My daughter, a freshman in college, wants to do a summer abroad in Italy this summer. It is four weeks. They go to class four days a week and then go traveling each weekend. She is allergic to milk and peanuts. She is very responsible, but I worry about her being given wrong information in a restaurant. Italian culture is very laid back and not at all precise. She wants to go now and not when she is older, because she took four years of Italian in high school, including AP, and figures she should go while her Italian skills are good. She would not know anyone there, although she makes friends easily. We would purchase foreign travel insurance so if she ended up in the hospital or needed to be medi-vacced out, they would make all of the arrangements. They would also give us the names of allergists in the area. She would go with three or four epi two packs, so she would not have to find epis if she had to use hers. She has self administered one time. She has only had two reactions requiring epi in her life. One was due to a restaurant mistake. I have several concerns, especially her arriving and being jet lagged and tired, not the best time for making important decisions about what is safe to eat in a foreign country. Has anyone ever let their food allergy college student study abroad? We have been told there is not a lot of peanuts in Italy, but there is a lot of milk. She is fine with milk x contamination, but not peanut x contamination. She tested negative to tree nuts, but avoids. She would be fine with tree nut x contamination. Thanks!
I know of one member whose son spent a year abroad in Scotland during college, but that (obviously) didn't present the language and quite the cultural barrier re: food that Italy would present.
Can you give any idea what PART of Italy she's interested in spending time in? That might help. I know that several members here have spent time studying and traveling in Italy.
I've studied in Italy--pre FA. Most of my time was spent in Rome and Florence. I can't help with FAs much but can with general info.
I can say, having recently done an international trip with FA's (I accompanied my teen-- she was significantly younger than your DD) that I think this concern:
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I have several concerns, especially her arriving and being jet lagged and tired, not the best time for making important decisions about what is safe to eat in a foreign country.
is a really astute observation. When we're tired or off-balance, it's easy to let your guard slip. We carried prepackaged snacks and meal replacements-- which turned out to be a lifesaver in a lot of circumstances where it just wasn't SAFE to eat something-- or when the rest of the group would get their food in a restaurant, by my DD would wait-and-wait-and-wait for her "special" order. Sometimes the wait was so long (an hour or more) that it just didn't make any sense to wait for the food at that point. DD ate about 2 dozen Enjoy Life bars over a period of 3 weeks, but then again, we weren't in one place long enough to find much that was actually safe (other than McDonald's). That brings me to another tip-- investigate international fast food options. Some things were safe in Ireland, some in England, and some in Paris-- at McDonald's, I mean. Check the country's particular website for allergen and nutrition info.
I will also add that with the language barrier in place, it
really helped to have a handful of safe brands in mind while we were in Paris. We were able to get my DD baguette (yes, it was a risk-- but one that we felt was culturally worth it, and-- IN Paris proper-- reasonably low since volume means that boulangeries tend to do only breads), fresh cheeses, and fruit preserves without nut/egg contamination at almost any tiny market. I don't know what the equivalent might be where your DD is headed, but it's something to think about. Consider what is culturally so ubiquitous that it is likely to be available everywhere, and relatively 'single-sourced' in terms of not being contaminated with a lot of other food prep. Bread was like that in Paris. Crepes would have been, too, for someone with, say, a shellfish allergy (like me).
I also carried an immersion heater with a small metal cup to heat water in, a pair of collapsible bowls and some instant Ramen noodles (Maruchan is peanut-free), oatmeal packets, and freezer-dried vegetables and fruit from Just Tomatoes. It didn't take up a LOT of room in a suitcase and made it so that neither my daughter (with peanut and egg allergies-- both very severe, and both with low reaction thresholds) nor myself (shellfish allergy)
ever felt that we were in a position where we HAD to eat food served to us. The peace of mind of that is tremendous-- and it means that you can continue to just make-- well,
good decisions, not pressured ones.
If she were to be in one location for a while, you could probably SUPPLY her with some safe emergency rations at regular intervals. International flat-rate or UPS global shipping would be ideal. :)
Other things that I did--
MedicAlert in French language-- this was not as straightforward as it sounds, by the way-- it had to go through MedicAlert's translation people before they'd approve it for engraving, and they wanted to put the international line on the engraving, too.
