change across the airline industry.

TPG spoke with Mandelbaum, who is also an airline correspondent for Allergic Living , to learn what travelers with food allergies can do to protect themselves when they fly, and also how she is pushing for change in the airline industry.

Preparing for a safe flight

You can't control other passengers or airline employees, but there are steps you can take before you fly to ensure a safe flight and be your own safety advocate. These are the most important tips Mandelbaum shared with TPG:

• Talk with your physician before you travel: They can advise you on best practices and provide you with a doctor's note to verify that you are allowed to carry medication and safe food on the plane.
• Read up on the airline's policies before you travel: Every airline is different when it comes to which accommodations they will allow for passengers with food allergies. Get familiar with your airline's policies either by speaking with them or searching online . Some airlines request advance notice for any allergy-related accommodations, so give as much notice as possible.
• Choose your flight carefully: Mandelbaum advises that the first flight of the day will likely be the cleanest. Whenever possible, a direct flight is also going to be better because you will only need to clean your area once.
• Pack your own food: Even if a meal or snack is labeled nut-free, the only way to eliminate any room for error is to bring your own food. Mandelbaum shares that some meals do not have a list of ingredients, and even if they do, there is still a risk of cross-contamination. She also recommends bringing more food than you need in case of delays or cancellations.
• Know your rights: Travelers with severe allergies do have the right to preboard on U.S. airlines. Check with your individual airline ahead of time to learn the proper procedure to be allowed preboarding.
• Clean the area around your seat: Mandelbaum recommends thoroughly cleaning your area, including the tray table, armrests, seat and anything else you may come into contact with during your flight, with disinfecting wipes, not hand sanitizer, which is not strong enough to remove the allergens. You can also cover your tray table with a napkin before you eat.
• Keep your medication with you: Always keep your medications with you and accessible at all times. Make sure they are labeled and in the original boxes to reduce delays at security.
• Enroll in TSA Cares: TSA Cares provides additional screening assistance to travelers with disabilities. You can also reach out to them for information on what to expect during your screening and guidelines for bringing food, medicine and other exempt items through the security checkpoint. You may also request the services of a TSA Passenger Support Specialist (PSS) at the airport, who can provide you with additional screening assistance. These officers have received specialized training to assist passengers who require special accommodations.
• Share your experience: Whether good or bad, you can share your experience on Mandelbaum's website to inform other food allergy travelers better.

Food allergy policies vary from airline to airline

Although most airlines no longer serve peanuts during their complimentary inflight service, some still serve tree nuts and also serve meals and snacks with peanuts and tree nuts available for purchase. On top of that, airlines cannot control what other passengers eat during a flight.

That doesn't mean passengers with food allergies must entirely fend for themselves when they fly. Most airlines have policies to protect passengers with food allergies. However, they vary wildly and are not always well-known or understood by airline staff.

For example, United , Spirit Airlines , JetBlue and others state in their allergy policies that they will provide a "buffer zone" around a passenger with a nut allergy. This means they will request the passengers sitting in the rows in front of and behind the passenger not to consume nuts during the flight. They cannot demand that passengers not consume nuts, but they can make the other passengers aware and ask them to comply with the request.

If you make Delta aware that you have a peanut allergy before your flight (by filling out an Accessibility Service Request form or calling Delta at 404-209-3434), they will refrain from serving peanuts or peanut products during your flight, instead offering non-peanut snacks to everyone onboard.

You can view the food allergy policies for all major U.S. airlines on the U.S. Department of Transportation (DOT) website.

In addition, the DOT's Air Carrier Access Act prohibits U.S. airlines from discriminating against passengers on the basis of their disabilities. This act ensures that passengers with severe food allergies have the right to board the plane early in order to clean the area around their seats of any potential allergens.

Despite these policies, many travelers with food allergies are met with confusion or outright disdain. Mandlebaum's website has story after story of passengers who deal with airline staff disregarding the policies or passengers who lash out at them, claiming they don't deserve special accommodations.

"We don't want to be the center of attention," Mandelbaum said. "We don't want to be on our hands and knees cleaning our area before the flight. We are only asking for what we need to keep our families safe."

For every negative story, there are just as many positive interactions. It's these inconsistencies, however, that cause travelers with food allergies to feel anxious when they fly. A recent survey of 4,704 people with food allergies conducted by Northwestern University's Center for Food Allergy and Asthma Research found that 98% of respondents had anxiety related to air travel because of their allergy.

