Chapter 21

Ten Tips for Traveling with Asthma

In This Chapter

Making sensible travel plans

Taking asthma and allergy medications and other essentials with you

Dealing with asthma and allergy problems on the road

Attending to children with asthma and allergies while traveling

I f only airlines could lose your asthma the way they sometimes lose your baggage. Imagine if you could leave your wheezing instead of your heart in San Francisco. And wouldn’t waking up in the city that never sleeps because the Big Apple stirs you to the very core — instead of an asthma episode interrupting a good night’s rest — be nice?

Of course, getting away from asthma isn’t that easy. Extensive studies over the past 15 years show that this respiratory ailment is an ongoing condition that you usually don’t outgrow, although its symptoms can certainly vary in character and severity throughout your lifetime.

Think of asthma, and often-related conditions, such as allergic rhinitis (hay fever), as constant companions. Wherever you may roam, these conditions will be along for the ride. Knowing how to control the symptoms of these ailments is vital to ensuring that no matter what else may go wrong during your travel, your respiratory condition won’t complicate or ruin your plans.

Planning a Safe, Healthy Trip

A key element in proper travel planning is avoiding places where you know pollens, dander, tobacco smoke, or other allergens and irritants may be prevalent and could, depending on your specific sensitivities, trigger your respiratory and/or allergy symptoms.

The following points are general guidelines for preventing problems frequently associated with these triggers:

Dander: Beware of visiting or staying in homes with cats, dogs, and other animals, including rabbits, birds, and gerbils and other domesticated rodents. Even if the animal lover removes the pet from the area, you can still suffer an adverse reaction because of the residual dander and/or hair in the room. Horseback riding also may not be advisable. Before you saddle up for a dude ranch out West, make sure you can control any symptoms that Trigger’s horsehair may just trigger. Consult your doctor about preventive medications (and see Chapters 5 and 10).

Food allergens: The foods that trigger allergic reactions most frequently in adults with food hypersensitivities include fish, shellfish, peanuts, and tree nuts. For children, the most common triggers are milk, eggs, peanuts, tree nuts, fish, soy, and wheat (see Chapter 8). Because of the swiftness and severity with which a food allergy reaction can strike (especially with peanuts), be especially vigilant in avoiding these triggers when traveling. In particular, if you or your child is sensitive to peanuts and you’re planning to travel where these seemingly harmless legumes are a regular part of local cuisine (many parts of East Asia, for example), ask your doctor about additional precautions you can take. Although you can clearly identify peanuts in many dishes, they may be a hidden part of the cooking process itself in many cases (for example, foods cooked alongside dishes prepared with peanut products). When in doubt, avoid local fare in these parts of the world, rather than risk reactions such as an asthma attack, hives, or worse yet, a potentially life-threatening case of anaphylaxis (see Chapter 8).

Ragweed: Avoiding travel to the eastern half of the United States and Canada from mid-August through October is probably advisable (assuming you don’t already live there) if you’re sensitized to ragweed pollen. If you must travel to those areas during ragweed season, ask your physician about preventive medications that you can take to keep your symptoms under control (see Chapter 10). Also, the National Allergy Bureau (NAB) of the American Academy of Allergy, Asthma, and Immunology (AAAAI) has seasonal allergen maps that chart the prevalence of allergenic pollens, as well as several other allergens around the country throughout the year. Check out the NAB Web site at www.aaaai.org/nab or call 414-272-6071. (See Chapter 10 for more information on pollens.)

Adjusting Treatment for Travel

Prevention is the key to a safe and trouble-free trip, which usually means consulting your physician ahead of time to evaluate your asthma management and to make any advisable adjustments, based on where and when you’re going and what you’ll be doing while traveling. You may need to adjust your medication because of increased exposures to triggers. In addition, remember that changes in time zones may affect the dosage schedule of some medications you’re taking (for any ailment, not just asthma or allergies).

You’ll also need to make sure that you’ll be able to stick with the program that your physician advises. If possible, get a letter from your doctor summarizing your medical history, as well as the treatments and medications you’re currently taking. If you’re at risk of acute asthma or allergy attacks, ask your physician about wearing a MedicAlert pendant on your wrist or around your neck. (See the appendix for information on this and other valuable asthma and allergy products.)

