Food Protection Trends - September 2008 - 658

FIGURE 1. Restaurant food items (number, percentage) responsible for 29 fatal allergic reactions In subsequent FAAN surveys conducted in 2004 (n = 479) and 2006, (n = 627) about one-third of the conference attendees reported similar incidents. Of those responding to the 2006 surveys, 44% reported that they had been told by restaurant staff that the establishment was unable to provide a safe meal, 24% reported impolite or rude treatment by restaurant staff because of informing staff of the food allergy, almost 10% were prevented from bringing their own “safe” food into the restaurant, and almost 10% were asked to leave a restaurant because of their food allergy. METHODS The Food Allergy & Anaphylaxis Network (FAAN), with support from the American Academy of Allergy, Asthma & Immunology (AAAAI), established a reporting registry to investigate the circumstances surrounding food allergy fatalities. The registry does not represent a systematic or complete accounting of all fatal food-induced reactions in the United States. From 1994 to 2006, a total of 63 such fatalities were studied. An initial study of 32 of these fatalities was published in the Journal of Allergy and Clinical Immunology (JACI) in 2001 (2). A follow-up study of the 31 additional fatalities appeared in JACI in early 2007 (3). To investigate the circumstances surrounding each fatality, a FAAN representative contacted a family member or acquaintance and a structured questionnaire that addressed issues such as the type of food ingested, the progression of symptoms, emergency treatment, patient history, and contributing factors. Investigating these tragic events helps provide lessons for avoiding similar tragedies in the future. and catered events. Sadly, most of these reactions could have been prevented by due diligence on the part of the consumer and/or the restaurant staff. Food-allergic individuals sometimes fail to identify themselves to restaurant personnel, and sometimes eat a food item that may in fact contain an allergen. Additionally, restaurant employees are sometimes ill-equipped, through lack of training, to understand the serious nature of food allergy, to read ingredient labels, and to avoid cross-contact during food preparation. Through an analysis of 29 fatal food-allergic reactions caused by restaurant food, strategies emerge that can help restauranteurs prevent such tragedies in the future. Ample research demonstrates the prevalence and severity of food-allergic reactions caused by restaurant food, as well as the need for better education and training on the part of restaurant and food service personnel. Of the 5,149 registrants in the United States Peanut and Tree Nut Allergy Registry, 14% reported reactions associated with restaurants and other food service establishments. Researchers studied more than 150 such episodes and found that the establishments most commonly involved were Asian restaurants (19%), ice cream shops (14%), and bakeries or doughnut shops (13%) (5). Other researchers conducted an Internet-based survey of 51 patients with food allergies and found that 18% of the reported reactions occurred in restaurants (4). Investigators in Ireland conducted chemical analyses and found that about 21% of restaurants (13 out of 62) pro- vided meals that could possibly have triggered a fatal reaction in an individual with peanut allergy. In each case, the restaurant staff had asserted that the meal was suitable for someone with a peanut allergy (6). Researchers who examined hospital discharge records and fatal anaphylactic reactions in the United Kingdom found that foods with “hidden” allergens and meals at restaurants were particularly dangerous for patients with food allergies. They concluded that restaurants present major risks for individuals with food allergy (11). In a study of more than 100 members of the Anaphylaxis Campaign, the major British patient resource group for individuals who have suffered severe allergic reactions, restaurants were implicated in 14% of the reactions (10). Findings from a survey of 100 restaurant personnel in the United States, including managers, chefs, and wait staff, showed that one-quarter of the respondents incorrectly indicated that removing an allergen from a finished meal (e.g., removing nuts from already prepared food) was safe, and one-quarter incorrectly indicated that consuming a small amount of an allergen would be safe (1). In a survey of more than 426 attendees at educational conferences hosted in 2001 by the Food Allergy & Anaphylaxis Network (FAAN), almost half (47%) of the respondents reported that they had had an allergic reaction to food served in or provided by a restaurant. The allergens identified as most often responsible were milk (26%), peanuts (19%), and tree nuts (11%). However, in 23% of the cases, the allergen was unknown. RESULTS Nearly half of the 63 fatalities (46.0%, n = 29) were caused by food from a restaurant or some other food service establishment, including sit-down restaurants, fast food establishments (including mall food courts), university dining halls, school cafeterias, ice cream shops, and catered functions. Packaged food items (typically dessert or candy items) were responsible for 27% (17 of 63) of the 658 FOOD PROTECTION TRENDS | SEPTEMBER 2008

Food Protection Trends - September 2008

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