September 2014 Issue
Food Allergy Management In Restaurants — More Resources Are Available to Keep Customers Safe
By Sherry Coleman Collins, MS, RDN, LD
Vol. 16 No. 9 P. 18
A study about fatalities resulting from food allergy anaphylaxis found that 25% of deaths recorded over a five-year period occurred while dining out.1 With an estimated 15 million food allergic individuals in the United States, restaurants have a greater opportunity to protect their patrons with food allergies.2
But how do these individuals stay safe while dining out when so many adverse reactions occur in these settings? Visiting restaurants during nonpeak hours is one way to stay safe, as is calling the restaurant beforehand to ensure it has a solid food allergy policy in place and the staff has a clear understanding about food allergies, says Eleanor Garrow-Holding, president and CEO of the Food Allergy and Anaphylaxis Connection Team, an organization that specializes in education, advocacy, and raising awareness about food allergies and anaphylaxis, and the parent of a food allergic child. “Never assume restaurant staff will remember your needs. Always inform restaurant staff of your needs during each visit and ask to speak to the manager and/or kitchen chef upon arrival,” she says, adding that allergic diners also should carry epinephrine with them at all times.
Nonetheless, restaurants are becoming more responsible when it comes to food allergies. For example, foodservice operators and staff members are taking advantage of various education and training opportunities to become more informed and ensure customer safety. In fact, food allergy training is mandatory in some establishments.
Regulating Food Allergy Safety
National legislation requiring restaurants to follow standardized food allergy management policies doesn’t exist as it does in the area of food safety, but activists have been lobbying for such requirements at state and local levels. As a result, certain states and communities have adopted their own food allergy management policies.
Massachusetts was the first state to sign into law specific food allergy legislation with the 2009 Food Allergy Awareness Act after working closely with Food Allergy Research & Education (formerly the Food Allergy and Anaphylaxis Network), a nonprofit organization whose mission is to increase food allergy awareness, conduct research, and provide education and resources to those with food allergies, and celebrity chef Ming Tsai. This law requires food allergy management training for certified food protection managers and for restaurants to hang food allergy posters in staff areas. It also requires notices to be posted on menus asking customers to inform servers about their food allergies.3 According to the law, all food establishments (eg, grocery stores that sell prepared foods, takeout counters) that cook, prepare, or serve food intended for immediate consumption either on or off the premises are included.3
In 2013, Rhode Island joined Massachusetts with nearly identical requirements, although the law in Rhode Island still is being implemented.4 In New York City and St Paul, Minnesota, restaurants are required to hang posters in kitchen staff areas describing food allergies and their associated adverse reactions.4 In these cities, legislation has been proposed to include food allergy training, but it hasn’t become law. Other states, such as Georgia and Illinois, have introduced food allergy legislation for restaurants, but it hasn’t yet been adopted.
Still, Garrow-Holding says restaurants are becoming increasingly prepared to manage food allergies, due in part to food allergy awareness provisions being added to the FDA Food Code along with allergens being classified as a hazard in the 2011 Food Safety Modernization Act. State and local health departments use the Food Code to establish food safety regulations, as it requires restaurants to have a person in charge who knows about food allergy management and can identify reactions.5
The person in charge is responsible for ensuring that employees are properly trained in food allergies and food safety management. However, the Food Code doesn’t specify what the training should entail or how to assess knowledge.
Taking It to the Table
Restaurants that embrace the opportunity to meet their customers’ specific dietary needs experience the benefits of returning patrons. According to Paul Antico, president of AllergyEats.com, an online peer-reviewed directory of user-friendly restaurants across the United States, and the parent of three children with food allergies, 90% of families managing food allergies eat out regularly. He also notes that Disney World is considered the gold standard of food allergy accommodations. “In fact, many families spend the exorbitant amount of money for a Disney World trip in order to have their food allergic child eat in a restaurant for the first time,” he says.
In addition to Disney World, Antico cites chain restaurants Red Robin and P.F. Chang’s as known leaders in the area of food allergy management. They successfully make accommodations for all major allergens, showing that it’s possible to safely serve both allergic and nonallergic customers simultaneously. In addition, they have a step-by-step process for identifying food allergic customers, train all staff on food allergy management, and have a “when in doubt, throw it out” attitude to ensure allergen-safe foods.
Regional restaurant chain Burtons Grill also is building a reputation for caring about customers with food allergies. According to CEO Kevin Harron, making food allergies a high priority is good business. “Our company is about trust and integrity. The discipline involved in serving [diners with] allergies is good behavior,” he says, adding that doing a good job serving those with food allergies means positive word-of-mouth publicity, which ultimately leads to increased sales.