Taking Medications and Other Essentials

Make sure you have all your necessary medical supplies, devices, and prescriptions with you when traveling. If flying (or riding on a train or bus), keep these items in your carry-on bag. After you arrive at your destination, keep your essentials with you instead of leaving them in your hotel room (or other accommodation) when you’re out and about. If you need to leave your medications in the room (for example, while using hotel recreational facilities), make sure you store these products in a safe and secure location, such as the room safe or in a locked suitcase, instead of leaving them out on the bathroom countertop.

Keep medications in their original containers and never mix pills of different types into one receptacle. By keeping them in their original containers, you’ll have the proper dosage information readily available, which is especially important if someone else needs to administer your medication to you. Also, if you’re traveling internationally, customs officials are generally less suspicious of pills and capsules in their original containers.

If you or your child uses a nebulizer at home, ask your doctor about taking one with you on your trip. If you’re traveling overseas, don’t forget to bring whatever adapters and converters (available in most luggage, electronics, and travel stores) you may need in order to use your domestic devices in different countries. The electric current in many other parts of the world is 220 volts rather than the 110 volts that is standard in the United States and Canada. If you have a portable nebulizer, don’t forget extra batteries.

Getting Medications and Medical Help Abroad

Ask your doctor about special medical considerations for specific countries and areas. Some countries require that you take certain vaccine shots before your visit. As for medications, don’t assume that every place you visit has pharmacies stocked with the supplies you need. Write down both the brand names of your medications and their generic names. In a pinch, having both names available may allow a local pharmacist to find what you need.

When planning your trip, you may want to obtain a booklet that lists qualified, English-speaking physicians in just about every country of the world. The International Association for Medical Assistance to Travelers (IAMAT), a voluntary organization based in Canada, offers this booklet. You can contact them in the United States at 716-754-4883 or via their Web site at www.iamat.org for further information.

Also, if you’re a U.S. citizen, the U.S. State Department’s American Citizens Services can provide help in case of an emergency. Call the State Department’s Hotline for American Travelers, 202-647-5225, or check the State Department’s Web site, www.state.gov , before your departure to receive information on contacting U.S. embassies and consulates for assistance with medical matters.

Flying with Allergens and Irritants

Sad to say, but your fellow airplane passengers may make you sick. Studies show that airplane passenger cabins are some of the worst indoor dust mite and animal dander sites. Because airliners are tightly sealed environments that often lack adequate air filtering or cleaning, they often concentrate sky-high quantities of allergens and irritants that hundreds, even thousands, of passengers constantly track in with them. So be advised: Your seat may already be occupied by frequent-flier allergens.

Many airplane seats house thriving colonies of dust mites and their allergenic waste products. In addition, although all U.S., Canadian, and many European flights ban smoking anywhere on the aircraft (and in most parts of airport terminals), some international flights still allow smoking.

If exposure to tobacco smoke triggers your asthma symptoms, find out as much as possible about an air carrier’s smoking policies. If your travel includes flying an airline that permits smoking, try to get seating as far away from the smoking section as possible.

Take my advice when you’re planning air travel:

Pack your medications in a carry-on bag so they’re immediately available in the event of a serious asthma episode and/or allergic reaction and in case the airline loses your luggage. (You want to avoid finding yourself in strange territory without your medications.)

Stay hydrated during your flight. Avoid alcohol and drink plenty of water. Not only does drinking water help minimize potential asthma and allergy problems, but it also can put a dent in whatever jet lag you may otherwise develop.

If you have the opportunity/financial ability, consider upgrading to first or business class. If available, the leather seats may be less likely to harbor allergy triggers, and at the very least, you’ll give yourself more breathing (and leg) room.

Considering Allergy Shots and Travel

When you’re traveling, I usually recommend transferring your immunotherapy (allergy shots) program to another location only if you’ll be gone at least a month or more (if you’re a snowbird from the North wintering in southern California or southern Florida, for example). If you’ll be gone for a month or more, ask your physician for a referral to a doctor in the area where you’ll be staying and have that physician administer your shots in a medical facility.

Although practices vary in different areas of the United States and the world, don’t give yourself allergy shots. The risk, although low, of a bad reaction or even anaphylactic shock means you need qualified medical personnel around you, just in case (see Chapter 11).

When visiting the physician in the new location, bring your allergy serum (vaccine) vials in a refrigerated or ice-insulated pack, and make sure you have clear written instructions from your doctor regarding your dose.

