Coping with autoimmune conditions
when travelling abroad
Travel Tips from Dr Ruth Handford
People with autoimmune conditions travel all the time with no problems at all.
You may not be able to have a holiday from your autoimmune condition – but you can definitely have a holiday with it! With some simple planning, you can minimise risks and optimise your travel plans to get the best experience you can.
What are autoimmune diseases?
Autoimmune conditions are very common. Essentially, they are a variety of medical conditions that are caused by the patients immune system attacking their own body. This can occur in many ways – examples are rheumatoid arthritis (the body attacks the joints), crohns disease (affecting the digestive tract), diabetes (type 1), vasculitis (affecting the blood vessels), and thyroid problems.
Because autoimmune conditions can affect any part of the body, there are multiple symptoms that can occur. Treatments are usually aimed at symptom control, and at suppressing the immune system to limit the damage it causes. These ‘immunosuppression’ therapies can be hugely beneficial, but by suppressing the immune response, the patient becomes more vulnerable to other attacks on the immune system, for example, from infections.
Some of the medication used for autoimmune conditions is quite complex and requires special storage and sometimes injections. There may also be treatments needed to prevent or reduce side effects and the risk of other infections as a result of the medication.
If you or a family member suffer from an autoimmune condition, or are on immunosuppressive medication, then it is worth thinking ahead about travelling and the implications this might have.
Masks remain compulsory whilst at the airport and on an aeroplane, unless you are medically exempt. If you are, you should get some documentation to prove this in case you are questioned. If you are unable to wear a mask for whatever reason, don’t worry too much about being on the aircraft. Although they are airconditioned, the recirculating air is HEPA filtered continuously throughout the flight, removing germs including Covid-19 from the air you breathe.
There are plenty of hand sanitizer stations all over airports now, so don’t worry about taking your own on the plane (remember you are restricted with the volume of liquids you can take through security).
Hand washing – continue to wash your hands regularly whilst in transit. This is a great way to help prevent transmission of covid-19.
Before you travel
The most exciting part – choosing a destination! If you have flexibility about where you are travelling to, here are a few tips and things to consider.
- Choose a destination with a climate that won’t aggravate your symptoms.
- Consider an all-inclusive resort or a cruise so that you have easy access to everything you need.
- Choose a destination with reliable, accessible local transportation.
- If you think you might need medical care during travel, choose a destination where you will have access to safe, reliable, quality medical care.
- Choose an off-season destination to avoid the added stress of crowds.
You are the expert on YOU and your medical condition. Plan according to your personal needs and build your trip around what works for you. For example, plan your travel for a time of year that is best for you. If you are prone to flares during certain seasons, avoid travelling then.
You know your own abilities and limitations, so take this into account when thinking about what you want out of your trip. Walking through busy cities or countless museums may not be the type of trip that works for you – but often, these types of destinations provide wheelchairs and other mobility aids, so planning ahead can allow you to take part.
Research where you want to stay and book somewhere that meets your needs. Consider whether you would be more comfortable in a ground floor room, or one with accessibility for a wheelchair. Make sure in advance that the room has a fridge if you need one for medication storage.
Also, book a hotel with amenities that might help—such as a pool, hot tub, or an on-site restaurant. Think about whether a more central hotel would make activities easier whilst away, or if you prefer somewhere secluded and peaceful.
A minimum of 8 weeks before you plan to leave you should access a travel medicine clinic for a travel risk assessment, including advice on reducing travel-associated disease risks, malaria and guidance on vaccines you might need.
Some vaccines may not be given if you are immunocompromised, for example the yellow fever vaccine.
Vaccines work by stimulating your immune system, so if it is suppressed, they may take longer to develop and may not be as strong compared to those who do not have a compromised immune system. This may mean additional booster vaccines are required.
As well as vaccination, you should follow additional advice on preventing infections.
Malaria can be life-threatening. It is an illness that is caught from mosquito bites in certain parts of the world. If you are immunocompromised, you are not more likely to be bitten, but the malaria infection may be more severe.
To protect yourself you should:
- Be aware of the risk of infection - check whether your destination is in an area affected by malaria.
- Avoid being bitten by mosquitos.
- Take antimalarial medicine if recommended. Whoever prescribes this for you should check this is compatible with your other medication.
Stomach and Gut Infections
Stomach and gut infections can largely be prevented by good handwashing and careful food choices. Avoid ice and tap water, choose peelable fruits, and avoid street food vendors.
Chest and ‘Air-borne’ Infections
Chest and ‘air-borne’ infections are usually spread by coughing and sneezing. Make sure to be careful with good handwashing and the use of an alcohol gel hand sanitiser. If you are immunocompromised, you should have been offered vaccination against pneumococcal pneumonia and influenza – check with your GP practice if you are eligible for these and make sure they are up to date.
