Module 5. Experiences of Consumers with Food Allergies

Learning Objectives

After the module, students will be able to:

1. Identify the impacts of food allergies on individuals' lives, including social impacts
2. Encourage the creation of food allergy prevention programs in restaurants

Module Content

• General feelings and perceptions about dining out
• Reported behaviors when dining out
• Past dining experiences reported by adults and children with food allergies
• Past experiences of food allergy reactions
• Consumer expectations from foodservice establishments
• Additional information
• References

Note: all content in this module is from the following three sources:

• Kwon, J., & Lee, Y. M. (2012). Exploration of past experiences, Attitudes and preventive behaviors of consumers with food allergies about dining out: A focus group study. Food Protection Trends, 32, 736-746.
• Kwon, J., Sauer, K., Wen, H., Bisges, E., & Myers, L. (2014). [Dining experiences of customers with food allergies]. Unpublished raw data.
• Leftwich, J., Barnett, J., Muncer, K., Shepherd, R., Raats, M. M., Hazel Gowland, M., & Lucas, J. (2011). The challenges for nut-allergic consumers of eating out. Clinical & Experimental Allergy, 41, 243-249.

General feelings and perceptions about dining out

Customers with food allergies and parents of children with food allergies often:

• Feel a strong sense of personal responsibility about being safe when dining out.
• Experience anxiety and/or fear when eating outside the home, especially when going somewhere for the first time, due to complications of identifying and explaining allergens.

Perceived causes of allergic reactions when eating out:

• Cross-contacts
• Hidden ingredients
• Poor communications between "front of house" and "back of house"
• Inconsistent and insufficient product labeling
• Unknown change of ingredients and/or supplier

Perceived barriers for establishments to provide allergen-free food

• Lack of employee training, knowledge, and awareness
• Inconsistency from location to location for franchises and other restaurants with multiple locations
• Frequent changes of product

Perceived risks of food allergy reactions and characteristics of food service facilities

High Risk

• Ethnic restaurants, due to potential hidden food allergens in sauces
• Buffets, due to potential cross-contacts
• Specialty restaurants with complicated food ingredients
• Up-scale restaurants, due to quick changing chef recipes
• Small establishments (e.g., ice cream shops, snack shops), due to the common use of nuts and potential cross-contacts
• National chain franchise restaurants, due to the minimal training level of employees

Low Risk

• National chain franchise restaurants, as preparation is simple and allergenic ingredients are handled separately (i.e., in pre-portioned packages)
• Establishments where food is prepared from scratch, as they avoid pre-prepared food, which has high risk cross-contact
• Overall clean establishments
• Establishments with allergy-friendly practices (i.e., specific policies, rules, and food allergy training)
• Establishments where staff shows concern for ensuring the safety of customers with food allergies and accommodating special requests

(top)

Reported behaviors when dining out

Consumers with food allergies choose places that have the following qualities:

• Have been safe in the past
• Do not have an individual's allergen on the menu
• Accommodate special orders or requests
• Provide allergen information, especially online
• Have knowledgeable staff in terms of food allergen on the menu
• Have a good reputation among the allergy community

Before going out to eat, consumers with food allergies do the following:

• Call the restaurant ahead of time
• Check online menus, ingredients, and allergen information when available
• Seek food allergy related information through extensive investigation
• Take advice from members of the food allergy community, such as Food Allergy Moms (http://allergymoms.com/index.php) and AllergyEats (http://www.allergyeats.com/)
• Parents of food-allergic children often bring "back-up food" for situations when doing so is easier than explaining needs or when they feel that a service cannot provide safe food for their child

When ordering food, do the following:

• Try to keep orders simple
• Notify the server and/or manager of allergens and needs to avoid embarrassment or unwanted attention

(top)

Past dining experiences reported by individuals with food allergies or children with food allergies

Positive

• Staff members were accommodating when special requests were made.
• Staff exhibited a good attitude, understanding, and/or empathy when it came to meeting needs.