The study also revealed that close to two-thirds of respondents who reported that air travel makes them anxious said they would feel less stress with better policies and accommodations in place. According to Mandelbaum, the benefits of consistent, solid food allergy policies are twofold. Not only would passengers feel safer and more comfortable, but there's a real economic potential for the airlines.

"[Travelers with food allergies] are often searching for airlines with the best policies, and we provide free advertising because we share our experiences with others, guaranteeing the airlines new customers and repeat business," Mandelbaum explained.

Advocating for travelers with food allergies

In addition to the DOT's Air Carrier Access Act, the DOT also recently introduced a Bill of Rights for passengers with disabilities. The first item on the list promises that air travelers with disabilities have the right to be treated with dignity and respect.

"That's what we deserve at the very least," Mandelbaum said. "We deserve not to be mocked and made fun of, which can push people to not even disclose their legitimate health conditions."

Mandelbaum does feel that the response to DOT complaints has improved as a result. Before the Bill of Rights was introduced, there wasn't a clear recourse for travelers who had been disrespected, disregarded or worse, laughed at by airline staff. Now, this treatment would be in violation of the DOT's Bill of Rights and, as mentioned along with her other tips, Mandelbaum recommends those who feel their rights have been violated should file a consumer complaint with the DOT .

While Mandelbaum is hopeful this will lead to fewer negative experiences for travelers with nut allergies, it isn't the only initiative she is working on right now.

"My biggest focus is to try and get epinephrine auto-injectors on airplanes," she said.

She's not alone. "Most allergy organizations and the American Association of Pediatrics (AAP) want auto-injectors on airplanes," Mandelbaum explained.

There are a handful of airlines, including JetBlue and American Airlines, that voluntarily carry this life-saving medicine in their emergency medical kits, but others either don't carry auto-injectors or carry vials of epinephrine and syringes, which take more time to administer in the event of a severe allergic reaction (anaphylaxis).

"Time is precious with an allergic reaction. Getting medicine in is of the utmost importance, and you can get it in much faster with an auto-injector than a vial," Mandelbaum said. "The tools to save lives exist, but airplanes aren't stocking the right tools to save people," she added.

There are other benefits to requiring airlines to carry auto-injectors.

"Hopefully, there would be some food allergy training that goes along with training staff on how to use auto-injectors, Mandelbaum shared. "The more you know, the more likely you are to treat someone with dignity and respect."

Mandelbaum has worked tirelessly for 10 years to get epinephrine auto-injectors on airplanes, making it as far as introducing legislation to require all flights to carry auto-injectors with the help of U.S. Senator Tammy Duckworth. She hasn't yet succeeded in getting a bill signed into law, but she isn't giving up.

"I'm hoping for a stand-alone bill at some point so we can initiate this change before tragedy strikes," Mandelbaum said.

Bottom line

"There are lives at stake, and those lives matter," Mandelbaum shared. "My goal is to act in front of a tragedy."

Severe food allergies are a legitimate disability that shouldn't affect a person's ability to travel. Mandelbaum is at the forefront of the movement to make air travel safer for those with food allergies, but until those protections become mandatory, there are proactive steps food allergy travelers can take to ensure a safe flight.

Related reading:

• Key travel tips you need to know — whether you're a beginner or an expert traveler
• The best travel credit cards
• The 18 best places to travel in 2023
• 6 real-life strategies you can use when your flight is canceled or delayed
• 8 of the best credit cards for general travel purchases
• 13 must-have items the TPG team can't travel without

Editorial disclaimer: Opinions expressed here are the author’s alone, not those of any bank, credit card issuer, airline or hotel chain, and have not been reviewed, approved or otherwise endorsed by any of these entities.

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• v.3(1); 2013 Jan

Food allergy in Asia: how does it compare?

Alison joanne lee.

1 Department of Paediatrics, Khoo Teck Puat National University Children's Medical Institute, National University Hospital, Singapore 119228, Singapore.

Meera Thalayasingam

Bee wah lee.

