This study aims to describe the connection between food allergies, specifically celiac disease, and an individual's decision to travel. Approximately 15 million Americans have a food allergy that can range from mild to severe or life-threatening reactions. Celiac disease requires strict lifelong adherence to a gluten-free diet to avoid intestinal damage. Many celiac sufferers feel they cannot travel or dine out due to a lack of safe, gluten-free food options. This study will survey celiac individuals to determine how the availability of gluten-free products, employee training, and food labeling at destinations would influence their willingness to travel. Providing access to gluten-free options could attract a significant number of potential travelers and

1. TRAVELING WITH FOOD ALLERGIES: HOW CELIAC SUFFERERS PERCEIVE
THE DESTINATION EXPERIENCE
Nicole Schnell & Bridget Bordelon
Approximately 15 million Americans have a food allergy, an “abnormal response to a food
triggered by the body’s immune system” (NIAID, 2010).There are eight foods responsible for
90% of allergy reactions: milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish (Food
Allergy Research & Education). Symptoms of a food allergy reaction can range from mild to
severe and can take place minutes after contact with the allergen (NIAID, 2010) and in some
cases require immediate medical attention and are life-threatening. Food intolerance is a “non-
immunologic adverse reaction to foods caused by an enzyme defect” (Food Allergy Education).
In addition to food allergy and intolerance, celiac disease is a permanent, genetic autoimmune
disease affecting sensitivity to gluten in individuals and is currently only treatable by lifelong
adherence to a gluten-free diet (GFD) (Kolia, 2010; Ciaccio, 2012; Hallert, 2005; Burrows,
2006). If the GFD is not followed, the small intestines will be progressively damaged and can
lead to osteoporosis, reproductive problems, neurological illness (Burrows, 2006), as well as
psychological and psychosocial distress (Burrows, 2006; Kolia, 2010; Hallert, 2005; Ciaccio,
2012).
Problem Statement
Celiac disease is commonly misunderstood and misdiagnosed because the disease can be
asymptomatic or present itself as severe malabsorption (Ciaccio, 2012). The only solution for an
individual with this intestinal disease is strict adherence to a gluten-free diet (Burrows, 2006;
Hallert, 2005; Ciaccio, 2012). The restricted diet and lifestyle associated with gaining access to
“safe” foods can cause feelings of isolation, shame, and prevent some individuals from traveling
or dining out (Kolia, 2010; Hallert, 2005). More common dietary preferences such as veganism
and vegetarianism are not as difficult to accommodate because a food preference is not
potentially life-threatening as an allergy can be. This study seeks to provide evidence to tourism
stakeholders that difficulties encountered by individuals following the GFD create a strong need
for the development of quality services targeting celiac patients at popular tourist destinations
and their restaurants.

2. Purpose
This study aims to describe the connection between food allergies and an individual’s decision to
travel with a special emphasis on celiac disease. This information can provide destinations with a
more accurate estimate of demand for gluten-free products. Some individuals may feel they
cannot travel to a destination because there will be a lack of safe food. There are standard
thresholds for “safe” gluten levels, but it is unclear how many industry employees have received
training. A study conducted in 2004 found the “safe” threshold to be less than 500mg of gluten
daily, but could be more than 10mg (Collin, 2004).The demand for gluten-free products by these
travelers needs to be proven more profitable than the cost of supply for destinations and their
restaurants. The following literature review examines the purpose of this study from the
perspective of celiac patients, defines their need for gluten-free products, and develops the
hypotheses supporting the need for destinations to create and promote such products.
Literature Review
The Centers for Disease Control and Prevention found that food allergens in children had
increased 50% from 1997 to 2011 (Food Allergy Research & Education). The Journal of Human
Nutrition and Dietetics found studies indicating celiac disease affects nearly 1% of the United
States population (Ciaccio, 2012), and other research supports that women are the most
negatively affected demographic (Ciaccio, 2012; Hallert, 2005; Burrows, 2006). Studies have
shown depressive symptoms when an individual with celiac encounters problems with the GFD
(Hallert, 2005). The Journal of Human Nutrition and Dietetics describes quality of life (QoL) as
a wide-ranging perception of health and well-being influenced by five aspects of an individual’s
life. For the purposes of this study, we will focus on the emotional, social, economic (Ciaccio,
2012) and safety domains of QoL. The “individual” is not only the focus of this study, but needs
to be the target market of tourism bureaus wishing to promote the availability of gluten-free
products.
Feelings of shame and isolation (Hallert, 2005) may develop when the individual is hindered by
the disease in a social setting with friends or family. This hindrance could be caused by
inadequate food labels, expensive food prices for the gluten selection, or a lack of gluten-free
products (Ciaccio, 2012) at a restaurant or grocery store. Destinations that do not provide or
promote gluten-free products are losing important potential business from the previously stated 3

3. million of the United States population. In his study, Ciaccio found that celiac disease caused
68% of males and 68% of females not to dine out and 52% and 55%, respectively, avoided travel
(2012). This shows a majority of respondents that might choose to travel and dine out should
gluten-free products become available and promoted to the right target market.
Proposed Methodology
The aim of this study is to test the hypothesis that people with celiac disease would select travel
destinations and specific attractions based on whether or not the food requirements can be
adequately covered. The second objective is to further delve into the factors behind their decision
to travel and dine out in a variety of settings. An electronic survey will be administered to a
sample of individuals with celiac to determine how likely they would be to travel, knowing their
allergy or intolerance will be well prepared for in a variety of settings. They will then indicate
the level of quality each factor (i.e. gluten-free products, employee training, food labels) must
have to positively influence their decision. This survey will be distributed through Food Allergy
Research and Education (FARE) via an online survey to reach food allergy and celiac patients in
one particular location. The resulting data will be analyzed using SPSS analytics software.
Conclusion
Food allergy and intolerance, including celiac, limits millions of potential travelers from
participating in regular tourism experiences. Tourism stakeholders including CVBs, attractions,
and restaurants, need proof that providing access to gluten-free food would highly benefit their
destination. This can be provided through a study that connects celiac patients’ willingness to
travel to the availability of gluten-free products in tourism destinations. Destinations that support
and provide information and access to safe food, including restaurants, attractions, and
transportation, will succeed in attracting this significant part of the population.

4. Bibliography
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Ciaccio, E. J., Diamond, B., Green, P. R., Lee, A. R., & Ng, D. L. (2012). Living with coeliac
disease: survey results from the USA. Journal Of Human Nutrition & Dietetics, 25(3),
233-238. Retrieved October 16, 2014 from EbscoHost.
Collin, P. Thorell, L., Kaukinen, K. & Maki, M. (2004). The safe threshold for gluten
contamination in gluten-free products. Can trace amounts be accepted in the treatment of
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Food Allergy Education. (n.d.). Department of Hospitality Management. Kansas
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