Food Protection Trends - September 2008 - 660

IgE antibodies, which results in the release of histamines and other chemicals that adversely affect the respiratory system, the circulatory system, or the skin. A good method to remind restaurant staff of the severity of food allergies is posting a food allergy awareness poster in the kitchen and staff areas. Do not convey ingredient information to the food-allergic customer unless completely certain Sadly, a number of fatal reactions involved restaurant personnel providing incorrect information concerning ingredients. For example, an 18-year-old woman was told by a college cafeteria worker that a dish contained pecans, when the dish actually contained walnuts. Another victim, a 33-year-old woman, had asked her waitress numerous times whether her entrée contained peanuts, and the waitress had repeatedly told her that it did not. ability. However, it is recommended that restaurant managers arrange for their staff to receive basic information periodically about food allergy, i.e., recognizing the signs and symptoms of a reaction, reading ingredient labels, and preventing crosscontact during food preparation. Numerous educational resources are available, notably Welcoming Guests With Food Allergies, a training program developed by FAAN in cooperation with the National Restaurant Association. This program, which is available in English and Spanish, provides the tools to train restaurant staff to safely prepare and serve food to guests with food allergies. The program can be downloaded free of charge via the FAAN website, www.foodallergy.org. Become familiar with local policies concerning Emergency Medical Technicians (EMTs) and epinephrine The availability of epinephrine from emergency 911 personnel is not uniform across the nation. Not all ambulances are equipped with the medication, and in many states only certain types of EMTs (Paramedics, or EMT-Intermediates) are authorized to administer the medication in the field. When calling 911, then, it is crucial to communicate to the operator that an allergic reaction is occurring. Epinephrine availability from EMTs takes on greater urgency when considering that many of the victims were not in possession of their prescribed epinephrine at the time of the reaction. In fact, in only two of the 29 fatalities was epinephrine administered in a timely manner, i.e., within minutes. In most of the fatal events, epinephrine was either not administered at all (45%, n = 13), or was administered late (24%, n = 7). Call 911 immediately in the event of an allergic reaction Upon suspicion that a customer (or staff member) is experiencing a foodallergic reaction, it is imperative to call 911 immediately and clearly communicate the allergic reaction to the operator. This will help ensure that appropriate emergency personnel respond to the scene. Beware of cross-contact during food preparation Because trace amounts of an allergen can trigger a life-threatening reaction, kitchen staff needs to learn how to avoid cross-contact between allergenic and non-allergenic ingredients. One fatality resulted from shrimp coming into contact with a man’s chicken entrée. Shared utensils, preparation areas, and cooking oil are commonly the source of contact between allergens and non-allergenic food. CONCLUSIONS All of the fatal food allergy reactions reported in this paper could have been prevented. In some instances, there was clear failure on the part of the allergic individual to take proper precautions. In other instances, there was inappropriate behavior on the part of restaurant personnel. Generally, the behavior involved customers being misinformed about the ingredients of a particular dish. In the remaining instances, the facts surrounding the fatal events were unclear. In most of these cases, efforts to contact family members were unsuccessful, so information about the events could not be appropriately obtained. Certainly, with increased education and training for both restaurant and food service personnel and the allergic individuals themselves, future fatalities can be prevented. Recognize the signs and symptoms of an allergic reaction The signs and symptoms of a reaction include a tingling sensation in the mouth, swelling of the tongue and the throat, difficulty breathing, hives, vomiting, abdominal cramps, diarrhea, drop in blood pressure, and loss of consciousness. Symptoms typically appear within minutes. Pay special attention to peanuts and tree nuts Although there are eight major food allergens, all of which can trigger a lifethreatening reaction, research shows that peanuts and tree nuts cause a significant percentage of deadly reactions. Of the 29 fatalities, peanuts accounted for 19 (66%), and tree nuts 6 (21%) (Fig. 3). The remaining events were triggered by shrimp, fish, and milk. Recognize that epinephrine (adrenaline) is crucial Prompt administration of epinephrine (adrenaline) is crucial to surviving a life-threatening allergic reaction. Epinephrine is generally prescribed as an autoinjector device (EpiPen® or TwinJect®), and it is recommended that allergic individuals carry their prescribed device with them at all times. Sometimes, individuals experiencing a reaction will self-inject or will ask a friend or family member to administer the device. Otherwise, the epinephrine is generally administered by emergency medical personnel. REFERENCES 1. Ahuja, R., and S. H. Sicherer. 2007. Food-allergy management from the perspective of restaurant and food establishment personnel. Ann. Allergy Asthma Immunol. 98:344–348. 2. Bock, S. A., A. Muñoz-Furlong, and H. A. Sampson. 2001. Fatalities due to anaphylactic reactions to foods. J. Allergy Clin. Immunol. 107: 101–103. Periodically train restaurant staff on food allergy issues Understandably, staff training is inconvenient becauses of factors such as turnover, language, scheduling, and avail- 660 FOOD PROTECTION TRENDS | SEPTEMBER 2008

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Food Protection Trends - September 2008

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