2 Department of Paediatrics, National University of Singapore, Singapore 119228, Singapore.

Asia is a populous and diverse region and potentially an important source of information on food allergy. This review aims to summarize the current literature on food allergy from this region, comparing it with western populations. A PubMed search using strategies "Food allergy AND Asia", "Food anaphylaxis AND Asia", and "Food allergy AND each Asian country" was made. Overall, 53 articles, published between 2005 and 2012, mainly written in English were reviewed. The overall prevalence of food allergy in Asia is somewhat comparable to the West. However, the types of food allergy differ in order of relevance. Shellfish is the most common food allergen from Asia, in part due to the abundance of seafood in this region. It is unique as symptoms vary widely from oral symptoms to anaphylaxis for the same individual. Data suggest that house dust mite tropomysin may be a primary sensitizer. In contrast, peanut prevalence in Asia is extremely low compared to the West for reasons not yet understood. Among young children and infants, egg and cow's milk allergy are the two most common food allergies, with prevalence data comparable to western populations. Differences also exist within Asia. Wheat allergy, though uncommon in most Asian countries, is the most common cause of anaphylaxis in Japan and Korea, and is increasing in Thailand. Current food allergy data from Asia highlights important differences between East and West, and within the Asian region. Further work is needed to provide insight on the environmental risk factors accounting for these differences.

INTRODUCTION

Food allergy has been referred to as the second wave of the allergy epidemic, asthma being the first [ 1 ]. Peanut allergy is one of the main food allergies contributing significantly to this food allergy epidemic [ 2 ]. Its prevalence has doubled over the decade in the 1990s and 2000s in the United Kingdom [ 3 , 4 ] and the United States of America [ 5 , 6 ]. The reasons for this increase are not known. However, environmental lifestyle changes and modernization have been implicated. Complex environmental-gene interactions seem to have resulted in a loss of oral/gastrointestinal tolerance. Not only is there an apparent rise in IgE mediated food allergies, but immune disorders of the gut such as eosinophilic oesophagitis are also more frequently seen [ 7 ].

Large population based epidemiological surveys are relatively few in Asia. This region is, however, an important resource for research and should not be ignored. It is the most populous regions in the world with many diverse populations and vast genetic, cultural, racial, language and socio-economic differences [ 8 ]. The diets are also varied in the type of food, methods of cooking, and the age of weaning. Introduction of new foods in infants follow traditional rather than professional guidance. Amongst clinicians in Asia, the prevalence of food allergy is perceived to be low. With the recent research activity in food allergy, more evidence-based data is emerging from this region and this review attempts to provide a broad overview of the current knowledge of food allergy in Asia. To this end, published studies on food allergy in Asia over the last 8 years were examined and its patterns and trends analyzed. Comparisons were also made with studies from Europe, North America and Australia, as these are populations where the food allergy epidemic has been reported. This information may provide clues on modifiable lifestyle risk factors.

A PubMed search strategy was performed using the terms "Food allergy AND Asia" and "Food anaphylaxis AND Asia". To confirm that individual Asian countries were included, a search on "Food allergy AND several individual Asian countries - Brunei, Cambodia, China, East Timor, Hong Kong, India, Indonesia, Japan, Korea, Laos, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam" was made. The initial search included all relevant articles in all languages, which resulted in 217 articles from January 2005 to December 2012 (inclusive). There were 5 countries - Brunei, Cambodia, East Timor, Laos and Myanmar - which yielded no results. There were also 6 countries - Bangladesh, Indonesia, Malaysia, Myanmar (Burma) and Vietnam, -which yielded no published epidemiological data. Articles from the Middle East and Turkey were excluded. Overall 53 original articles from South Asia, East Asia and South-East Asia were included in this review ( Fig. 1 ).

Methodology: outlines of results of PubMed literature search.

The methodological concerns and food allergy prevalence in Asia

Self-reported food allergy surveys tend to overestimate the rates of food allergy. It is well documented that the prevalence of perceived food allergy exceeds that of true food allergy. Surveys that include skin prick testing and oral food challenges (OFC) (which remains the gold standard for the diagnosis of IgE-mediated food allergy) tend to give a better picture of the true prevalence [ 9 ]. However, despite OFC being the gold standard, the data may be compromised by many factors. These include open versus double blind placebo controlled food challenges, the choice of food used for the challenge (raw versus cooked), the challenge procedure itself (dose escalation, timing interval, outcome after 24 h or after a week), and the lack of universal criteria to define a positive challenge.

Population food allergy surveys in Asia also illustrate the importance of an accurate clinical history from well designed survey questionnaires and testing to provide a more precise evaluation of the food allergy in a community. In general, the prevalence of food allergy is higher in surveys that relied on questionnaires alone compared to those that incorporated allergy skin prick and oral food challenge testing ( Table 1 ).

Population studies on food allergy prevalence in Asia

Report: self/parent-reported based on symptoms provided only; Convincing history: symptoms occurring in less than 2 h. SPT, skin prick test; FE, food elimination; DBPCFC, double-blinded placebo-controlled food challenge; OFC, open food challenge.

