From a previous issue of Wisconsin Restaurateur magazine
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by Mary Lou Santovec

When Kelli Miller was 2 years old, her father was shelling peanuts in the living room of the family home. Even though the Greenville, Wisconsin resident didn’t ingest any peanuts, airborne proteins caused her face to swell and required an unexpected visit to the emergency room. She was later diagnosed as having a severe food allergy to peanuts and tree nuts.

Miller, a registered nurse, is not alone in her situation. Some 12 million Americans suffer from one or more food allergies according to the Food Allergy & Anaphylaxis Network (FAAN). Established in 1991, the Virginia-based nonprofit organization raises public awareness of food allergies, provides advocacy and education, and advances research on the issue.

Ninety percent of those with food allergies react to the Big 8—eggs, milk, peanuts, wheat, soy, tree nuts, shellfish and fin fish. Reactions can range from mild to life-threatening.

The National Restaurant Association (NRA) and the Wisconsin Restaurant Association take the issue seriously. Along with FAAN, NRA has developed campaigns to educate operators about food allergies. “The National Restaurant Association—and the restaurant industry as a whole—recognizes that food allergies are an important issue and that educating staff is crucial to ensuring proper attention to guests with food allergies,” says Sheila Weiss, registered dietitian and nutrition consultant with the NRA. “Restaurants want to ensure that their guests are receiving a safe meal. A [severe] food allergy is a life or death situation.”

Restaurants are encountering more customers with food allergies than ever before and need to know how to handle their questions and requests.

Your business needs to understand the issue. And you and your staff must know how to deal with a guest who notifies you of a food allergy. “Awareness of people with food allergies and diseases such as celiac disease by the general public is on the rise,” says Susan Quam, executive director of the WRA Education Foundation. “The demand for accommodation is much higher than it has been.”

The number of people who are allergic to one or more foods has doubled over the last 10 years. Scientists are unsure why, but one of the theories, called the “Hygiene Hypothesis,” points to the increased use of antibacterial products and more sanitary conditions overall. With cleaner environments, the immune system has limited opportunities to act in its primary role as a germ fighter. The immune system responds to protect the body against the food, which it perceives as an enemy, says Deb Scherrer, vice president for educational programs at FAAN. Sherrer explains that in fact, “There are no food allergies in Third World countries.”

People with food allergies who come in contact with the offending item(s) can experience breathing difficulties and coughing. They can develop a rash, break out in hives, or swell up. Other potential symptoms include vomiting, diarrhea and abdominal cramps. When the reaction affects the cardiovascular system it can cause a sudden drop in blood pressure and fainting.

With food allergies, anaphylaxis is always a danger. Anaphylaxis overwhelms the body’s systems, preventing them from working properly. It happens quickly and may cause death. To reverse it, epinephrine (adrenaline) is administered using a self-injectable device called an EpiPen® or Twinject®. Death occurs when the drug is not given or given too late. There’s no cure for food allergies and avoiding the offending food is the only way to prevent a reaction.

Few people want to live a sheltered life, but food allergies drastically limit personal activities. Miller and her family tend to stick to tried and true chains with well-known menu offerings when eating out. If she wants to try a new food, Miller will test it out at the Fox Valley hospital where she works. And she never leaves the house without her EpiPen.

Is it a food allergy or a food intolerance?
In people with a food allergy, a protein in the offending food causes the immune system to respond. A food intolerance doesn’t involve the immune system. Instead, the body lacks a mechanism or an enzyme to digest a food as in the case of a lactose intolerance or the more severe celiac disease.

People with celiac disease are unable to process gluten. When celiac sufferers eat a food containing it, they can experience symptoms such as iron deficiency anemia, an itchy rash and unexplained weight loss although there are some who show no specific symptoms. While not immediately life-threatening, exposure to gluten does cause physical harm. Repeated long-term exposure can lead to malnutrition, chronic diseases, even some intestinal cancers.

Tim Craft, a 49-year-old Racine resident and member of the WRA Education Foundation’s board of directors, was diagnosed with celiac disease two years ago. “My iron count was low and in the process of investigating that, the celiac disease was diagnosed,” he says. “The iron deficient anemia and associated symptoms, being tired and an inability to concentrate, were my only symptoms.”

Since his diagnosis, Craft has had to eliminate most processed foods and drastically change his diet. Eating out now poses a challenge. “The little snacking during the day or stopping for a bagel or a donut is gone,” he says. “When I eat out, it’s very limited.”

For people whose food choices are determined solely by what’s safe for them to eat, finding a restaurant that can meet their needs can seem a bit like winning the lottery. “The food allergy community is a very tight-knit community,” says Quam. A Facebook page for FAAN includes member comments sharing where the good places are to eat as well as which operators to steer clear of.

