How to safely eat while traveling internationally for those with known food allergies.
Deep fried crickets. Image by SadiaK123 from Pixabay
Travel medicine often focuses on preventing infectious diseases: think malaria, dengue fever, and travelers’ diarrhea. And rightly so, as these are important considerations for the international traveler. But infectious diseases are not the only concern while traveling overseas.
Traveling around the world can be a wonderful and fulfilling experience, exposing one to different cultures, sites, peoples, locales….and food. It is this last possibility, exposure to new and different foods, that can pose a hazard to those with known food allergies and severely interfere with one’s trip, potentially resulting in hospitalization and even death.
In the November-December 2023 issue of the journal Travel Medicine and Infectious Disease, Charoensakulchai et al. share a case of a Taiwanese backpacker who experienced an allergic reaction after consuming a variety of exotic insects, such as grasshoppers, sago worm, and silkworm pupae. This traveler had a known food allergy to shrimp which can have a cross-reactivity allergic reaction with insects.
The authors state:
This patient had a history of a marine shrimp allergy, consumed fried insects, and subsequently experienced allergic reaction due to the potential time lapse between consumption and symptoms development. Although there is no strong evidence to fulfill the criteria of anaphylaxis in this case, the treating physician decide to treat him as anaphylaxis to prevent the escalation into severe, life-threatening conditions, given the possibility of cross-reactive hypersensitivity with shrimp allergy. IgE antibodies in individuals allergic to crustaceans can cross-react with tropomyosin found in insects, as both belong to the Phylum Arthropoda. Up to 87 % of patients allergic to shrimp may also exhibit allergic symptoms following the ingestion of insects. Therefore, cross-reactive hypersensitivity is clinically significant within this phylum.
Crustaceans, such as shrimp, and insects both belong to the phylum Arthropoda, which is one taxonomic level lower than the highest level of kingdom (if you have a biology background, you may remember the order of taxonomy from highest to lowest of Kingdom, Phylum, Class, Order, Family, Genus, Species--- a mnemonic I've used for years to remember this is Kings Play Chess On Fat Green Stools). Phylum is a high level and, thus, contains many members. In fact, the University of Hawai'i' at Manoa's Exploring Our Fluid Earth module on the Arthropoda phylum states that "over 85 percent of all known animals are arthropod species." As Charoensakulchai et al. state above, there is a high percentage of cross-reactive hypersensitivity between shrimp and insects due to their membership in Arthropoda.
Thankfully, this traveler was treated and recovered, and the case serves as a very important reminder that those with known food allergies should be extremely careful and vigilant with what they eat while traveling in new, exotic locations. But among the normal, everyday traveler, who would think of this? While preparing for one's trip, who would pause and evaluate their allergies, perhaps having an internal monologue along the lines of, "I know I have a pretty bad reaction to shrimp, so I must also avoid eating insects from a market?" I assume this is unlikely!
This scenario underscores three things.
First, it shows the importance of a traveler seeking a pre-travel health consultation from a trained travel medicine specialist. Such a consultation is an opportunity for the traveler to learn ways to stay safe while traveling and may include topics of which the traveler was previously unaware. Some travelers may simply not know what they don't know, at no fault of their own. A pre-travel health consultation can fill these knowledge gaps. For example, the travel medicine specialist could inform the traveler to be careful eating insects due to a known shrimp allergy. To learn about what travel medicine is and how it can benefit an international traveler, check out a previous blog post of ours here.
Second, it shows the importance of a travel medicine specialist being competent, continuously seeking new information and knowledge that can benefit their travelers. The travel medicine specialist should review travel medicine literature to stay up-to-date and, perhaps, learn brand new things. For example, I likely would not have made the connection between a known shrimp allergy and a recommendation to not consume insects prior to reading about this case. Now I am more equipped for this important situation.
Lastly, it shows how important it is for a traveler with a known allergy to be prepared in case of an allergic reaction while overseas. These travelers should:
Recognize the signs and symptoms of an allergic reaction, including an anaphylactic reaction.
Know where to go to seek immediate medical care.
Bring necessary and important supplies, such as medications, to treat their symptoms. This is especially vital if no or poor medical care is available in country.
Have appropriate travel health insurance.
In their chapter titled "Highly Allergic Travelers," the Centers for Disease Control and Prevention's 2024 Yellow Book has a great checklist for travelers with food allergies, screenshotted below (click the link to access the actual chapter with working links).
Being proactive, rather than reactive, can help a traveler with food allergies travel the world and eat safely. Following recommendations and being prepared for the worst case scenario can help these individuals travel with peace and confidence.
And if in doubt, don't eat bugs.
(This article was written by a human, not A.I. Feel free to share it with others.)