A self-reported random based expert screened questionnaire of Taiwanese children aged 4-18 years estimated the prevalence of food allergy as 7.02% [ 10 ]. In this questionnaire survey, the authors' criteria for food allergy required a convincing history of IgE allergy and included information on the age of the first attack, the clinical manifestations, and searched records for allergy tests, but OFC were not performed. Likewise a Korean study involving 1,176 infants with convincing history of reproducible food allergy symptoms via a telephone interview alone reported an overall prevalence of 5.2% [ 11 ]. The overall prevalence of self-reported or questionnaire-based food allergy in the paediatric age-group in Asia ranged from 3.4 to 11.1%. When more rigorous criteria were used in a study conducted in Northern Thailand on 452 children aged 4-7 years of age, where food challenges were included as part of the diagnostic criteria, a prevalence of 1.1% was reported. Another food challenge-proven study from three cities in China (published in Mandarin) demonstrated higher challenge-proven rates of 6.2% in a population of 1,604 children aged 0 to 2 years old [ 12 ]. The reason for the relatively higher prevalence of food allergy in this cohort is likely to be due to the inclusion of non-IgE food allergy, as well as conditions such as eczema.

Despite the notion that food allergy is less prevalent in Asia, these prevalence figures from Asia seem comparable with those reported from western populations ( Table 2 ). In the European and US studies in the paediatric age-group (less than 16 years old) that are based on questionnaire surveys was reported to range from 3-35%, and those with added testing for allergen specific IgE and confirmatory food challenge tests from 1 to 10.8% [ 9 ].

Population studies on food allergy prevalence in Western countries

Report: self/parent-reported based on symptoms provided only; Convincing history: symptoms occurring in less than 2 h; SPT, skin prick test; DBPCFC, double-blinded placebo-controlled food challenge; OFC, open food challenge. * Individual population numbers for different age groups not provided.

There are only two Asian studies that have evaluated prevalence trends in food allergy. As with the global trend, a study of 0 to 2 year olds from Chongqing, China by Hu et al. [ 13 ] who used the exact same methodology 10 years apart showed that the prevalence of challenge-proven IgE-mediated food allergy has doubled from 3.5% in 1999 to 7.7% in 2009. In contrast, in a study of Korean school-children, based on food allergy symptoms alone, showed little change in prevalence over a 5 year period. The prevalence of 'ever having food allergy symptoms' for 6 to 12 year olds was 10.9% in 1995, and 8.9% in 2000, and for 12 to 15 year olds 11.3% and 12.6% respectively. It is therefore difficult to make firm conclusions on the trends in Asia, but they appear to be quite unlike those of western populations, where robust evidence shows doubling of peanut allergy prevalence over the last decade [ 5 ].

The most commonly reported food allergens in the European and North American populations are cow's milk, egg, peanuts, tree nuts, wheat, crustacean shellfish, fish and soy [ 14 ]. However, the true prevalence of fish and soy allergies are low in challenge-proven studies [ 9 ]. Egg and milk allergy are also the most prevalent food allergies in infants and young Asian children. Other than egg and cow's milk allergy (CMA), the pattern of food allergy in Asia appears quite different from other parts of the world and these will be discussed in the subsequent sections of the paper.

Food-induced anaphylaxis

There have been several hospital-based surveys evaluating anaphylaxis triggered by food. The epidemiology of food induced anaphylaxis is difficult to specify for a number of reasons. These include the lack of consensus on the definition of anaphylaxis, especially in those studies published prior to the recent consensus document by the Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium [ 15 ]. Published studies would suggest that anaphylaxis is increasing in the industrialised world specifically the United States, United Kingdom and Australia [ 16 ]. Although epidemiological studies in Asia are lacking the overall incidence data, appears to be low as suggested in a recent Singapore study [ 17 ].

The spectrum of foods responsible for causing anaphylaxis varies with age and is also country specific. In a recent cohort of Singaporean children (with non-local residents excluded) [ 17 ], the following food triggers were reported for each age group: egg and cow's milk in those less than 1 year old, peanut between 1 to 5 years old and shellfish after 10 years old. Peanut emerged as the most common trigger overall, whilst seafood and bird's nest continued to be important local triggers. This is of interest, since "nut" allergy and "nut induced anaphylaxis" has traditionally been unique to the West, and this may indicate a changing pattern of food anaphylaxis. In contrast, a similar Singapore study conducted 15 years ago did not identify any peanut or tree nut triggers for anaphylaxis and at that time bird's nest allergy was the most common trigger [ 18 ]. The authors postulated that migration and genetic predisposition are unlikely to account for this paradigm shift, and that possibly the change in exposure from boiled peanuts to processed peanut butter and previous peanut avoidance advice may in part account for this trend.