FULL documentation of all prescription medications and fresh handwritten scripts for them from our US allergist. No, they won't be good in Italy, but an Italian physician will know what they are and can maybe use them for some quick guidance if she needed a local script. I also kept scans of the same in a flashdrive that I wore against my skin under my clothing-- just as important as scans of my passport.
Take extra meds-- about double what she thinks she could even remotely need. (For why-- see Hedgehog's DD's story right now in Havana-- she is without epinephrine because she can't get a refill there because there aren't any available.)
Chef cards-- I had them printed in BRILLIANT pink cardstock in French, and another color (for English). Take a lot of extras, because you don't always get them back.
Get a REALLY good under-clothing waist-pack to carry extra epinephrine in. Pickpocketing is surreal now in Spain and in Italy, particularly in Rome, Venice, and Florence-- so the wisest thing is to basically plan to lose your bag, even though you do all that you can to guard against it. My anxiety would have been SO much higher if I'd not known every minute that the worst still wouldn't leave me without epinephrine. That and my passport were pretty much all that I guarded like that.
Where will she be when she's not traveling on the weekends? In a city? Does she have a dorm room or will she live with a host family?
Thanks. These are all really good suggestions. She would be in Rimini which is near Bologna. When I go to Europe it takes me a week to get over jet lag. I feel spacey for the first week. I never would have thought of pickpockets. I would imagine bread would be fine there and possibly deli meats, although I am trying to figure out if cheese cross contamination from the slicer would be enough that she could react, or if there is any chance of peanut cross contamination from the slicer. They will be staying in a hotel. Breakfast is included and they are on their own for lunch and dinner. There will be a fridge in the room, but no microwave. There will be a microwave downstairs in some common area. I do have some concerns about that as far as how clean it might be or if there would be food residue, although peanut seems unlikely.
I really wonder what the standard of medical care is in Italy, though. They have socialized medicine. We have great insurance here and have managed to stay away from Obamacare and all of its restrictions.
I read the post about the girl in Cuba, same age as my daughter, right before I posted yesterday. I was cringing as I was reading it, since I can completely imagine being the mom in that situation. I wonder if epis are easily obtained in Italy.
We took a total of 18 autoinjectors with us to Dublin-- and we were only staying for three weeks. Now, granted, my DD's history made that prudent and there were two of us, so technically she had 5 refills with us and I had 4; still, we planned for it to be difficult to impossible to obtain a refill in an urgent situation-- meaning that we assumed that it might take as long as a week to refill one if it were used.
That took some planning because our insurance company will only pay their portion of 1 pair every 30 days-- period. So in the five months before we went, I refilled them at 31 day intervals.
A zippered/secure snapping cross-body day bag just large enough to carry your essentials (a couple of energy bars of some sort, camera, phone, and a pair of epis), a wallet that you wear on a wrist (that zips), and that under-clothing carrier for extra cash (cab-fare), passport, and an epi...
Taking just those kinds of fairly reasonable precautions, we had no trouble at all-- and we rode the Metro/Tube everywhere and visited pickpocketing hotspots galore, like Montmartre, Notre Dame, the Louvre, d'Orsay, Versailles, etc. We saw bag snatchings and pickpocketing activity, all right.
We did okay with jet lag both directions-- but we were coming from the west coast, so a complete "reset" of the body clock, while vicious on the outbound, was the key. We left the west coast at 6 AM, flew to east, had a long layover and flew to Europe on the overnight flight. While neither of us slept much on the flight, we caffeinated upon landing and hit the ground running. That night, we crashed (after what was effectively 40 hours awake with only an airplane catnap). DD did fine. Me, I'm over 45, and well, I won't lie-- I was pretty beat that first couple of days.
Flying home, same deal-- left mid-morning and landed back on the west coast (after ~16 hr of flights) at night. Travel being as exhausting as it is now, that worked fine, too, though I had more trouble with jet lag on the return... more just still being on Paris time, though.
