Module 6. Prevention and Management of Food Allergy Reactions in Foodservice Operations

Learning Objectives

After the module, students will be able to:

1. List key steps in preventing food allergy reactions in restaurants and on-site foodservice operations
2. Discuss food allergy prevention strategies as a part of the food safety program
3. Develop communication strategies for customers with food allergies
4. Identify steps in managing emergency situations due to food allergy reactions in foodservice establishments
5. Discuss best practices for various foodservice establishments

Module Content

• Food allergy management plans in foodservice establishments
• Challenges and issues specific to foodservice operations
• Strategies to reduce/eliminate food allergy risks
• Best practices
• Additional information
• References

Food Allergy Management Plans in Foodservice Establishments

Below is a list that outlines food allergen control and management plan to prevent food allergy reactions from occuring in foodservice establishments, and to prepare for emergencies due to food allergy reactions.

Recommended Food Allergen Control and Management Plan

General

1. Establish/maintain a group of advisory board members who can provide advice to the foodservice operators.
2. Determine common types of food allergens used in specific foodservice operations.
3. Develop an allergen control plan through food production and service systems as a part of the food safety program.

Segregation of allergenic food or ingredients during storage, handling, and processing

1. Store allergenic ingredients or products separately to prevent cross-contacts with other food items.
2. Have a separate kitchen area for the production of allergen-free foods.
3. Develop standard operation procedures (SOP) for the production of allergen-free foods.

Supplier control programs for ingredients and labels

1. Require food suppliers to notify changes of food ingredients.
2. Locate detailed ingredient information from commonly used manufacturers and a person(s) to contact when questions arise.
3. Review food ingredient lists regularly and update SOP for the production of allergen-free foods.

Prevention of cross-contacts during processing

1. Set aside dedicated processing equipment, tools, containers, utensils and work areas to prevent allergen cross-contacts.
2. Clearly mark allergen-free tools, containers, and utensils (e.g., color-code them) and store them away from other equipment and utensils used for general production and service.
3. Minimize the reuse of processing and/or cooking media (water or oil).
4. Restrict personnel working on processing lines containing allergenic ingredients from working on allergen-free production lines.

Training

1. Provide general training on allergen awareness and control for all employees in your foodservice establishment.
2. Train staff how to check ingredients of menu items to see if they contain allergens.
   1. Have a list of ingredients for each menu item.
   2. If ingredients cannot be changed in menu items or are unavailable, staff should inform the guest that they cannot provide safe food for them.
3. Provide training to all new staff on food allergies before they interact with customers to create better awareness and understanding.

Serving consumers with food allergies

1. Know who will answer guests’ questions about food allergies:
   1. Have at least one person available during hours of operation who can handle questions and special requests.
   2. If a guest says he or she has an allergy, direct the designated person to handle the order.
2. Advise cutomers with allergies not to eat certain foods:
   1. Fried foods should be avoided, as the cooking oil may be used for many foods unless there is a designated fryer.
   2. Desserts should be avoided, as many desserts incorporate the main food allergens, such as nuts. Fresh fruit may be a good alternative.
   3. Sauces should be avoided, as these sauces may include unexpected ingredients.
   4. Buffet or cafeteria services should be avoided, as there is a high possibility of cross-contact due to dishes being close together and guests serving themselves.
3. Establish steps to avoid cross-contact.
   1. Have scheduled times throughout the day for a staff member to check the kitchen and preparation areas for proper cleanliness and organization.

Note: Adapted from “Cleaning and other control and validation strategies to prevent allergen cross-contact in food-processing operations,” by Jackson et al. (2008). Copyright 2008 by the International Association for Food Protection.

Even though foodservice operators and staff try earnestly to prevent food allergy reactions, accidents may happen. In case such an emergency occurs, foodservice staff must prepare and be trained for how to react to the situation. Having emergency numbers and the restaurant’s address posted by all telephones makes the response to emergency easier.

The emergency plan should include the following (FARE, 2010):

• Call 911 immediately for emergency medical attention.
• Locate management, have a list of individuals to call if the immediate supervisor cannot be reached.
• Keep individual from standing up.
• Comfort the guest and keep others calm. Do not leave the scene until the emergency medical crew arrives.
• If an epinephrine auto-injector (e.g., Epipen®) is available, make sure it is stored in a designated area so that it can be easily found.
• Teach employees how to administer epinephrine auto-injector, if applicable.