Likewise in a recent New York study [ 19 ] conducted in an urban paediatric emergency department that caters for 0-18 years of age, showed a similar pattern of food triggers of anaphylaxis. For children 6 years of age and below, cow's milk was the most common trigger and shellfish occurred mainly in children 7 through to 18 years of age. Also peanuts and tree nuts were reported more commonly as a trigger in the 0-6 years compared to the older age group but these findings were not statistically significant. Peanuts and tree nuts are a common trigger of anaphylaxis and an important culprit in fatal anaphylaxis in other Western populations including United Kingdom [ 20 ] and Australia [ 21 ].

A Taiwanese report by Hsin et al. [ 22 ] also focused on the younger paediatric age group where egg seemed to be the most common trigger followed closely by shellfish, and in a Japanese cohort where 50% of the population comprised less than 2 year olds, egg followed by cow's milk most commonly caused anaphylaxis [ 23 ]. This is similar to data from the US, where eggs are also commonly implicated in less than 5 year olds in the USA [ 24 ].

In the adult population, shellfish is the most frequently implicated food causing anaphylaxis as evidenced by presentation to emergency departments in adults and older children in most Asian countries such as Hong Kong (China), Singapore and Thailand [ 25 - 28 ]. Shellfish is also the leading cause of adult food-induced anaphylaxis in the US [ 24 ] and Australia [ 29 ]. In Korea, wheat and buckwheat are the main culprits of anaphylaxis [ 30 ].

Egg allergy

In most parts of Asia (China, Korea and some South East Asian countries), egg allergy predominates over cow's milk in children below the age of 5 ( Table 1 ). This prevalence ranged from 3 to 4% in a Chinese food challenge-proven study [ 12 ]. These rates are higher than the western challenge-proven prevalence for egg allergy of 1 to 1.6% [ 31 , 32 ]. With the exception of the Australian HealthNuts study [ 33 ] which reported one of the highest published raw egg challenge proven prevalence (9%), compared to the parent reported cumulative incidence of IgE-mediated CMA of only 2.7%. The authors suggested a possible explanation could be the use of raw versus cooked egg, the young age of the participants (11-16 months) and the high eczema rates in Australia. Furthermore, food challenges to raw eggs were undertaken based on a positive skin prick test rather than a history of clinical symptoms. Interestingly, children living in Australia with an East Asian parent have a higher risk of egg allergy compared to the other ethnic groups [ 33 ].

Cow's milk allergy

After egg allergy, CMA is the second most common food allergy in young Asian children. In China, the challenge-proven prevalence for large urban three cities (Chongqing, Zhuhai, and Hangzhou) ranged from 0.83-3.5% in 0 to 2 year olds. However, this study did not distinguish between IgE and non IgE-mediated CMA [ 12 ]. Their diagnostic criteria for challenge-proven allergy included symptoms reported up to 72 h post challenge [ 34 ]. The prevalence of IgE-mediated CMA from studies in Taiwan in less than 3 year olds [ 10 ] and from Korean infants [ 11 ] reported prevalence rates of IgE-mediated CMA as 1.1% and 1.7%, respectively. Though not challenge-proven, these two studies captured IgE-mediated food allergies via a history of convincing allergic symptoms occurring within minutes of exposure and/or sensitization through skin prick testing or IgE levels for the Taiwanese study, and within 2 h of exposure in the Korean study. In a clinical review of CMA cases in Thai children, non-IgE mediated CMA gastrointestinal symptoms were observed in 22% of cases, indicating that non-IgE mediated forms a significant proportion of CMA in at least some of our populations [ 35 ].

These prevalence rates are comparable to those reported in Western populations. In Europe, a meta-analysis by Rona et al. [ 9 ] reported the prevalence of IgE-mediated challenge-proven CMA to be as low as 0.4% by 3 years of age in Denmark, and when non-IgE mediated cases were included, it was 2.2% in children below 4 years in the Netherlands. In this latter study non-IgE mediated CMA comprised about half of the positive cases [ 36 ]. In the USA, the prevalence of 1.8% in 1 to 5 year olds was based on IgE sensitization levels that were above a threshold predictive of clinical allergy [ 37 ]. Another US study by Luccioli et al. [ 38 ] used doctor diagnosis or symptoms of angioedema and urticaria to define probable IgE-mediated food allergy, and reported CMA rates of 3.8% in infants. Despite the varied methodologies and the inclusion of non-IgE mediated CMA in some and not in others, the prevalence rates of CMA in young children in both Asia and the West ranged between <1% to <4%.

