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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

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 Unpublished raw data.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

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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

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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.

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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.

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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.

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Additional information

Coping with food allergies - a guideline for consumers with food allergies
http://www.norcalallergy.com/pdfs/coping_with_food_allergies.pdf

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

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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