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Challenges and issues specific to foodservice operations

• Staff members rely on customers to inform them about specific accommodations due to food allergies
• Untrained or inadequately trained staff members are not reliable for informing customers about food ingredients (Kronenberg, 2012)
• Food labeling for major allergens is not a requirement for restaurants (Taylor & Baumert, 2010)
• Recipes can be modified to use unintuitive or creative ingredients such as peanuts in pizza sauce (Taylor & Baumert, 2010)
• Space and equipment available for food preparation is limited (Taylor & Baumert, 2010)
• Many other avenues of cross-contact exist:
  • Fish, shellfish, and gluten can become airborne during cooking processes (FARE, 2010)
  • Shared cooking surfaces and cooking oils in fryers (Taylor & Baumert, 2010)
  • The sharing of cooking and serving utensils can be habitual in some operations (Taylor & Baumert, 2010)
  • Serving methods, such as the use of the same tray to serve both allergen-containing items and allergen-free items, salad bar cross-contact that occurs due to customer actions, and plates overlapping when the server carries dishes to the table, can result in cross-contact (Taylor & Baumert, 2010)

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Strategies to reduce/eliminate food allergy risks

Following are the prevention strategies and plans put in place by restaurateurs.

Implement cross-contact prevention.

• Set up the kitchen with food allergens kept away from commonly used items.
• Thoroughly clean and sanitize work areas before preparing allergen-free orders.
• Wash hands and change gloves before handling allergen-free orders.
• Use separate grills and cutting surfaces for allergen-free orders.

Ensure ingredients disclosure.

• Follow recipes strictly. Do not allow other ingredients to be added into the food.
• Keep the most current ingredient listings for all food items so that they are readily available for viewing.
• Train staff on menu ingredients and how to read labels to determine the presence or absence of allergens.
• Verify ingredients periodically for pre-made and convenience products.
• Make common allergen information available to staff.

Foster communication.

• Communicate with your customers about their food allergies.
  • Encourage your customers to carry a Chef Card (FARE, 2013) and give it to the chef who will prepare allergen-free foods.
    
    A Chef Card outlines the foods that your customer needs to avoid due to their food allergies. See example of a Chef Card at: http://www.foodallergy.org/document.doc?id=219
    
    
  • Introduce the ingredients of the dish and how it is prepared to customers with food allergies
• Communicate effectively (The Culinary Institute of America, 2008)
  
  When a guest requests an allergen-free meal, all employees who may be involved in preparation of the guest's food and service to the guest need to be alerted immediately. When communicating with the guest, the staff should do the following:
  
  • Be honest
  • Look the guest in the eye
  • Say “I understand” to communicate attentive listening
  • Repeat the important points back to the customer to clearly demonstrate understanding
  • Ask, “Is there anything else we can do?”
  • Offer to have the guest meet the manager
  • Communicate the allergy information to other staff members in plain language that everyone can understand
• Establish standard operating procedures for allergen-free meal preparation.
  • When the chef is notified about an allergen-free meal request, he or she should visit the customer’s table to make sure the specific needs are clearly communicated.
  • If the chef is unable to provide an allergen-free meal, or is unsure of his or her ability to do so, the customer should be informed and provided other options.
• Implement a comprehensive food allergy risk plan (Kronenberg, 2012). A well-established plan reduces liability challenges in case of an emergency and may increase the customer base.
• Train employees to manage the risks.
  • Some states require food allergy safety training for employees
    • The Massachusetts Department of Public Health enacted the Food Allergy Awareness Act (FARE 2014). Restaurants are required to do the following:
      • Display a FARE food allergy awareness poster in an area visible to staff
      • Include the following notice on menus and menu boards: “Before placing your order, please inform your server if a person in your party has a food allergy”
      • Have a manager who has undergone training through a certified vendor of the Massachusetts Department of Health (FARE, 2014)
    • Rhode Island has enacted a law similar to that of Massachusetts (FARE, 2014)
    • The city councils of New York, New York have already approved a proposal requiring restaurants to present food allergy awareness posters (FARE, 2014).
    • New Jersey: provides posters that remind staff that allergen-free requests should be taken seriously, to check product labels, and to avoid cross-contacts (Kronenberg, 2012).
  • Staff should be aware of the possible modes of cross-contact specific to their operation’s environment (The Culinary Institute of America, 2008)
  • A plan and specific practices should be developed for handling food for a customer with a food allergy (The Culinary Institute of America, 2008).
  • At all business hours, an employee who understands food allergies well should be scheduled (Wachs et al., 2012).

