Allergic reactions can occasionally be life-threatening and people who know they are at risk must always remain vigilant when food is around.
The most common dietary cause of severe reactions are peanuts (ground nuts) and tree nuts e.g. walnuts, almonds, hazelnuts, brazils, pistachio, cashew, macadamia etc., however any food has the potential to cause a severe reaction – not just nuts. This is a common misconception.
Many manufacturers, retailers & caterers have responded well to this knowledge by improving customer information and many go a long way to try and keep the allergic consumer safe, but sufferers are still being ‘caught out’ by unexpected ingredients. This could be because of poor communication, a lack of understanding about the severity of the problem and the tiny traces of a food that have the potential to cause a severe life threatening reaction. Communication needs to be clear and a good understanding of the issues by the person preparing the food is essential. The following link provides further information from the government body The Food Standards Agency. (Tel 020 7276 8516)
Anaphylaxis is the most severe form of an allergic reaction – the extreme end of the allergic spectrum. The whole body is affected, usually within minutes of exposure to the allergen but occasionally after one to two hours. Common causes include foods, insect stings, latex exposure and medications.
Any or all of the following symptoms may be present:
- Itching or a strange metallic taste in the mouth
- Swelling of the throat and tongue
- Difficulty in swallowing saliva or speaking
- Difficulty in breathing – due to severe asthma or throat swelling
- Hives (nettle rash) anywhere on the body
- Generalised flushing of the skin
- Abdominal cramps, nausea and vomiting
- Sudden feeling of weakness/faint (drop in blood pressure)
- A sense of impending doom
- Collapse and unconsciousness
Medications should be readily available and knowing what to take and when to take them is essential. If a severe reaction was to occur, an ambulance should always be called without delay.
Eating food prepared by others always carries an element of risk, but the risks can be reduced significantly by good communication. It is the responsibility of the person with the food allergy or their family/carers to ensure that all the correct steps are carried out to reduce as many of the risks as possible. They must communicate clearly, double check everything and question politely, until they have the information required to make an informed decision as to whether it is safe to eat the food on offer. They should also be prepared to go elsewhere if they are not completely happy that they have been understood and the meal will be as safe as it can be.
Action Plan….for the person with the food allergy
- Obtain detailed information about ingredients of every food you plan to eat
- Ask where and how the foods chosen are to be cooked
- Discuss and assess whether cross contamination is likely - from foods being chopped, prepared or cooked together. Cooking oil, spoons, knives, pans, grills and chopping boards are the usual culprits
- Tell the chef about the potential severity of reactions that can be caused by tiny amounts of a particular food
Caterers will be much more receptive to this questioning if it is done in a polite and grateful manner and if they have a full understanding of why you are asking for this information. This is best done at a quiet time of day or at a pre-arranged time. Expecting full attention from a busy chef at peak time is unrealistic and unfair on the chef.
Chefs and catering staff are usually happy to cater for customers with food allergies, especially if they have prior notice. Some prefer to make up the meal at the start of their shift before other foods contaminate the kitchen and cover it ready to reheat later.
As a caterer you can:
- Be receptive to people with a food allergy asking questions about the food on offer
- Ask the person how allergic they are and whether traces of the food from cross contamination could be a problem
- Let the allergic person or carer check food labels and speak to the chef themselves
- Let the person bring their own pan or utensils to reduce the risks of cross contamination if they wish to
- Give the person dignity and respect – some people have a poor tolerance of people with food allergies – usually due to poor understanding about them so learn all you can about food allergy which will help both of you
- Do not offer to cater for the person if you are unable to do so safely
- Train serving staff in pertinent food allergy issues
- Ask suppliers to provide accurate written details about all ingredients
- Avoid the indiscriminate use of nuts, e.g. powdered nuts as a garnish, unless this is an essential part of the recipe
- If a dish is meant to contain nuts, why not make sure this is reflected in the name: e.g. nut & carrot salad
- If possible, keep certain preparation areas designated as nut free areas or food allergy preparation areas that ever member of staff is aware of
- Put up a prominent sign or a note on the menu encouraging people with allergies to question staff. For example, this could state: “Some of our dishes contain nuts. If you are allergic to nuts, please, ask the waiter to suggest a nut-free meal”
- Try to ensure that where a dish contains certain allergens – that this is indicated in some way on the menu. Some restaurants adopt a symbol
- Organise a training session on allergies for your staff. Make sure that all new staff members (including part-time and casual staff) are aware of the implications of severe allergies and how to cater for them safely by reducing the risks as much as possible
- If a customer claims they have a life-threatening food allergy (Anaphylaxis), listen to them carefully so that you can assess whether you are able to provide a safe meal for them – let them speak directly to the chef rather than you relaying the message
- Peanuts and tree nuts (almond, brazil, walnut and hazelnut) are the foods most commonly publicised foods to cause severe allergic reactions but any food can potentially do this, so listen carefully to what the customer is telling you about their food allergies
- Other common foods include sesame seeds, dairy products, eggs, soya, wheat, shellfish, fish, pulses and fresh fruit; especially kiwi
- Find out which member of staff has access to accurate information about ingredients. Approach that person if you need the information
- If there is any doubt about whether a food is free from of a certain ingredient admit to the customer that you are unsure
- If on examining his meal, a customer realises it contains nuts and asks you to replace it, remember it is not enough simply to pick the nuts from the plate and return it to the customer. Tiny traces that remain may be enough to cause a severe reaction
- Encourage the customer to choose foods on the menu that have the lowest risk of contamination or hidden allergens – plain foods without sauces are the best choice
- Remember that cooking in unrefined groundnut oil (peanut oil) or sesame oil may leave traces of nut protein in the food being cooked
- ANY oil that has previously been used to cook products containing nuts/egg/batter/fish etc may contain traces of these foods so are unsuitable for anyone who is highly allergic to these foods
- If you are preparing food for someone with a severe allergy, beware of transferring food from one dish to another and contaminating a ‘safe’ food with unsafe allergens
- Hands, utensils, cutlery and work surfaces should be washed scrupulously after handling foods containing nuts – they should even be wiped/rinsed before they are put in a dishwasher if they are sticky eg peanut butter, mayonnaise, chocolate sauce, creamy puddings
If an allergic customer becomes ill, it is likely that person – or someone with them – will state that he/she is suffering an allergic reaction. They may use the word
This is what to do:
- Immediately send someone to dial 999 giving the following information:
- “This is an emergency. A customer has collapsed and we believe they are suffering from anaphylaxis.” (Pronounced Ana-fill-axis)
- Speak clearly so that the ambulance crew will know exactly where to come Someone should be sent to stand at the entrance to direct the ambulance crew to the patient
- Ask other customers if there is a Doctor in the Restaurant if the ambulance has not arrived and the patient is becoming very unwell
Any staff trained in First Aid should make a point of learning what to do if someone suffers from anaphylaxis.
Please remember that severe reactions can take place within a few minutes and in very extreme cases where prompt treatment is not sought – can be fatal.
Immediate action is vital.
Last updated: October 2012