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Customers’ and Employees’ Allergies in Foodservice Operations

When we began our careers in foodservice management many years ago, allergies were not very commonplace.  Yes, occasionally there were customers who had a random allergy – peanuts, or perhaps MSG (which is actually an intolerance) – but nothing like what goes on today in most food operations, with both customers and employees dealing with potential deadly reactions to either food or materials. Dealing with allergies and intolerances are now a common concern among foodservice operators across the country.  And this concern is warranted as recent research indicates almost 11% of adults have a food allergy [1]. Those working in school nutrition are well aware that between 1997 and 2011, the prevalence of food allergies among those under 18 years of age increased by more than 50% [2].  An additional note of caution for those in foodservice operations is that over 50% of reported fatal allergic reactions involved items from restaurants or on-site foodservices, including private clubs, camps, schools, and university feeding sites [3, 4]. Thus, our blogs this month will delve a bit deeper into allergies in foodservice operations.  This first blog addresses the topic from the perspective of dealing with customers and employees with allergies, while our blog later this month will identify some resources to help train staff on food and other allergies, as well as food intolerances. 

First and foremost, give some thought to how you and your staff will respond to those with food allergies before the customer is sitting in your restaurant.  As you know, recent versions of the Food Code require managers and staff be knowledgeable about the most common food allergens, often referred to as the Big 8 (milk, eggs, shellfish, wheat, peanuts, fish, soy, and tree nuts). These Big 8 allergens represent about 90% of the cases. Someone with an allergy could experience a mild reaction (such as trouble swallowing) to anaphylaxis or death within minutes.  Food intolerances are not life threatening, but they can cause considerable discomfort. So, it makes sense that management and key staff should plan out a standard operating procedure to be followed when a guest signals that they have an allergy or intolerance.  Think through the entire system in your operation, developing specific strategies to avoid cross contact with the identified allergen during all preparation and service procedures.  Every step in the service encounter presents a new opportunity where a simple mistake could be fatal. In the process of developing your standard operating procedure, include members of your staff who interface with customers, they have great insight into issues that could arise, perhaps more so than managers.  

When a server approaches a table and is informed by the guest of a food allergy or intolerance, it should be taken seriously.  Some operations may designate specific servers each shift to be the point person, while others train all front-of-house staff. What should the training include? In addition to knowledge about the most common food allergens, the server must be well-versed in menu items, ingredients, and preparation practices.  It is this initial rection from the server and how well informed they are that signals to the guest how seriously these issues are taken by the operation. The server who handles these issues knowledgeably helps put the guest at ease, assures the guest that they will be safe, and that staff are prepared to effectively handle any allergen-related request. Individuals with severe allergies may shy away from restaurants, rather than deal with the consequences of service or kitchen staff who do not take them seriously. If the sever is fully trained on how to handle food allergies and intolerances, they are in a much better place to help protect the guest.  If a guest requests no cheese on the garden salad, a knowledgeable server should inquire about a possible dairy intolerance or dairy allergy because perhaps the bun served with the ordered burger is butter-grilled, although that is not mentioned on the menu.  Another strategy is to keep a list of all ingredients used in each menu item available for both front- and back-of-house staff to access. However, it is also imperative that this list be updated when a new brand of item is purchased or substituted, as vendors may have different formulations for products.  

Ensure that your operation’s menu clearly marks items which are allergen-free, such as gluten (wheat)-free options, and make sure your protocol on special diets is noted on the menu.  The menu can be a great communication tool and most customers will do their homework before making the decision to dine at a restaurant by investigating posted menus (on-site or online) to see if options are available to them, so use menu space wisely.    

