The Sergio Lopez Food Allergy Awareness Act is a Texas law that made Texas one of a handful of states requiring restaurants to post educational materials about food allergens, risks, symptoms of allergy attacks, and first aid. The Act became law several years after Sergio Alexander Lopez died from anaphylactic shock after eating a taco that contained peanuts. Lopez, a 24-year old music teacher with a peanut allergy, had confirmed with the restaurant several times that the taco was peanut free, but shortly after consuming it, he went into a coma and passed away a few days later.
The restaurant later defended themselves by explaining that Lopez had asked if the taco had peanuts, when it didn’t. It had peanut butter…
It may seem obvious that a dish containing peanut butter would present a problem for someone with a peanut allergy. However unfortunate, this shocking level of ignorance isn’t uncommon in the food world and this ignorance can and has cost the lives of customers and the reputations of restaurants. And that’s why more and more restaurants are committed to educating their staff and customers about food allergies. Here’s what restaurant owners and food manufacturers need to know about allergies.
What is an Allergy?
An allergy occurs because of an autoimmune response to something in the environment. The body’s immune system is supposed to fight off foreign and dangerous substances that can harm the body, but for some people, that same system is hardwired to recognize innocent materials as dangerous.
When people come into contact with these materials, for example pollen, dust mites, peanuts, or milk, their immune system mounts a response that ranges from mild to severe. People with more mild allergies may develop hives, stomach cramps, vomiting, or nasal congestion. However, allergies can also cause severe swelling. When this occurs in the throat, it’s called anaphylaxis and can lead to death.
Mild allergy symptoms can be treated with antihistamines, like Benydryl. When an allergy is severe, a shot of epinephrine, from an Epi-Pen, can reverse throat swelling and allow airways to open again, saving lives (although even after epinephrine is administered, someone who experienced a severe reaction should still be examined by emergency services). Most severe allergy sufferers carry an Epi-Pen with them wherever they go. Thirty five states allow public entities, like restaurants, to keep an emergency Epi-Pen on hand in case of emergencies. Restaurant owners should check their state’s laws and determine if it’s worthwhile for them to keep an Epi-Pen in stock in case a diner goes into anaphylactic shock.
How Common are Food Allergies?
According to CDC data, more than 15 million Americans suffer from food allergies and the numbers are rising every year. One out of every 20 babies and 6% of adults – in America – are allergic to something. In addition, allergies are responsible for approximately 30,000 emergency department visits and 150–200 deaths each year. More worrisome to restaurateurs is that about half of the fatal food allergy reactions that have occurred over a 13-year period were caused by food from a restaurant or other food service establishment.
The Big Nine
So, it’s important to know, which foods tend to be allergy prone. It turns out that 90% of allergies stem from nine food categories, which are sometimes referred to as the “Big Nine.” They include:
- Dairy: Around six million Americans have a dairy allergy. This form of allergy is more common in young children and babies, and many outgrow it in their early childhood. People who are allergic to dairy are reacting to either the casein, which is the part of the milk that curdles, or the whey, which is the liquid part of the milk. Many with dairy allergies are sensitive to sheep and goat milk, as well as cow’s milk. Some people with milk allergies have a delayed reaction allergy where they experience severe stomach upset hours after consuming dairy.
- Eggs: Around 1-2% of American children are allergic to eggs. Most only experience hives and skin irritation, but some have more severe or deadly reactions to eating eggs. People with egg allergies are typically only reactive to the whites of the eggs, but since it’s impossible to completely separate them from the yolk, they are usually advised to avoid eggs altogether.
- Peanuts: Although peanuts aren’t the most common allergen among the Big Nine, they are the most likely to cause anaphylaxis. Peanuts are a common ingredient in some forms of Asian cuisine, like Thai, so it may be better for people with severe peanut allergies to avoid these restaurants altogether, especially if they are sensitive to inhaling peanut dust in the air as well.
- Tree nuts: Peanuts are actually legumes, in the same family as beans and peas. By contrast, tree nuts, like hazelnuts, cashews, almonds, and pistachios grow on trees. If someone is allergic to even one of these nuts, there’s a 50% chance they will be allergic to the other tree nuts as well, and a significant chance that their reaction will be severe. There may be more than 18 types of nuts that can cause an allergic reaction, and these are found in thousands of products, so it’s important for people to educate themselves as to how to avoid these triggers.
- Fish: Fish allergies are a bit tricky in that people sometimes develop them later in life or in adulthood. It’s important to note that fish is sometimes found in sauces and dressings, so restaurants should carefully read the labels on barbeque sauces, Caesar dressings, and Worcestershire sauces, and make sure to warn diners if they contain fish.
- Shellfish: This category includes crustaceans, like shrimp and lobster, and mollusks, like clams and oysters. These ingredients are also common in fish sauces.
- Soy: Soy allergies are significant not because they are so common, only about one in 200 children have soy allergies and most outgrow them by age ten, but because soy is an extremely common ingredient in processed foods. As soy is a legume, soy allergies are sometimes comorbid with peanut allergies.
- Wheat: Sometimes wheat allergies are confused with celiac disease, but the two are not the same at all. An allergy is an autoimmune disorder where the body reacts to a specific protein or substance. However, offering gluten-free and wheat-free options in your restaurant can benefit the celiac, the gluten-insensitive, and the allergic diner.
- Sesame: This seasoning is common in Asian and Mediterranean cuisine and is the ninth most common food allergen.
Notably, although it isn’t included in the Big Nine, a large number of people are allergic to the latex which is sometimes used in food-service gloves. This can cause staff to have a reaction, and trace amounts of latex in food can harm customers as well. Some states recommend or require using non-latex gloves in food service.