The biggest thing for us was making sure that we had enough food to allow for flight delays/etc. and a reasonable supply of stuff upon landing. The TSA went through my (very carefully packed) bag and ruptured one of my bags of dehydrated fruit... and I wound up throwing it out. (and, er-- washing all the stuff that smelled very strongly of strawberries) Luckily I had planned on a margin of error.
I recommend freeze dried over merely dehydrated because of the weight and volume difference.
About 30% of our suitcases was emergency foodstuffs. Yes, this meant that we took less clothing than most people in a standard suitcase, but it was lightweight, and our bags were LIGHTER and had more room for mementos coming home. :) Doing laundry in a hotel sink was really no big deal.
Rick Steves has some of the best travel advice ever. IMO. That and Just Tomatoes were my two favorite links.
I'll dig up my planning thread for you. This is really something that she can do, in my experience. My DD could do it on her own at 20, I think. She was only 13, but made no truly stupid moves that I could see-- she enjoyed herself enormously, but was very aware of her surroundings and the food safety issues. One problem that I had not anticipated is that even chefs who read and understood DD's chef card... still... sometimes... didn't get it. Like the restaurant in Paris where "no egg" apparently meant "skip the overt one put on TOP of the savory crepe" rather than "batter can't contain egg either." Luckily I know enough to recognize that what they initially sent out very definitely had egg in the crepe batter-- dd wouldn't have. Of course, her tolerance for cooked egg is high enough now that she probably would have taken a cautious sampling bit and sent it back anyway. Or at least quit eating.
She DID have a pretty significant reaction after one restaurant meal-- in Paris. No idea what it was from, honestly, because they made her a special meal, even. Had to have been cross-contamination. Had it not been the end of our first night in Paris, we probably would have opted to go to the emergency room. But air quality was SO bad that it wasn't clear at the time that it wasn't just a major asthma flare.
Oh, you can absolutely count on pickpockets on busses in Rome. Rick Steves has some great tips. What I've seem is group of pickpocketers crowd around the victim.
When I was in Florence one of our group had appendicitis or something else that required emergency surgery. It was a very good experience all around.
Here's a tip--it will be important to not appear to be an arrogant American. What I have found while living in Switzerland in an international community and traveling in France, Italy and Switzerland is that Americans have a reputation. I have also been in Italy when our contrary committed an atrocity toward another country. It was NOT a fun few days to be an American. Your might not talk about socialized medicine (and other things) like you do, but I would urge her not to compare US and Italian systems disparagingly in a public way. Ever.
What is her cow's milk tolerance in specific terms? Can she eat small amounts of high-heat treated milk in baked goods like cake or breads? Just to get a sense for planning purposes.
There are Pharmacias widely available in Italy (green signs). I personally found an incredibly helpful pharmacist when I was trying to buy hydrogen peroxide for a nasty canker sore. And fwiw the socialized medicine served me beautifully in Switzerland when I had bronchitis. It was no different than the US except that I wasn't deterred from going to the doctor by a worry about how I was going to pay for it on my tight student budget. So I actually went.
Oh-- pre-program her cellular phone (and make sure that it's a global phone) with contact numbers for local assistance as well as home (N. American) numbers. Make sure that at least a couple of other people in her party can access the information via a password-locked cell phone. I kept mine unlocked just in case, though I knew it was a risk with a pickpocket (I just kept the "deactivate" emergency provider number with my passport and on my magic flashdrive just in case).
This thread
International Travel (http://foodallergysupport.olicentral.com/index.php/topic,6151.0.html)
has many, many details of how I went to Europe with an MFA teen (and my spouse met us there).
My locked screen for my cellphone has my ICE info there. I basically just added the text I wanted to an image/background, took a screenshot of it, and selected that as my locked screen.
Is she even going to be able to eat the breakfast? If it's a hard roll and cheese or butter, is she going to be ok just eating bread plain for a month for breakfast?
This sounds like a lot of work where she doesn't even have a kitchen for a month. It is doable, but she's going to have to find and negotiate three meals a day for herself and that's a lot of work.