“I’ve learned through past mistakes what to avoid,” says Miller. “We stay away from fancy restaurants with lots of sauces and I never eat dessert out.” And she’s learned to be very proactive in asking restaurant staff about what’s in a particular dish.

On a recent three-day weekend, Craft and his family stopped at a restaurant where he explained his special dietary restrictions to the waiter. “The waiter was fantastic,” he says. “He instantly knew what I meant, told me what the go/no-go items were, and was really helpful. We went back there the next night instead of trying a different place, just because they took good care of me.”

A restaurant perspective
Catering to guests with food allergies does take some pre-planning. “Handling any special dietary requests begins with training,” says Kris Timmer, general manager of Andrew’s Restaurant located in The Delafield Hotel. “Our dining room staff is instructed to bring any special dietary request to the attention of the chef on duty.”

The upscale restaurant features North American cuisine. The majority of its dishes are prepared “a la minute” so last minute adjustments are easy to do. Although it doesn’t actively market itself as a place for those with food allergies, the service staff is trained to ask questions to find out exactly what the guests are looking for. And they’re also trained to consult the chef. “Our goal is to have every guest in our restaurant have a memorable experience and accommodating special requests is a part of that,” she says.

Rather than viewing accommodations as a burden, Quam encourages restaurant operators to see it as a way to differentiate themselves in the marketplace. “Our executive chef, Shawn Kolo, doesn’t look at these [requests] as a substitution, [but] rather an opportunity to simply be creative and be able to provide something unique for the guest,” says Timmer. “Our culinary team understands the importance of taking care of our guests, down to the smallest detail.”

Training to avoid cross contact
You may be taking all the right steps in accommodating your customers, but you can be tripped up by cross contact. If your restaurant is noted for Friday night fish frys and you’re frying your potatoes in the same oil, your customers with the fin fish allergy can be in big trouble if they order the fries without knowing that.

Miller has no room for error with her food choices, but Craft is willing to accept a few risks when eating out. “In talking with my doctor, I asked about the cross contamination issue,” he says. “His advice was that everyone has different levels of sensitivity, and sadly, it’s often down to trial and error. My sensitivity level is fairly low so I don’t worry too much about cross contamination.”

To prevent cross contact, Andrew’s Restaurant focuses on training and good procedures such as using product specific equipment. “Attention to detail is key,” says Timmer.
Sound policies and procedures coupled with continuous training can head off many problems. FAAN has cards for servers to carry that provide a quick guide to food allergies. The WRA and NRA have included information on the issue in the ServSafe® managers’ training program for the past five years.

Utilizing equipment such as color-coded cutting boards and a specific coding system for orders can reinforce the importance of following certain procedures. Developing a binder that contains a list of ingredients for each recipe and/or a copy of the ingredient label may take some initial work to compile, but once it’s done, it’s simple to maintain.
Many restaurants also encourage open communication between the guest with food allergies and the staff. At local restaurants, Miller and her family know most of the wait staff.

“If I talk to the server and they don’t understand [my needs], then it’s ‘forget it,’” she says, and the Miller family immediately takes their business elsewhere.

But she does her part by researching menus for new restaurants online or calling ahead and talking with the manager or chef. “We always tip well and thank our server,” she says. “That goes a long way.”

“Being on the WRA Education Foundation board of directors means I understand the importance of staff training. I recognize untrained or uncaring staff,” says Craft, “and I just walk out if that’s the case. I go to local establishments that ‘get it’ and won’t eat anywhere that doesn’t.” Restaurants that do “get it,” see repeat business from people like Miller and Craft.

Regulation and liability
The restaurant industry as a whole has never shied away from wanting to make accommodations since the first appearance of the food allergy issue at the 2004 National Conference for Food Protection. “We saw advocacy groups coming and saying this is a food safety issue,” says Quam. The groups wanted to find out how they could get food allergies included in the regulatory guidelines. An update to the FDA Food Code will be released later this year and Wisconsin will review its current code to see what changes should be adopted.

If you make claims that your restaurant is able to accommodate customers with food allergies, you have to follow through. Liability is out there. Just look at all of the disclaimers now on pre-packaged food about the potential for cross contact. You can do your utmost best to answer questions, prevent cross contact and try to accommodate allergic guests but it doesn’t always work out.

Train your wait staff to say, “I don’t know” rather than having them make a blanket statement that a particular dish doesn’t contain a specific allergen. It’s also appropriate to discourage a customer’s business. “I was at a restaurant and the manager said, ‘I can’t guarantee 100 percent your safety and from a business standpoint, I’d rather you not eat here,’” says Miller. “At first I felt insulted, but then I realized it was a good thing.”

Customers with severe food allergies certainly recognize that their next meal could be their last. “I feel fortunate that I’ve lived this long even with all that could go wrong,” says Miller. But with proper training, sound policies and procedures and attention to detail, your restaurant should be able to accommodate all guests, even those with life-threatening food allergies. WR