What the Law Says
The first rule of being an allergy-friendly establishment is to be in compliance with your local laws.
Although the laws vary from state to state and municipality to municipality, places like Maryland, Massachusetts, Rhode Island, New York City, St. Paul Minnesota, and soon Texas as well, require restaurants to hang up posters educating staff about the Big Nine.
In addition, any food that is packaged for resale must be properly labeled. According to FALCPA (the Food Allergen Labeling and Consumer Protection Act), any ingredient that contains one of the Big Nine, must have the name of the allergen specified in parenthesis in the ingredients list, using this format “Lecithin (soy).” In addition, there must be a “contains ____” statement under the ingredients list specifying any of the Big Nine included in the product.
An Allergy-Friendly Restaurant
However, the law is only half the story when it comes to protecting diners. A legally-required poster in the kitchen is a good start, but not enough to keep customers safe or to allow them to dine with confidence. Here are some other interventions restaurant owners can use to protect customers.
Staff Education
A food establishment that wants to be safe and allergen-friendly needs to educate staff about several different aspects of food allergies. Firstly, staff, both in the front-of-the-house and the back-of-the-house should understand the severity of allergies and how they can manifest. Once they realize how deadly allergies can become, this will help prevent them from dismissing diner’s concerns, and ensure their dedication to preventing accidents.
In addition, staff need to understand the issue of cross-contamination. Basically, some people with allergies are sensitive enough to react to the allergen even in small quantities. This means that, for example, if a chef uses a cutting board to chop nuts for a pesto, and then clears the nuts away and uses the same board and knife to cut lettuce for a salad, trace amounts of the nuts may remain behind. These particles can contaminate the lettuce and end up in the salad. That means even if the salad itself doesn’t contain nuts, it can still send an allergic diner into anaphylactic shock because of the nut particles.
Avoiding Cross Contamination
There are a number of ways to get around the cross contamination issues. A good idea is to have a special process when it comes to making meals for a diner with food allergies. The restaurant can deputize a “point person” in the kitchen when it comes to preparing meals for customers with allergies. That means only one person touches the meal in progress and that person, a staff member trained in handling food allergies, takes full responsibility for all elements of preparing the meal. That chef should use a special area of the kitchen, isolated from busy areas with regular food, change his/her gloves before starting on the dish, and, in addition to fully washing all pots, pans, utensils, knives, and serving dishes that will be used, use dedicated allergen-free utensils when possible
Cross contamination is hardest to avoid in buffet style dining, where even if allergy-safe dishes are prepared in the kitchen, once they make it to the buffet, it’s very easy for one dish to get mixed with another, or serving utensils to get swapped. Restaurants that have buffets should therefore offer single-serve options for customers with allergies.
Labels Products as Containing Allergens
Labeling products and ingredients that contain allergens is another way to avoid cross contamination and tragic mistakes. Any ingredient entering the restaurant should be checked to see if it contains any of the Big Nine. Ingredients that do should be stored using a color coded system to denote which allergens they do contain. Equipment that is regularly used with an allergen can be color-coded as well, for example a pizza parlor will want to have separate dough scrapers for their gluten-free and conventional pie doughs.
Labels can help with the customer service element of the allergen equation as well. Restaurants should print allergen warnings in the menu, making sure it’s clear which dishes contain which of the Big Nine allergens, as well as possible substitutions (if a substitution isn’t possible and the dish can’t be made without the allergen, that should be clearly noted on the menu as well). Menus can even include a “allergy-friendly” label for food items that basically everyone can consume without issues.
Avoid Miscommunication
Many tragic accidents, like Lopez’s, that occur in relation to allergies are the result of miscommunication between front-of-the house and back-of-the house staff or between the diner and the server. There are a number of ways to mitigate potential miscommunications. Staff training is at the forefront here. Servers need to ask diners about any food preferences or allergies. The menu can also contain a statement that says: “before placing your order let your server know if you have any allergies.”
Sometimes diners can fake allergies to avoid foods they don’t like, for example pretending they are dairy-free in order to get a milk substitution. Because it takes a lot more to ensure that a meal is allergen-free (including from cross contamination) than to ensure that it doesn’t have one specific ingredient, waiters should make it clear that they will honor customer’s preferences whether or not it’s a health issue. That way diners are less likely to fake allergies when the issue is really a preference.
To improve communication between staff members, restaurants can print the allergen instructions in bold colored letters for the kitchen staff to ensure they don’t miss it, and follow up to make sure the allergen instructions were carried out. For diners, having a chef card in their pocket when they venture out to eat can save lots of time and save their life too. A chef card is printed up by the customer and provides a complete list of all the foods they are allergic too. This card can be presented to wait staff when ordering, who can then hand it over to the chef.
Proper Allergen Education Can Save Lives!
In the wake of Sergio Alexander Lopez’s tragic death due to an allergic reaction, Texas took a crucial step by enforcing legislation mandating allergen warnings in restaurants. The devastating incident shed light on the critical need for enhanced awareness about food allergies. Education and understanding surrounding allergies, their severity, and their prevalence are vital for both patrons and establishments. Compliance with existing laws serve as a starting point, but deeper measures are essential for ensuring a safe dining experience.
Empowering restaurant staff with comprehensive education on allergies and cross-contamination avoidance, implementing clear labeling, and fostering effective communication channels are pivotal for creating an allergy-friendly environment. Such concerted efforts not only mitigate potential risks but also reflect a commitment to prioritizing diner safety and inclusivity within the culinary world. It’s not merely a legal obligation; it’s a responsibility to safeguard patrons and prevent tragedies like Lopez’s from occurring ever again.