Shellfish allergy

Shellfish (crustaceans and molluscs) allergy in Asia is the most common food allergy in older children and adults [ 39 , 40 ], and the leading causes of food-induced anaphylaxis in South-East Asia [ 22 , 28 , 41 ], Hong Kong [ 27 ], and Taiwan [ 22 ]. Population surveys show prevalence rates in teenagers in Philippines and Singapore of 5.12% and 5.23% respectively [ 42 ]. In contrast, a similar survey from the US showed a prevalence of shellfish allergy of 0.7% in 6-17 year olds [ 43 ]. Shellfish is also not a prominent cause of anaphylaxis and allergy in Korea [ 30 ] and Japan [ 44 ].

Due to the high prevalence of shellfish allergy in Asia, there is a special interest in the clinical manifestations of prawn/shrimp allergy in the South East Asian region. Two unique features in the clinical manifestations of prawn allergy have been described. Firstly, resembling the oral allergy syndrome, prawn allergy can result in mild oral symptoms such as itch and lip swelling [ 45 ]. Tropomyosin is a major allergen of prawn/shrimp and the invertebrate tropomyosin is considered a pan-allergen [ 46 ]. It is tempting to speculate that the mild oral allergies to shrimp/prawn observed in our South East Asian populations is due to cross reactivity with tropomyosin of dust mites which is so ubiquitous in our environment, and some case reports do support this notion [ 47 - 49 ]. This phenomenon may be akin to the oral allergy (inhalant-food) syndrome seen commonly in Europe, where individuals with pollen allergy react to cross reactive allergens in fruits and nuts. A multi-centre study in Italy [ 50 ] identified peach being the most frequently offending food in serious allergic reactions which was attributed primarily to sensitization to lipid transfer protein.

Secondly, prawn allergic reactions may fluctuate from severe anaphylaxis to mild reactions on separate occasions of exposure [ 51 ]. The reasons for this varied manifestations within the same patient is not clear. However, the prawn species [ 45 ], dose [ 51 ], the part of the prawn consumed (head versus body) [ 52 ] may be some of the reasons for these clinical observations.

Peanut and tree nut allergy

Although peanut and tree nut allergy constitutes an important part of the food allergy epidemic of the 1990's and 2000's in the western world, there is an impression amongst clinicians in Asia that these allergies are not as prevalent. Population prevalence studies of peanut and tree-nut confirms this clinical impression. It has been reported to be 0.67% in Korean infants [ 11 ], 0.47 to 0.64% in Singaporean children, 0.43% in Filipino children [ 42 ], 0.5 to 1.1% in Taiwan [ 10 ], and almost no cases in children in China [ 12 ] and Thailand [ 53 ]. These rates are at least half of those reported in the United Kingdom (1.2 = 3.3%) [ 3 ], Canada (0.26-1.0%) [ 54 ], USA (0.6-2.7%) and Australia (3%) [ 55 ]. In fact, these populations have experienced a doubling of prevalence rates over the 1990's to 2000's [ 5 ].

The reasons for this stark difference in peanut allergy compared to the western population are not known. It is tempting to speculate that early exposure to peanut which is cooked braised or boiled may be one of the reasons for the development of tolerance, as Asians including children are often exposed to peanut rice porridge. It has been shown that roasting of peanuts increases its allergenicity [ 56 ]. However, other environmental factors that modulate mucosal immunity of the gut and induce mucosal tolerance may also be implicated and requires further study. Environmental influences are suggested by studies on migrant populations (see section below on Risk factors for food allergy). In the Singapore survey, it was shown that irrespective of ethnicity, those born in Asia had lower risk of peanut and tree nut compared to those born in Western countries [ 57 ].

Wheat allergy

Within Asia, marked differences in wheat allergy prevalence are observed. Most notably, wheat allergy is prominent in Japanese school children [ 58 ] and the leading cause of food-anaphylaxis in both Japan and Korea [ 30 , 44 ], and ranked above both shellfish and nuts. In Japanese adults, the prevalence of wheat allergy confirmed by skin prick test and serum ω-5 gliadin-specific IgE test is 0.21%. In contrast, the prevalence of wheat allergy prevalence is low in other parts of Asia. It was reported to be 0.08% less than one year olds in Korea, and in large population studies in Taiwan [ 10 ], Hong Kong [ 59 ], and China [ 12 ], the number wheat allergic children was uncommon. More recently, however, wheat allergy is increasingly reported from Thailand, with a report of 7 children described as having wheat anaphylaxis in Bangkok, Thailand in 2005 who demonstrated positive wheat skin prick test and IgE level results [ 60 ].

