Food Allergies: Tips for Eating Out
By Colette Bouchez
Whether you’re trying to avoid peanuts or dairy products, experts offer strategies for dining safely at restaurants.
Having a food allergy used to mean dining out was limited to carrying your plate from the kitchen to the porch or, at best, eating at the home of a close friend or relative who could guarantee your food offenders were nowhere in sight.
Today, however, eating out is a lot easier—and safer—for the 2 million Americans who suffer with a mild, moderate or even a severe food allergy. One reason: Restaurants are more aware and more prepared.
"The awareness of food allergies has definitely increased within the food service industry, and many restaurants now take steps to not only train their staff about the need for accommodating those with a food allergy, but also train them on what to do if an allergic reaction occurs," says John W. Fischer, associate professor and restaurant manager of Escoffier Restaurant at The Culinary Institute of America.
Among the most important steps in this direction is a training program for restaurants introduced by the Food Allergy and Anaphylaxis Network (FAAN) and The National Restaurant Association several years ago.
Developed as both an educational and informational tool, the program not only helps make restaurants more aware of food allergies, but also what to do in the event that an allergy-related incident occurs.
Medical doctors caution, however, that greater awareness on the part of the restaurant doesn’t mean you can let your guard down completely.
"The level with which you practice vigilance is obviously linked to the severity of your food allergy—but everyone who is allergic needs to personally take steps to ensure their safety when dining out," says David Rosenstreich, MD, director of the division of allergy and immunology at Montefiore Medical Center and professor of medicine at the Albert Einstein College of Medicine in New York.
Where do you begin? Experts say it starts with a good understanding of your food allergy.
Clearly, the most obvious way to avoid having a food allergy reaction
while eating out is not to order the offending food. But that’s not
always so easy. Sometimes you can’t fully see what you’re getting on
your plate.
"You really have to be aware of hidden ingredients.
Your allergen could be lurking in breading, a salad dressing, baked
goods or sauces, then it might not be obvious when your meal arrives,"
says Jonathan Field, MD, director of the Allergy and Asthma Clinic at
NYU Medical Center and Bellevue Medical Center in New York.
You
should also know the other names for your offending foods. Sometimes,
Rosenstreich says, products used by chefs—such as mixes for sauces or
dressings—list ingredients by alternate names. That means if you’re
going to request that something be left out of a dish, it’s vital to
know all the terms, including derivatives under which your allergen may
be listed.
The FDA considered this step so important it
instituted the Food Allergen Labeling and Consumer Protection Act in
2004, which mandated that all food manufacturers clearly label product
ingredients as they relate to eight major food allergies by 2006.
Before the law, people with a dairy allergy, for instance, may not have
realized that the ingredient labeled "casein" was really a protein from
milk. Now the product must say "milk."
Still, experts caution
this law only pertains to the eight most common food allergens: milk,
eggs, wheat, soy, peanuts, tree nuts, shellfish and regular fish. These
are responsible for more than 90 percent of all U.S. food allergies.
Here are the most likely places key food allergens may be lurking, according to the experts WebMD interviewed.
Allergy: Milk/Dairy
Hidden sources:
hot dogs, canned tuna, some chewing gum, margarine made from corn oil
(skim milk powder), granola bars, chocolate chips, desserts containing
caramel coloring, brown-sugar flavoring, coconut-cream flavoring,
natural chocolate flavoring, grilled steak (many restaurants rub steaks
with butter after grilling)
Allergy: Eggs
Hidden sources:
Milky Way or Snickers bars (nougat contains eggs); any baked good with
a shiny surface, including bagels and pretzels; the foam on some coffee
drinks; the pasta in prepared foods such as soups
Allergy: Nuts
Hidden sources: Barbecue sauce, bouillon, chili (nuts are used sometimes as thickener)
Allergy: Wheat/Gluten
Hidden sources:
Hydrolyzed wheat protein is sometimes listed only as a flavor enhancer
or binder in prepared foods and sauces, alcoholic beverages, hot dogs,
ice cream cones, licorice, soup mixes, coffee creamer substitutes
(grain based), butter flavoring, caramel coloring, some brands of
butter, couscous
Allergy: Seafood
Hidden sources:
Caesar salad (anchovies); caponata (Italian relish/anchovies); foods
fortified with omega-3 fatty acids (fish source), including some orange
juice, baby cereals, and soymilk.
Choosing a Restaurant
While what you order is
important, where you order it matters too. That’s because some
restaurants are more likely to not only accommodate your food allergy,
but also be better educated on how best to do that.
Not
surprisingly, Fischer says that the larger and more established a
restaurant is, the more likely it has dealt with food allergies in the
past. So the staff is less likely to be surprised or thrown by your
requests.
Other good alternatives are corporate chain
restaurants—places like Olive Garden, Applebee’s or Ruby Tuesday.
Fischer says chains often have tighter controls on their menus and
ingredients than independently owned restaurants, so the staff is more
likely to know exactly what’s in each dish.
Field agrees.
"While a local mom-and-pop restaurant may be more likely to veer from
the norm in an effort to please you, there is also more variability in
these places, so the dish may not be cooked the same way twice, and
that can be a problem," he says.
And while not every
restaurant staff can tell you exactly what’s in every dish (many chain
establishments use precooked foods that are only heated on site), most
of their corporate websites provide either a menu listing major
ingredients or an email address where you can access specific recipe
information. Some, like Olive Garden, provide recipes online so you can
find out exactly what is in the food on the menu.
Food Allergy: Preplanning Strategies
Phone the
restaurant ahead of time and find out what its policy is on serving
people with food allergies. "Ask if they have accommodated other people
with food allergies and ask what they ordered, and how they went about
letting the restaurant know about their problems," Field tells WebMD.
Tell the wait staff about your food allergy when you arrive. Having an
allergy card to hand to your server may help too. These small
business-size cards feature your name and food allergy and all
offending ingredients with a request that the kitchen leave them off
any dish you order.
You could also try "Allernotes,"
preprinted sticky notes detailing your food allergy that the server
attaches directly to your order. Allernotes sell for $8.50 for 100,
while printable allergy cards are available free online.
If
you’ll be traveling to a foreign country, for $10 you can create a food
allergy card in your native language that is then automatically
translated into the language of your choice.
While they cards won’t replace a discussion with restaurant staff, they can help you get your message across.
Make sure to have your food allergy medications with you such as
injectable epinephrine and an antihistamine. A severe allergic reaction
can be life-threatening, so it is important to have your emergency
medication with you.
SOURCES: John W. Fischer, MS, CHE,
associate professor, restaurant manager, Escoffier Room, The Culinary
Institute of America, Hyde Park, N.Y. David Rosenstreich, MD, director,
division of allergy and immunology, Montefiore Medical Center;
professor of medicine, Albert Einstein College of Medicine, New York.
Jonathan Field, MD, director, Allergy and Asthma Clinic, NYU Medical
Center and Bellevue Medical Center, New York. News release, National
Restaurant Association: "Committed to Food Allergies." The FDA’s Center
for Food Safety and Nutrition web site. Olivegarden.com. Talk About
Curing Autism web site: "Hidden Sources of Gluten." American Academy of
Allergy Asthma & Immunology website.
http://www.oprah.com/article/health/20080723_partners_foodallergies/5