Travel Health Wilderness

Dealing with allergies and travel

Image: Nalilo

Most every person I know suffers from allergies, in some way or another.  Those who claim to never have allergy troubles are just probably not coming into contact with their allergic “triggers” on a regular basis.  However, this is exactly what people do when they travel…come into contact with new things.  Some of these new things can cause allergies which can not only be dangerous but can also really slow down a fun trip.

Allergy Symptoms:

Symptoms of an allergic reaction can range widely, from a slight rhinitis (runny nose) to full blown and life threatening anaphylaxis, the most severe form of allergic reaction.  Typical reactions can include:

  • Rhinitis (runny nose)
  • Watery eyes and redness
  • Urticaria (hives)
  • Skin pruritis (itch)
  • Angio-edema (swelling of lips and tongue)
  • Shortness of breath

anaphylaxis treatmentPerhaps the most important thing that can be said about allergic symptoms is the prompt recognition of a life threatening allergy.  Life threatening allergic reactions are some of the scariest things I have ever had to deal with, as they can go from bad to worse, in a matter of minutes.  The biggest concern with anaphylaxis is loss of the ability to breathe.   A body can only live a few seconds to minutes without adequate breathing and this is a life threatening emergency.  Typically, massive swelling of the throat, lips and/or tongue actually block the path of air into the lungs.  This is a true medical emergency and immediate professional medical help should be sought, without delay.  Some clues that may indicate a progression from a simple allergic reaction to a real emergency include any kind of shortness of breathing, including wheezing.  I also feel that any kind of swelling of the lips, tongue or throat should be treated as an emergency, as well, due to the potential rapid progression of the reaction.  Sometimes, a sense of paresthesia (tingling or numbness) in the lips, tongue or mouth can signal involvement of the airway.  Most anaphylactic reactions occur within 5 minutes to 1-2 hours of contact with the trigger.  Also, the quicker the reaction, the more severe it will be.

Allergy Triggers:

Things that can trigger or provoke an allergic reaction very from person to person.  Another important thing to remember is that one can develop an allergy to previously tolerated substances, such as shellfish.  This development of a “new allergy” can occur at anytime.

  • Plant pollens
  • Pet and animal dander
  • Insect bites
  • Foods (shellfish, peanuts, wheat)

How Allergic Reactions Work:

How allergic reactions occurAllergic reactions are a very complex cascade of chemicals in the body, released from special cells called Mast Cells and Basophils.  These special cells release histamine, which is the major cause of allergic reactions.  Histamine, among its many other functions, increases the permeability of the blood vessels.  This results in the urticaria (hives), the runny nose and the common other symptoms seen in an allergic reaction.  This is also why “anti-histamines” are the drug class of choice in dealing with allergic reactions.

Treating Allergic Reactions:

A basic allergic reaction should respond well to an oral anti-histamine, such as diphenhydramine (Benadryl), fexofenadine (Allegra) or loratadine (Claritin).  These types of medicine are generally the “first line” treatments and should be carried in every first aid kit.  Care should be used with taking anti-histamines, as some can produce a sedating effect and cause drowsiness.  I often suggest testing these medicines out, prior to your trip, to see which ones you can take with a minimal amount of drowsiness.  Most of these medicines are available over the counter, without a prescription.  Several forms of the drug may exist, such as syrup or cream.  Syrups work great for those who cannot swallow pills, like kids.  Creams are also good for direct application to skin irritation and hives. 

Anti-histamines are great for preventing histamine release, and generally help alleviate the symptoms that cause so much trouble, like runny nose, itch and eye irritation.  Sometimes, an inhaled nasal steroid can do wonders to help “dry-up” that stuffy nose.  Triamcinolone (Nasacort) and budesonide (Rhinocort) are common brands in North America.  These medicines use small doses of steroids to decrease inflammation in the nose and sinuses, helping alleviate the itch and mucus production.  These inhaled steroids aslo work well for the post-nasal drip and resulting sore throat, as well. 

Sometimes, an allergic reaction can be so troublesome that oral steroids may be required to treat the reaction.  Methylprednisolone (Medrol) is one option and is often taken twice per day, for 3-5 days, in low doses.  These require a prescription and you should check with your doctor before taking these. 

EpiPen auto injector
EpiPen auto injector

Treating severe allergic reactions, like anaphylaxis, require the use of two specialized medicines: Epinephrine and Albuterol.  Most people with a history of severe allergic reactions should know about EpiPens.  EpiPens are designed to be carried by the individual and self-administered at the first sign of an allergic attack.  Basically a small tube with a needle, the EpiPen injects a dose of epinephrine directly into the body, acting to stop the allergic reaction.  Typically given into the thigh, the epinephrine is a powerful drug that helps open airways and mitigate the severe allergic reaction. 

Image: Net_efekt

Albuterol is a medicine designed to be inhaled, often through a MDI (metered dose inhaler) or “puffer”.  Albuterol stimulates the beta-two receptors in the lungs and airways, helping “open up” swollen air passages.  Albuterol is also a common medicine treating asthma. 

Should there be a suspicion of an extreme allergic reaction (anaphylaxis), treatment should begin early and aggressively.  Multiple medicines should be used in treatment, including an EpiPen, anti-histamines and steroids.  Bystanders may need to help the person administer the epi-pen and medications, while calling for professional help.  Unfortunately, the bystanders may also be required to perform CPR, until definitive medical care arrives. 

What to Carry:

 Most importantly, every first aid kit should carry an oral anti-histamine.  They take little room and can help save a life, in an allergic reaction.  Often times, travelers who have little trouble with allergies at home can run run into many new things that can trigger an allergic reaction.  Having easy access to anti-histamines can not only help save the trip, but also a life. 

Travelers with a history of anaphylactic reactions should ALWAYS carry an EpiPen with them, at all times.  I frequently prescribe several EpiPens, so one may be carried in a purse or day pack, one left in the hotel and another to be used as back-up.  Albuterol inhalers are the same way, carry one with you at all times and have several strategically placed in your gear, as back ups. 

Travelers with history of difficult to control allergies should plan well before their trip and speak with their doctor about what to pack in their first aid kit.  Some things to ask about include: carrying an inhaled steroid for symptomatic relief of runny nose and sinus “itch”, a short course of oral steroids and a need for rescue medicines such as EpiPens and Albuterol.

The vast majority of travelers will experience an allergic reaction, of some sorts, during their trip.  As with most things in travel medicine, taking a few minutes to prepare before the trip can make all the difference.  Adding anti-histamines to the first aid kit and learning the signs of allergic reactions can help keep you allergy symptom free on your trip and allow you to fully participate in your activities.

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