Although the reasons for this disparity in the prevalence of wheat allergy in the Asian region are not known, one possible postulation may be related to cooking methods and household exposure to wheat. Wheat flour in its form may be used more often in Japanese and Korean cooking, for example, dry flour is used in dishes such as tempura [ 61 ].

Wheat is the most common cause of food dependent exercise-induced anaphylaxis (FDEIA) in Japan [ 62 ] and Korea [ 30 ]. While shellfish was previously the most prominent cause of FDEIA [ 63 ], wheat is also an important trigger in Thailand [ 64 ], and in Singapore (personal communication Shek LPC, Singapore).

Buckwheat allergy

Common buckwheat ( Fagopyrum esculentum ) is not taxonomically related to other cereal grains (including wheat) and is termed a pseudocereal to highlight this. It is not even closely related to wild buckwheat ( Polygonum convolvulus ), which is grown in the US, which is from another genus level. However the similarity of the English terms makes this confusing, especially for those allergic to it. Common buckwheat is used to make buckwheat noodles in Japanese cooking and because of this frequent consumption, buckwheat allergy is the leading allergy in Japanese school children [ 58 ]. Inhalation or ingestion can often cause anaphylaxis as well. Currently in regions where buckwheat is not commonly consumed, allergy to buckwheat is rare [ 65 ]. However, there is an increasing number of cases seen in other Asian and western countries, especially as Japanese food popularises globally and common buckwheat is used as a substitute for wheat for gluten-free products [ 66 ].

Fish allergy

Despite the ubiquity of fish, fish allergy in Asia is relatively uncommon however there are some notable regional differences. In a recent population based study in late childhood, fish allergy was more prevalent in the Philippines (2.29%) compared to Singapore (0.26%) and Thailand (0.29%) [ 67 ]. Differences in prevalence were accounted for in part by food processing, dietary habits and other cultural practices. These figures were similar to a parent reported survey of adverse food reactions in Hong Kong where the estimated prevalence of fish allergy was 0.32% [ 59 ]. These figures are also similar to a US telephone survey, where the prevalence of 0.2% for fish allergy in children and 0.5% for adults [ 43 ].

The early weaning practices of Asian infants to fish (as early as 7 months) contrasts with Western populations where fish is introduced later [ 39 ]. This early introduction justifies the importance to better understand the allergen profiles of the commonly consumed tropical fish in this region. In Singapore Lim et al. [ 68 ] identified 12-kDa parvalbumin as the major allergen in threadfin, pomphret, indian anchovy and tengirri. This is important as parvalbumin is also the major allergen of cod (Gal d 1) and is a pan-allergen which shares various degrees of amino acid homologies, and therefore clinical cross reactivity amongst species is high. Children with tropical fish allergy had an early age of onset of clinical symptoms, male predominance and urticaria as the most common manifestation. In addition the majority developed symptoms on the first exposure to the particular fish suggesting alternate routes of sensitization.

Unique food allergens in Asia

There are food allergies that are unique to specific regions in Asia. In South East Asia, several unique allergies have been described. For example, bird's nest, a Chinese delicacy made from the saliva nests of cave swallows in South East Asia, is a common cause of anaphylaxis in Singapore [ 41 ]. In India, legumes, particularly chickpeas, are a major allergen due to high consumption in this populous region of vegetarians [ 69 ]. More recently, a cross sectional study from India established a high prevalence rate of eggplant allergy [ 70 ].

Specific to the tropics and subtropics, but not only confined to Asia [ 71 ], is the entity of ingested dust mite anaphylaxis occurring through the consumption of dust mite contaminated wheat flour has also been well described in several regions in Asia - Japan, Singapore and Taiwan [ 72 - 74 ]. It is common in regions where the warm and humid climate promotes growth of dust mites [ 72 ]. The use of wheat flour for cooking is also an important factor as dust mites contamination occurs in stored wheat flour and not in other forms of cereal [ 75 ].

From specific regions of Asia such as Japan [ 76 ] and Korea [ 77 ], where raw fish is traditionally consumed, allergy to Anisakis is common. Anisakis is a nematode which resides within raw fish. This allergy has also seen in other regions such as Spain where pickled anchovies are consumed. It is also expected to be increasingly reported elsewhere due to the rising popularity of raw fish consumption globally [ 78 ].