Negative

• Staff exhibited a lack of understanding and empathy regarding needs.
• Staff appeared frustrated when a special request was made.
• Staff did not attempt to accommodate consumers' needs.
• Staff did not take consumers' requests seriously.
• The server or other staff members did not believe food allergies to exist or did not think reactions are would be severe.
• The consumer had an allergic reaction (requiring antihistamine, epinephrine, and/or a hospital visit/emergency medical attention) to the food served.

(top)

Past Experiences with Food Allergy Reactions

Reported consequences of children's food allergy reactions:

Child reactions

• Become upset and terrified during the reaction
• Feel shaky, panicky, and agitated for several days after the incident
• Limited what they ate after the incident

Parental reactions

• Frustration
• Anxiety
• Frightened for child's life (during the reaction)
• Anger/infuriation
• Helplessness
• Sad about child's experience
• Recognized the need to educate others
• Decided to home-school children if food allergic reactions occurred at school

Establishment responses to food allergic reactions:

Positive

• Staff apologized sincerely
• The restaurant paid for medical costs of the food allergy reaction
• Staff members handled the situation professionally

Negative

• Staff immediately or continually denied their fault
• Apologies seemed insincere
• Staff appeared unsympathetic
• Staff did not grasp the severity of what had happened
• Customers were charged for a meal even though the meal was not completed
• Staff was impatient, not knowledgeable of food ingredients, and did not know where to locate allergen information, etc.

(top)

Consumer expectations from food service establishments

Management Practices

• Establish procedures to prevent dishes from being contaminated by allergens
  • Identify the top eight major allergens on menus
  • Use specific allergen symbols
  • Use "contains" statements
• Have specific allergen-free menus
• Provide allergy safety training for staff on the following topics:
  • The increasing number of individuals with food allergies
  • Consequences of food allergy reactions
  • Common food allergens (The Big 8)
  • Ways allergen exposure can happen
  • Reading labels for potential allergens
  • How to prevent cross-contact
  • How to communicate with customers and restaurant staff about food allergies
  • How to recognize allergic reactions
• Prepare foodservice staff, particularly managers and servers, to be able to confidently answer the following consumer questions (Walkowiak, 2011):
  • What protocols do you have in place to serve food-allergic individuals?
  • Which items on your menu are not safe, given my specific food allergies?
  • How are diner's allergies communicated to the kitchen and other staff?
  • How is the kitchen set up to prevent cross-contact?
  • Is separate equipment used to prepare orders for food-allergic individuals?
  • What kind of oil will be used in the preparation of my order, and is it safe, given my allergies?
  • Can I see the list of ingredients for a given menu item?

Communication

• Provide allergen information online.
• Have relevant and up-to-date food information on hand, such as recipes, ingredient lists, preparation methods, etc.
• If applicable, market as an allergen-friendly restaurant.
• Use signage to make the use of common allergenic ingredients clear
  • For example, "We use X allergen in our facility" or "We have X allergen-free products")
• Give full, honest, and straightforward disclosure with regarding what can and cannot be accommodated and when answering questions or providing any other information.
• Do not be afraid to say "I don't know" when unsure. Do not assume or pretend you know the answer when you are not sure about it.

(top)

Additional information

Coping with food allergies - a guideline for consumers with food allergies (pdf)

Parekh, R. (2010). Market for food-allergy-friendly biz more than peanuts. Advertising Age, 81(36), 32.

(top)

References

Kwon, J., & Lee, Y. M. (2012). Exploration of past experiences, Attitudes and preventive behaviors of consumers with food allergies about dining out: A focus group study. Food Protection Trends, 32, 736-746.

Kwon, J., Sauer, K., Wen, H., Bisges, E., & Myers, L. (2014). [Dining experiences of customers with food allergies]. Unpublished raw data.

Leftwich, J., Barnett, J., Muncer, K., Shepherd, R., Raats, M. M., Hazel Gowland, M., & Lucas, J. (2011). The challenges for nut-allergic consumers of eating out. Clinical & Experimental Allergy, 41, 243-249.

Walkowiak, A. (2011, March 14). AllergyEats founder offers tips for dining out with food allergies and intolerances. AllergyEats. Retrieved from http://www.allergyeats.com/blog/wp-content/uploads/2010/06/AllergyEats-Dining-Out-Tips-Release-FINAL-110314.pdf