Vacations increase risk for food allergy reactions among children
Click Here to Manage Email Alerts
Vacations increased the risk for severe accidental allergic reactions among children and adolescents with food allergies, according to a letter published in Annals of Allergy, Asthma & Immunology.
Miranda Crealey, MD, and Aideen Byrne, PhD, both with the department of pediatric allergy at Children’s Health Ireland, recruited 498 children aged 2 to 16 years (median age, 7 years) with confirmed food allergy.
Participants reported accidental allergic reactions by phone every 3 months for a year in addition to any vacations they took.
The cohort included 403 participants (81%) who took vacations, including 244 who traveled abroad, with 235 via plane and nine by ferry, and 146 who visited locations considered non-English speaking.
Of those who traveled by plane, 115 (47%) ate food they purchased at the airport and 90 (36%) only ate food they brought from home.
Also, 307 (76%) stayed in hotel accommodations and 96 (19%) stayed in self-catering accommodations, which the researchers defined as houses, tents, apartments or caravans where food was self-prepared.
Overall, 33 (15%) had vacation-related accidental allergic reactions for an annualized accidental allergic reaction rate while on vacation of 8.2% (95% CI, 5.7-11.3).
All of the reactions occurred following ingestion, although the allergen was unidentified in 14 (43%) of the cases. Identified allergens included peanut or tree nut (n = 6), cow’s milk (n = 5), hen’s egg (n = 3) and fish (n = 2).
Involved foods included ice cream (n = 3), cake (n = 6), pizza (n = 5), chocolate (n = 2) and fish (n = 2). In 15 of these reactions (45.5%), participants asked for or checked the food’s ingredients.
Compared with vacationing elsewhere in Ireland, participants tended to be more likely to experience reactions when they were abroad, with 18 (66%) of the reactions occurring in locations where English was not the primary language.
Hotels and restaurants accounted for 20 (61%) of the vacation-related accidental allergic reactions, with seven (21%) more in shops and cafes and one at an ice cream truck. Three reactions (11%) occurred on planes, including two from home-prepared food, and two (6%) in airports. There were no reactions in any of the self-catering accommodations.
The risk for reactions was higher for participants staying in hotels compared with those who were self-catering (RR = 3.1; 95% CI, 0.97-10.02).
Reactions were categorized as mild (73%) or anaphylactic (27%), with significantly more anaphylactic reactions on vacation compared with when participants were not on vacation (RR = 2.3; 95% CI, 1.17-4.58).
Two of the nine children who experienced anaphylaxis on vacation received adrenaline, and one of these children went to the hospital. None of the cases were fatal.
The researchers noted that these participants commonly vacationed in Ireland and abroad, frequently dining out as they did so, contrasting a previous study finding that 90% of Americans with food allergy do not leave the U.S. for vacations and that half of them eat meals in their room.
Although these participants experienced a significantly increased risk for severe accidental allergic reactions while they were on vacation compared with their home lives, the researchers did not attribute these incidents to unfamiliarity with restaurants, as 90% of them said they dined out in their home city at least once a month.
The lack of an identified allergen in nearly half of the incidents suggested that unfamiliarity with local ingredients may have contributed to these reactions, indicating a need for better preparation among these families, the researchers continued.
Similarly, with two of the three reactions on board planes involving food from home and the low use of epinephrine when reactions did occur overall, the researchers encouraged families to prepare for emergencies at all times.
The researchers further encouraged doctors to prepare targeted vacation-related education for families and recommended further studies to ensure this education is effective.