Once front-of-house staff take the order, it is imperative that back-of-house staff handle it carefully! Kitchen staff must be keenly aware of which items are allergen-free, so those products can remain that way throughout preparation and service.  Invest in special equipment that can be used in the kitchen to safely prepare allergen-free menu items.  For example, purple cutting boards can be used to prepare certain food items; the color serves as a cue for others in the kitchen to be aware of cross-contact.  Your staff should know that even trace amounts for some individuals who have severe allergies can be deadly.  For example, allergic reactions to eggs in some individuals can be triggered with 0.06 mg of egg [5] – that is the equivalent of 0.000001058208 ounces of egg!   Thus, you cannot remove the deviled egg from the salad that accidentally had egg added, or the peanuts from the Pad Thai if they were accidentally put on, and you certainly cannot cook the allergen out of the product by putting it back on the stove or in the fryer – all are common misconceptions among line staff. Avoidance of the item is the only way to keep the person who has the allergy safe. Avoidance means no contact! So, designate a preparation area for special diets, instruct the food preparer to wash their hands, put on clean gloves, and use clean and sanitary equipment in order to avoid cross-contact.

You get it – training both front-of-house and back-of-house staff is critical to the operation’s success.  No matter how well trained your front line staff are, they are bound to have questions or concerns, so consider appointing a designated staff member to serve as the go-to person on each shift to coordinate the response if an allergy is mentioned by a guest.  Perhaps it is a manager, perhaps the lead chef.  Whomever is selected, they must be knowledgeable about the menu and preparation practices, perhaps have additional training on allergens, and have earned the respect of other employees.

While paying customers are important (indeed, there is not an operation without them), we also cannot forget about internal customers – your employees (without them, there would not be a viable operation, either!). Considering the COVID19 situation, it is likely more employees than ever before are wearing gloves and other personal protective equipment while completing their work.   While food allergies are important, it is also critical for operators to recognize that some employees may have an allergic reaction to latex, one of the materials used in the manufacture of food-contact gloves.  Latex allergies can be life threatening, and direct contact with the material is not always needed before a reaction may occur. Several states (as well as local municipalities) have enacted bans to the use of latex gloves.  Fortunately, others materials, such as vinyl or nitrile, can be used. FoodHandler has a wide assortment of gloves and other personal protective equipment that can accommodate everyone on staff. In fact, the September 19th SafeBites Webinar is on the topic of glove use.

Just as we say about ensuring safe food – it only takes one person not following proper practices to cause an outbreak, and this is true in the allergy world as well.  Taking care of a guest with food allergies can cause extra work for all involved, but it is the right thing to do and given the potential market of those with food allergies, it makes good business sense. If there is one thing we’ve learned from our friends who have food allergies – they are very much aware of which restaurants will take care of them, and as a result they spend more in those businesses.  When thinking about ways to prevent reactions from a specific food or material allergen, remember what we say at FoodHandler, Risk Nothing!

[1] Gupta, R. S., Warren, C. M., Smith, B. M., Jiang, J., Blumenstock, J. A., Davis, M. M., … & Nadeau, K. C. (2019). Prevalence and severity of food allergies among US adults. JAMA network open2(1), e185630-e185630. doi:10.1001/jamanetworkopen.2018.5630

[2] Jackson, K. D., Howie, L. D., & Akinbami, O. J. (2013). Trends in allergic conditions among children: United States, 1997-2011 (No. 121). US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

[3] Bock, S. A., Muñoz-Furlong, A., & Sampson, H. A. (2001). Fatalities due to anaphylactic reactions to foods. Journal of Allergy and Clinical Immunology107(1), 191-193.

[4] Bock, S. A., Muñoz-Furlong, A., & Sampson, H. A. (2007). Further fatalities caused by anaphylactic reactions to food, 2001-2006. Journal of Allergy and Clinical Immunology, 119(4), 1016-1018. doi:http://dx.doi.org/10.1016/j.jaci.2006.12.622

[5] Taylor, S. L., Baumert, J. L., Kruizinga, A. G., Remington, B. C., Crevel, R. W., Brooke-Taylor, S., … & Houben, G. (2014). Establishment of reference doses for residues of allergenic foods: report of the VITAL expert panel. Food and Chemical Toxicology63, 9-17.