Reducing Trigger Exposures in Hotels and Motels

Tobacco smoke and its lingering traces can cause problems, especially outside the United States or Canada, where hotels and other accommodations are less likely to restrict smoking. Wherever you stay, reserve a room on a smoke-free floor. Likewise, if feathers pose a potential allergy problem for you, bring your own pillow and pillowcase (see Chapter 10).

Inspect the room before you occupy it, looking for signs of animal hair, dirty air vents, dust, or mold. If you find evidence suggesting that staying in the room will lead to breathing problems, ask for another room that appears safer and more comfortable. In some cases, your doctor may advise bringing along a portable HEPA air filter system (see Chapter 5). Check to see if your hotel offers allergy-free rooms, which may even come with HEPA filters and allergy covers on the mattresses.

Avoiding Food Allergies during Your Trip

In your travels, you may come into contact with foods to which you have an allergy (not just an intolerance — see Chapter 8 for the difference between the two conditions). In some cases, the menu in a given restaurant, hotel, or cafe reveals all you need to know about potentially problematic ingredients. But more often than not, you need to ask a lot of questions about the cuisine and how it’s prepared. Don’t be rude, but definitely don’t be shy.

As I explain in Chapter 8, you may need to do more than simply determine that a particular dish doesn’t contain foods to which you’re allergic. For example, in many restaurants, various dishes are all prepared on the same grill. In this case, if you’re allergic to shellfish, for example, make sure that the cooking surface and utensils used to prepare your food haven’t also been previously used to prepare shellfish. If they have, allergens from the shellfish may end up in your meal, potentially causing a distressful dining experience.

If your food hypersensitivities put you at risk for anaphylaxis, wear a MedicAlert pendant or bracelet. Also ask your doctor about prescribing an epinephrine kit such as an EpiPen (see Chapter 8), and be sure to carry the kit with you.

Finding Help in Case of Emergencies

Although the local hospital probably isn’t at the top of your sightseeing list, find out the location of the nearest medical facility equipped to treat you in case of a serious adverse allergic reaction or severe asthma episode. Knowing where the closest help is available can help ensure that you get effective treatment if you experience a life-threatening reaction.

Depending on your destination, you can easily obtain local hospital loca- tions from the organizations that I list earlier in this chapter (see the section “Getting Medications and Medical Help Abroad”) and in the appendix, your doctor, or your travel agent. In some cases, you may need to do more homework; however, your health and safety are worth the effort.

Asthma camps

Children with asthma can benefit from a spe-cial type of vacation experience. A number of organizations, including the American Lung Association (ALA), sponsor children’s asthma camps throughout the United States and Canada. If your child has asthma, consider sending him or her to one of these camps for a healthy, safe, educational, and fun nature-oriented vacation. Asthma camps generally offer one- to two-week programs that teach children how to recognize the signs of asthma and allergy triggers, use medications and inhaler devices properly, and understand the basics of asthma management. Call the Consortium of Asthma Camps at 651- 227-8014, or visit the organization’s Web site, www.asthmacamps.org, for a list of asthma camps.

Traveling with Your Asthmatic Child

When traveling with a child who has asthma, many of the same considerations that adults must contend with also apply. These points include the following:

Pack two containers of all medications, and make sure that you’ve labeled them properly. Keep one container as a carry-on with you, and keep the other in a purse, backpack, or briefcase.

Obtain a MedicAlert bracelet or necklace for your child to wear. If you’re not around, emergency medical personnel will immediately know what to do about your child’s condition.

Show your child how to pack his or her asthma and/or allergy medications properly. In addition to preparing your child for trips that he or she may take without you, this lesson can also help your youngster find out more about managing his or her condition appropriately.

Take at least two epinephrine kits (such as an EpiPen or EpiPen Jr. for children under 66 pounds) if your child is at risk for anaphylaxis to ensure that you’ll always have one at hand. Make sure that you and/or your child (depending on the youngster’s age) know how to use the kit. Knowing how to use the kit means you should receive instructions on the proper use of the injector in your doctor’s office, rather than waiting for a potential emergency to figure it out.

Ask questions about meals. If your child has peanut allergies, be especially vigilant on airplanes (particularly with the contents of those appealingly packaged snack bags), where peanuts can be as common as delayed flights (see Chapter 18).