David Crownover, product manager for the National Restaurant Association, says a 2012 survey of its members showed that while foodservice establishments were aware of the top food allergens, they didn’t understand what to do with that knowledge as it related to the restaurant environment. He reported that 78% of respondents identified food allergies as an important issue, yet less than 50% were providing training in food allergy management, and 1% reported they didn’t serve anything allergenic on their menu. Since more than 160 different foods have been implicated in causing food allergy reactions, Crownover concluded there was a problem.
The good news is that restaurant operators now have a variety of resources available to learn how to manage food allergies. Food Allergy Research & Education has developed SafeFare.com as a resource to help connect restaurant operators with food allergy training and diners with restaurants whose staff has completed training. Included on the site is the National Restaurant Association’s ServSafe Allergens Online Course, a comprehensive, interactive course geared to help restaurant staff better understand the safety precautions required when serving customers with food allergies. The training course began in July 2013, and so far more than 5,000 foodservice workers from across the country have participated.
Additionally, the AllerTrain Program, created by MenuTrinfo, a provider of nutrition analysis and allergen education, offers training in a classroom setting and via live webinars, which Antico describes as the best “deep dive” into food allergy management available.
Those who want to experience training on a larger scale among peers can attend AllergyEats’ annual Food Allergy Conference for Restaurateurs, which will be held in New York City in October. The conference covers the basics of food allergies and safe food handling practices as well as the financial reasons for implementing a food allergy management training program. According to Antico’s estimations, the food allergy and celiac disease communities represent 5% of the population, yet they may account for as much as 15% of diners when considering that an average party of three will choose to dine someplace else if a restaurant can’t accommodate a particular family member with food allergies.
To date, little has been done to measure the impact of food allergy management training programs on restaurants and their customers. Outcomes measures are needed to determine what type of training works best and how frequently it should be provided. “There’s nothing special about the techniques necessary [for managing food allergens], but not every restaurant can safely accommodate every allergic individual, [although] every restaurant can accommodate some allergic individuals,” Crownover says, noting that restaurants can be successful if they’re transparent about what food allergies they’re capable of managing and keep the lines of communication open with patrons.
Dietitians who educate themselves about food allergy management have additional job opportunities available to them. “RDNs are food and nutrition experts who can help separate facts from fads and translate nutrition science into information restaurants can use,” Garrow-Holding says.
Foodservice establishments need ongoing training for staff, assistance with safe menu development and appropriate substitutions, and evaluation of their current operation—all opportunities for the food-savvy dietitian. “Serving the food allergy community is about demystifying the serving of an underserved community. On top of that, there’s money to be made,” Crownover says.
To learn more about food allergy management, dietitians should familiarize themselves with the resources available to help clients and patients with food allergies navigate the world of dining out. RDs who work in foodservice can complete one or more food allergy training courses to begin understanding how to manage food allergies in restaurants.
— Sherry Coleman Collins, MS, RDN, LD, is a private practitioner in Atlanta, specializing in food allergies and sensitivities and digestive disorders. She also provides nutrition communications consulting services for the Peanut Board.
1. Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007;119(4):1016-1018.
2. Food allergy facts and statistics for the US. Food Allergy Research & Education website. http://www.foodallergy.org/document.doc?id=194. Accessed June 25, 2014.
3. Q&As for MDPH allergen awareness regulation. Massachusetts Department of Public Health website. http://www.mass.gov/eohhs/docs/dph/environmental/foodsafety/food-allergen-3-reg-faqs.pdf. Accessed June 25, 2014.
4. Food allergies and restaurants. Food Allergy Research & Education website. http://www.foodallergy.org/advocacy/restaurants. Accessed June 25, 2014.
5. FDA food code 2009: chapter 2 — management & personnel. FDA website. http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/FoodCode/ucm181242.htm. Last updated October 29, 2013. Accessed June 25, 2014.
• AllergyEats.com is dedicated to connecting food allergic individuals with food allergy–aware restaurants around the country. You can learn more about the AllergyEats Food Allergy Conference for Restaurateurs and Food Service Professionals at http://www.AllergyEats.com/conference.
• Food Allergy and Anaphylaxis Connection Team (http://www.foodallergyawareness.org) is an organization dedicated to education, advocacy, and raising awareness about food allergies and anaphylaxis.
• Food Allergy Research and Education (FARE) is the nation’s largest food allergy group. http://www.FoodAllergy.org provides resources to help individuals with food allergies and their families as well as tips and tools for restaurants.
• SafeFare.org is FARE’s website dedicated to connecting restaurant operators with educators in food allergy management and with potential food allergic customers.
• MenuTrinfo AllerTrain offers in-person and virtual instruction on managing food allergies and gluten-free foods.
• National Restaurant Association’s ServSafe Allergen Training is an interactive, avatar-based virtual training program in food allergy management available on demand at http://www.ServSafe.com/allergens.