Management strategies for potential food allergy reactions

Follow the four Rs when dealing with a customer with food allergies (FARE, 2013):

1. Refer the food allergy concern to the manager, chef, or person in charge
2. Review the food allergy with the guest and check ingredients on labels
3. Remember to check the preparation procedure for potential cross-contact
4. Respond to the guest and discuss your findings with him or her

Figure 6.1. Example of a System for Handling Food Allergies (The Culinary Institute of America, 2008)

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Best Practices

Programs that are appreciated by individuals with food allergies and their families

In schools

• Provide peanut-free schools or tables, or implement non–food-sharing policies
• Provide training to food handlers regarding food labels, and provide training to principals, nurses and teachers on epinephrine administration
• Communicate with parents of children with food allergies about special accommodations and possible concerns

In restaurants

• Provide online menu and ingredient information
• Communicate with consumers about their food allergies and which food items to avoid
• Provide specific allergen-free dishes
• Provide food allergy training to both front-and back-of-house employees

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Additional information

For more information, refer the following websites for training aides and other relevant information.

EpiPen. (n.d.). Directions for use. Retrieved from http://files.epipen.gethifi.com/footer-pdfs/patient-packaging-insert-pdf/Patient-Information.pdf

Food Allergy Research & Resource Program. (2008). Components of an effective allergen control plan: A framework for food processors. Retrieved from http://www.foodallergy.org/document.doc?id=146

Iowa State University Extension and Outreach. (n.d.). Food allergy training quiz. Retrieved from https://www.extension.iastate.edu/foodsafety/files/allergens/AllergensQuiz.pdf

The Food Allergy & Anaphylaxis Network. (2005). Food allergy training guide for college and university food services. Retrieved from http://www.foodallergy.org/document.doc?id=137

The Food Allergy & Anaphylaxis Network. (2006). Food allergy training guide for hospital and food service staff. Retrieved from http://www.foodallergy.org/document.doc?id=149

The Food Allergy & Anaphylaxis Network. (2009). Food allergy and cross-contact restaurant poster. Retrieved from http://www.foodallergy.org/document.doc?id=144

The Food Allergy & Anaphylaxis Network. (2010). Welcoming guests with food allergies. Retrieved from http://www.foodallergy.org/document.doc?id=143

The Food Allergy & Anaphylaxis Network. (2014). Tips for avoiding your allergen. Retrieved from http://www.foodallergy.org/document.doc?id=133

Yen, Gerry. [Gerry Yen]. (2008, August 27). Using EpiPen [Video file]. Retrieved from http://www.youtube.com/watch?v=pgvnt8YA7r8

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References

Abbot, J. M., Byrd-Bredbenner, C., & Grasso, D. (2007). “Know before you serve” Developing a food-allergy fact sheet. Cornell Hotel and Restaurant Administration Quarterly, 48(3), 274–283.

Jackson, L. S., Al-Taher, F. M., Moorman, M., DeVries, J. W., Trippett, R., Swanson, K. M. J., … Gendel, S. M. (2008). Cleaning and other control and validation strategies to prevent allergen cross-contact in food-processing operations. Journal of Food Protection, 71, 445–458.

Kronenberg, S. A. (2012). Food allergy risk management: More customers, less liability. Journal of Foodservice Business Research, 15, 117–121.

McMorris, M., & Rhim, G. (2001). School readiness for children with food allergies. Annals of Allergy, Asthma, & Immunology, 86, 172–176.

Taylor, S. L., & Baumert, J. L. (2010). Cross-contamination of foods and implications for food allergic patients. Current Allergy and Asthma Reports, 10(4), 265–270.

The Food Allergy Research and Education [FARE]. (2005). Food allergy training guide for college and university food services. Retrieved from http://www.foodallergy.org/document.doc?id=137

The Food Allergy Research and Education [FARE]. (2010). Welcoming guests with food allergies. Retrieved from http://www.foodallergy.org/document.doc?id=143

Food Allergy Research and Education [FARE]. (2014). Food allergies and restaurants. Retrieved from http://www.foodallergy.org/advocacy/restaurants

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