Have you found out how far the grocery store is to her home? When we travel with my milk allergy son, we always try to find foods that we can stock up on for breakfast so we aren't scrounging for food while we are still bleary eyed. It is more complicated for us since ds is allergic to dairy, pn, and eggs.
Beef jerky is our travel staple. Giant costco sized bags of it.
Europe was so interesting to DD and I that (truly) we didn't mind not really being able to experience the food as part of the culture.
But I do think that you have to go into things with that mindset.
She is fine with baked milk. Bread, cookies, cake, all fine as long as there is no peanut cross contamination. When I lived in Italy decades ago, breakfast was bread, butter, and jam. She`ll be fine with bread and jam. For lunch and dinner she plans to eat a lot of pasta with marinara sauce with no cheese or butter, but I worry that they will agree to no cheese or butter, but make a mistake. Cheese in the pasta sauce may or may not be obvious, and butter definitely would not be obvious.
Good points about the pickpockets. That is worrisome. It sounds like it has gotten worse since I was there. She is not street smart at all. She is 18, will be 19 by the time she goes.
Truthfully, though, I think that there is a difference between two "not street smart" people when one of them has food allergies.
DD has an awareness of her surroundings that is really unsurpassed even by my DH, who grew up in a city environment and is by every indication "street smart."
I think most kids who grow up with food allergies do have that awareness of other people around them, if that makes sense. They are really in tune with human behavior and body language/nonverbal cues.
I noticed this with my DD (13yo) and one of the 18yo students on this trip-- had a chance to observe them both together in Paris, and while there was superficially almost nothing that separated them-- same type of day bags, same basic body postures, roughly the same size... and roughly similar interests and maturity levels, my DD had this, I don't know... casual, relaxed sort of ALERTNESS about her that the other girl seemed to lack. There just wasn't any indication that my DD was consciously doing it, but she seemed far more aware of it all-- she was able to walk WITH the pedestrian flow seamlessly while sightseeing, able to match the pace and know how to be out of the way or dart quickly through a crowd to catch a train, that kind of thing.
I don't know if I can explain it better than that. She was clearly aware of what others were doing around her without gawking or looking nervous (which marked many of our tour group as inexperienced). I attribute that wariness to YEARS of paying attention to what others are eating, where they are putting their hands, etc, without being rude about it.
It was quite an interesting thing to watch. Some kids had it naturally, and some didn't.
That seemed (from our observations) to be what separated those that got targeted by pickpockets and those that did not-- we did see groups of them working in Paris, and who they were watching most closely. It certainly wasn't experience alone, because my DD has not spent much time in urban settings, and nearly NEVER on public transportation or in that kind of crowding.
I don't know that all FA teens could translate that life experience from the one domain to a more general one, but it might help to consider it. I suspect that it is a skill that many of them have.
Or just do what Rick Steves advises-- carry nothing much of value in your day bag-- bottled water, snacks, a guidebook, that kind of thing. Nothing irreplaceable.
At the risk of sounding incredibly insensitive (bear with there's a point), have you lately thought about a milk challenge of some sort to see if her tolerance is more than just baked by this time? I have no idea what the background with her baked milk consumption is and I certainly don't intend to push for a challenge per se, but if she's tolerating baked and cross-contamination it could present one option to talk to your allergist with her history (obviously including reactions) and maybe perform a modified challenge for next stage from high-heat treated? Only because she'd be going to such a milk heavy area with not a lot of experience. One way or another it's already pushing a boundary for tolerance/challenge, or revert to most safest option assuming she will react to a certain amount above traces which means more restrictions. Nothing wrong with the latter but where there is some tolerance it's possible to explore in a clinical setting before testing it out thousands of miles away.
Again, not recommending a path. You know best, you know all the details.
Oh, that is a really good thought-- knowing what that tolerance is (even approximately) might really prove helpful if it's at all feasible.