In addition, a new entity of allergy to galacto-oligosaccharide (GOS) containing formula has gained recent recognition in South East Asian countries such as Thailand, Vietnam and Singapore [ 79 ]. Despite GOS being approved for supplementation in infant formula in Europe since December 2001 [ 80 ], and conferred generally regarded as safe status by the US FDA in 2007 [ 81 ] - no such reports of GOS anaphylaxis have ever emerged from these western nations. This probably points to a environmental risk factor for the presence of GOS anaphylaxis in South East Asia, possibly similar to the postulation that carbohydrate sensitivity to alpha-galactose epitope in cetuximab and red meat allergic reactions in south eastern regions in the USA are a result of primary sensitization from bites of regionally distributed ticks [ 82 ].

Risk factors for food allergy

Food allergy, like other atopic disorders, is a complex trait where the interplay of genetic/epigenetic and environmental factors results in disease manifestation. There is a paucity of data emerging from Asia. However, studies on migration have contributed to the notion that environmental factors are paramount risk factors. The data shows that migrants appear to acquire the incident risk of their adopted country. Leung et al. [ 59 ] demonstrated that children born in mainland China compared to children born in and raised in Hong Kong had less parent reported adverse food reaction (4% versus 6.7%; p = 0.016). In the Singapore survey, it was shown that irrespective of ethnicity, those born in Asia had lower risk of peanut and tree nut compared to those born in Western countries [ 57 ]. Similarly data from outside Asia demonstrated that Jewish children in the United Kingdom have a prevalence of peanut allergy that is 10 fold higher than that of Jewish children in Israel [ 83 ]. The exact environmental factors contributing to these geographic differences are not fully understood. Factors that increase atopic susceptibility or reduce protection, such as early life microbial and parasitic exposure, the method of delivery (natural birth versus caesarean section), breast feeding rates; and factors relating to allergen exposure such as postpartum and weaning practices, the preparation and the processing of the food, and inhalant and cutaneous allergen exposure, are all likely candidates.

Genetics/epigenetics and ancestry are also important players in the development of food allergy. A study by Sicherer et al. [ 57 ] showed that monozygotic twins (64.3%) had significantly higher concordance rates for peanut allergy compared to dizygotic twins (6.8%). Similarly, in a Chinese twin study, food allergen sensitization as demonstrated by skin prick test showed that monozygotic twins were more likely to have concordant sensitization rates for peanut (odds ratio (OR) 3.7; 95% confidence interval (CI) = 1.4-10.0) and shellfish (OR 2.3; 95% CI = 1.0-5.2) than dizygotic twins [ 84 ]. Several genes have been implicated in genetic susceptibility to food allergy, and these include human leukocyte antigen, cytokine and immune genes: CD14, IL10, IL13, forkhead box P3 (FOXP3) [ 85 ]. Recently, mutations in loss of function variants in the filaggrin (FLG) gene have been identified as a risk factor (egg and peanut) allergy [ 86 ]. It is postulated that the impaired skin epithelial barrier resulting from these genetic defects facilitates epicutaneous sensitization through immune mechanisms, which in turn increases the susceptibility to food allergy. However these mutations are population specific as published by Chen et al. [ 87 ], where in a comparative study they identified 8 different FLG mutations account for 80% of the FLG mutations in Singapore while only 2 prevalent FLG null mutations dominated the European FLG spectrum. The relevance of the heterogeneity in FLG mutations in Asians is not well understood although in the HealthNuts study, infants with atopic eczema were much more likely to be of East Asian descent [ 88 ].

The prevalence of food allergy in Asia is increasing but still relatively lower, particularly for peanut and tree nut allergies, than the urbanized Western populations. These observed differences in prevalence are intriguing and deserve further study, since an affluent lifestyle is no longer an acceptable explanation as many urban regions of Asia are developed and affluent. The different pattern of food allergens also provides us with a unique opportunity to understand the environmental sources responsible for primary allergen sensitization. The marked genetic and environmental heterogeneity in Asia make future research challenging, and concerted efforts must be made to standardize definitions, procedures and food allergy outcomes to accurately identify risk and protective factors within the region.

ACKNOWLEDGEMENTS

We would like to acknowledge Dr Motohiro Ebisawa, Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Japan and Professor Pakit Vichyanond, Mahidol University, Siriraj Hospital, Bangkok, Thailand for the contribution of their data to this review.