Characteristics of food-related allergic reactions during travel: a scoping literature review

A substantial number of travelers have pre-existing food allergies, which can put them at risk of exposure to allergens during transportation, e.g. on aircraft, and at travel destinations. This review aims to identify the characteristics of food-related allergic reactions among travelers. A literature search was conducted on PubMed, Embase and Scopus using keywords related to food allergies and travelers. Eligible studies were grouped into cohort/cross-sectional studies and case series/case reports. Data were extracted on prevalence (for cohort/cross-sectional studies), common allergens, locations where reactions occurred, and impact on travelers. Twenty-four articles were included. The prevalence of in-flight food-related allergic reactions ranged from 1.7-3.0%, while reactions during travel ranged from 6.9-10.0%. Peanuts and tree nuts were the most frequent allergens, accounting for up to 75.0% of reported cases. Other common allergens included cow’s milk, eggs, fish, shellfish, wheat, and soybean. During international travel, most reactions occurred in non-English speaking countries and in Europe. Case reports highlighted exposure to exotic foods such as tropical fruits and insects. Consequences ranged from mild reactions to severe anaphylaxis, hospitalization, and flight diversion. Some travelers reported avoiding future travel after reactions. Two fatalities were described in case reports. Food-related allergic reactions in travelers are likely underestimated, with only severe cases typically reported. There is sparse information regarding the common food allergens, the profiles of allergic travelers and risk factors for allergic reactions. These findings underscore the need for improved counseling and prevention strategies among travelers, travel medicine practitioners, and travel agencies.