She had an inadvertent exposure to unbaked milk due to a restaurant mistake and had to use her Epipen. This was while away at college. I am happy to say that she used it quickly, which makes me a little more okay with this trip. She did not wait for the reaction to get bad. She had mild symtoms, but at least two organ systems and used it, as per her action plan. So she is definitely still allergic to milk, unfortunately.
Oh, no doubt to untreated milk. This is more of finding an impossible answer to a difficult question on avoidance in another country whose foods are deeply tied to the allergen, it's ubiquitous and the food service with regard to ingredients and disclosure is not as clear here stateside because we have more chain restaurant choices in terms of standardization. Did that give you a sense on how much avoidance she has to practice? If you had to put it in more concrete terms for the sake of determining how much avoidance is necessary?
For instance, no butter, no baked cheese, all the forms of ruminant milk she will have to avoid.
Another avenue is if she can't reliably go to Italy now then maybe Italy can come to your house in the form of a homestay student. Your daughter could practice Italian with a native speaker and you could learn a lot about a specific region and its cuisine and medicine from a local who has current knowledge, first hand experience. It would be a non-medical method of preparation.
Anaphylaxis Canada posted this link on fb. I have not read it, but thought of this thread and it might have some helpful info.
http://blogs.iesabroad.org/ebenz1ithaca-edu/studying-abroad-with-food-allergies-part-i/ (http://blogs.iesabroad.org/ebenz1ithaca-edu/studying-abroad-with-food-allergies-part-i/)
Just wanted to let everyone know that my daughter came back from Italy reaction free and having the best experience of her life. Her tolerance of baked milk is excellent and she really had no trouble at all. She only had to walk out of a restaurant once due to peanuts being served. She found dairy free peanut free gelato and ate it daily. She gained 6 pounds (prior to the trip she was 5 feet 2 and 95 pounds due to the milk allergy), so we are thrilled. She loved the food, ate a ton of pasta, and put a zillion pictures of the pasta and the gelato on her FB page. She spent pretty much the whole time with four or five other girls and taught her roommate the epipen. Even the alcohol is labeled for ingredients in Italy, which I did not know. She said they were very allergy aware in most restaurants. The hotel where she stayed made her a special breakfast daily, as the bread they served came from somewhere else, so she could not be sure about peanut cross contamination.
The only problem really was United. Her first flight out was late, she missed her connection, and she got stuck in Chicago. United refused to put her on the next flight out, tried to re-route her and leave her in Newark for 16 hours from 1 A.M. to 5 P.M. the next day. I said no, she was not spending the night alone in the Newark Airport, and she ended up spending the night in Chicago. This was a big issue with the food allergies, as she had brought enough food from home for the flight, but now was going to arrive in Italy one day later. United was really really horrible to her and someone in their Disability Assistance Office disability harassed her. On the way home, United lost her luggage. We did not get it back until 2 days later.
I am really glad I let her go. However, if she were not so tolerant of baked milk or if she were sensitive to milk cross contamination, it would have been a lot more complicated.
This is fantastic to hear! Except for the united part. Boo hiss to them!
What did she eat for breakfast? Just curious as that's our most difficult meal.
They made her pastries in the hotel. It sounded like some sort of a sweet roll with powdered sugar most days. Sometimes they would make fruit pies for her for breakfast. Also, they served fruit for breakfast to everyone and on some days they served meats (not our usual breakfast here, but it was safe for her.)
BTW, unlike what someone else posted on this thread, she found that Italians LOVE Americans. They were all so friendly to her. It was common for strangers to stop her and ask to have their picture taken with her because she is American. Also, she went to a One Direction concert in Milan, which she loved. At the concert one guy asked where she was from and when she told him what city in the U.S. she said he was so excited he was screaming. People on the trains were super friendly too. Everyone wanted to know where in America she was from.
Also, her milk threshhold for baked/heated milk seems to have gotten much better while she was gone. Yesterday I made her 1/2 a grilled cheese sandwich for lunch (so technically not even baked, just fried) and she had no symptoms. We don`t think she is tolerant of unheated milk as she had a reaction requiring epi 9 months ago due to a restaurant mistake. But her tolerance of baked milk has really gotten better. We think it is because she ate pizza almost every day.