Flying with a Food Allergy or Coeliac Disease: What to Know

If you have a food allergy or coeliac disease, you cannot rely on an airline or airport to provide a safe meal. The practical answer is to carry your own food, tell the airline and cabin staff before you fly, and bring prescribed emergency medicine and an allergy action plan. Airlines can offer special meals, but they cannot guarantee that a meal is free from a particular allergen.

Who this affects

This guide is for anyone with a diagnosed food allergy or coeliac disease who is flying or passing through an airport. A food allergy is where your body reacts to certain foods. It is often mild, but can be very serious for some people (NHS). Common allergens include cows' milk, eggs, peanuts, soybeans, peas and chickpeas, tree nuts, shellfish and wheat. You can be allergic to any type of food, including celery, mustard, sesame seeds and lupin flour found in some baked goods (NHS).

Coeliac disease is different. It is an autoimmune condition where eating gluten damages the lining of the gut and reduces the nutrients you can absorb. It is not an allergy or a food intolerance (York Hospitals). Gluten is found in wheat, barley and rye, and in foods such as pasta, cakes, breakfast cereals, most types of bread, certain sauces and some ready meals. Most beers are made with barley (NHS).

What to do step by step

1. Tell the airline before you fly. NHS advice is to tell airlines and cabin staff about your allergy before you fly. Ask what special meals are available and how they are prepared. Do not assume a meal is safe because it is labelled for your diet.
2. Carry your own food. Pack safe snacks and a meal for the flight in your hand luggage. Check the airline's rules on liquids and food before you travel.
3. Carry prescribed medicine. If you have been prescribed an adrenaline auto-injector such as an EpiPen, or a nasal spray such as EURneffy, carry 2 with you at all times (NHS). Keep them in your hand luggage, not in checked bags.
4. Bring your allergy action plan. Your specialist will give you an allergy action plan explaining how to manage your allergy (NHS). Keep a copy with you.
5. Prepare translation cards. If you do not speak the language at your destination, carry written cards explaining your allergy or your gluten-free diet. A restaurant card PDF is available from patientwebinars.co.uk (York Hospitals).
6. Check labels carefully. Check food labels and restaurant menus carefully to make sure they do not contain the food you are allergic to (NHS). Always check the labels on foods you buy, including processed foods, because additives such as malt flavouring and modified food starch can contain gluten (NHS).
7. Tell restaurant and café staff. Tell staff at restaurants and cafés about your allergy (NHS).

Costs and timing

Special meals usually need to be requested in advance. Ask the airline for its deadline when you book. There is no single rule that applies to every airline, so confirm directly with the airline you are flying with.

For coeliac disease, a gluten-free diet is the only treatment. Symptoms should improve considerably within weeks of starting a gluten-free diet, but it may take up to a few years for your digestive system to heal completely (NHS). This is why planning meals before and during travel matters.

In the UK, by law, food labelled as gluten-free can contain no more than 20 parts per million (ppm) of gluten. For most people with coeliac disease, these trace amounts will not cause a problem (NHS).

In the US, the FDA enforces labelling rules for major food allergens. The nine major allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and sesame (FDA). Sesame became the ninth major allergen on 1 January 2023. Products already in interstate commerce before that date did not need to be removed or relabelled, so some products may not carry allergen labelling for sesame right away. During the transition period, the FDA recommends checking with the manufacturer or distributor if you are not sure whether a product contains or may contain sesame (FDA).

The FDA has not established a threshold level for any allergen. A threshold is a value below which it is unlikely that a food-allergic individual would experience an adverse effect (FDA).

Exceptions and limits

Airlines and airports cannot guarantee that a meal is free from a particular allergen. Cross-contamination can happen if gluten-free foods and foods that contain gluten are prepared together or served with the same utensils (NHS). In the US, advisory statements such as "may contain [allergen]" or "produced in a facility that also uses [allergen]" are not required by law (FDA).

FDA labelling requirements do not apply to foods placed in a wrapper or container after a customer's order at the point of purchase, such as a sandwich made to order (FDA). This matters at airport food outlets.

Oats do not contain gluten, but many people with coeliac disease avoid them because they can be contaminated with cereals that contain gluten. If you want to include oats, check they are pure and that there is no possibility of contamination. Avoid oats or oat products that are not labelled gluten-free (NHS).

Some people with coeliac disease may need extra vaccinations, including flu and pneumococcal vaccines, because coeliac disease can cause the spleen to work less effectively (NHS). Ask your doctor whether this applies to you.

What is not yet confirmed

Rules on airline meals, airport food and allergen labelling can change. Always check the airline's own website and the official food safety authority for your destination before you travel. This guide does not cover every airline or every country.

This is general guidance only. Ask a doctor, pharmacist or travel clinic about your own situation, ideally weeks before travelling.