Infections from Insects
Infections from insects are common following bites and stings. Reducing your risk of being bitten in the first place is the best strategy, but consider taking antihistamines and possibly antibiotics with you if you are going to an area likely to have lots of insects.
Have a medical review
Make sure that you consult with your specialist or GP before travelling. It is important to make sure your medication reviews and any monitoring tests are up to date prior to travel.
Stock up on medication
Make sure that you take enough medication and prescriptions to last the duration of your trip.
Pack these in your hand luggage along with a copy of your prescriptions and the original packaging.
Consider any special storage requirements – some medication may need to kept at a particular temperature and there are devices on sale at pharmacies to help with this.
Your doctor may recommend compression socks or a daily aspirin to reduce the risk of inflammation or blood clots resulting from prolonged sitting.
You may want to ask your doctor about special prescription medications to make travelling easier, such as sleeping medication, antihistamines, pain relief, ‘just in case’ antibiotics, or steroids (if these are used in a flare up of your condition).
You may find that you don’t need these medications, but it’s good to have them just in case.
Travel, and especially flying, has been widely linked to worsening symptoms of autoimmune conditions. This is for several reasons and it is worth giving it some consideration when planning your trip.
Our immune systems are sensitive to fluctuations in hormone levels, and stress of any kind can put extra pressure on the immune system, potentially causing a flare in symptoms. Travelling can be hugely stressful, even without any complicating factors. Give some thought to how you might reduce this stress in advance. Some suggestions are:
Stagger your journey
Make the journey part of the holiday – take breaks en-route to your final destination, and try to ensure the maximum comfort you can afford during the trip. Extra space to stretch your legs, lay back, rest, or move about can all make a huge difference to arriving at your destination relaxed and comfortable. Consider the timings of your flights and your ability to rest before, during, and after long journeys.
Alternatively, you may prefer to avoid layovers on long haul flights in order to shorten your travel time as much as possible.
Flying can involve long waits, delayed flights, and long distances between gates. Airlines will provide assistance – although it is best to arrange this in advance.
Care around sun exposure is important, as immunocompromise may lead to increased risk of skin cancers. Also, some medications used in autoimmune conditions can make the skin extra sensitive to and cause rapid burning and rashes when exposed to sunlight. You should check the side effects of your medication in advance, and ensure you have high SPF sun cream with you and apply it regularly. Ideally, wear a hat when outdoors. If possible, avoid being out in the sun during the hottest and highest UV periods of the day, generally between 10am-4pm during summer.
Download a meditation app or listen to soft music leading up to bed to relax and unwind after a busy day. Try to get 7-8 hours of sleep each night even if it means missing out on something either the night before or the morning after. Sleep is vital for a healthy immune system and for managing stress. Do not underestimate its importance!
If you are able to, try to walk as much as possible. Try to fit in some exercise throughout your travels even if it is a gentle stretch before bed or a morning walk. Keeping moving can be really helpful for joint inflammation and for pain management, but be aware of your limitations and take your environment into account – avoid the hottest part of the day and choose safe, recommended routes for walks.
Take rest days
Travelling and keeping busy everyday is tiring for anyone, but can be especially draining for someone with an autoimmune disease. So schedule in rest days where appropriate and rest during the day when needed.
Just in case
Skin injury and infection is common in all travellers, and it is advisable to take a small first aid kit with you. Promptly cleaning and dressing a wound can prevent potentially severe infection. Pre-prepared first aid kits are readily available. I would recommend making sure you have some sterile dressings, alcohol cleaning swabs, and basic medication like diarrhoea relief, paracetamol, and antihistamines with you on any trip.
Both you and your travel companions should be prepared for possible medical problems. It is advisable to travel with a document that contains a brief medical history, a list of medications you take, insurance information, and contact information for your GP and hospital specialist. Make a couple of copies and ensure your travel companion knows where it is.
You may want to get medical alert tag or bracelet, or carry a card in your wallet with emergency contact and medical information. If you take regular steroids, I would strongly advise that you do this!
Always consult your own doctor before travelling
These travel tips are intended to provide general information to those planning to travel abroad. They do not replace a visit to your doctor . If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have.
About Dr Ruth Handford
Dr Ruth Handford is a GP with over 10 years' experience of working in both hospital and primary care. She is particularly interested in caring for the elderly in the community, child health, and family planning. Ruth lives and works in a rural community, and is kept very busy by her job and young family.
Travel Insurance for Medical Conditions
The Foreign and Commonwealth Office recommend that you have travel insurance in place every time you travel abroad. Make sure that your insurers are aware that you have existing medical conditions and ensure that your travel insurance provides cover for them.