Understanding Deadly Food Allergies – This Post Could Save A Life

Nuts

When I was a sophomore in college, a woman in my class named Katherine Brodsky died because she never imagined that a bowl of chili at a local pub would have peanut butter as a “secret ingredient”. She had the most severe form of food allergy, known as anaphylaxis. Her airway closed, and she died a couple of hours later. Although I didn’t know Katherine personally, her tragedy stuck in my head.

Almost two decades later, I met my wife Sarina, and she has the same type of allergy. Peanuts and every type of tree nut are poison to her. Although we eat out frequently and with pleasure, there is always an element of fear. Will this be a normal meal, or one of those horrible nights we spend at the emergency room? Or, god forbid, worse. In the 5 years, I’ve known her, we’ve had far too many instances where she has ingested nuts at a restaurant or catered event.

Now mind you, we always explain the situation to the waitstaff. We tell them that she has a life-threatening allergy to nuts. We ask about every dish. If we sense any uncertainty on the part of the server, we ask them to double check with the kitchen, and if it still isn’t clear, we’ll change our order or even leave. In spite of all this caution, we’ve had at least 6 cases where we ended up at the hospital. Two cases of a stray peanut in the middle of a bowl of Vietnamese noodles. Something cross-contaminated onto a loaf of bread in a German health-food restaurant. Two cases of sweet-lupine flour (who knew?) in industrial pastry crusts. Pine nuts in a phyllo appetizer at a very high end restaurant that caused us to miss her Step-mom’s 60th birthday party. Most recently, a dish of stewed farro and pine nuts. The nuts weren’t mentioned on the menu, the waitress swore it was a safe dish, and the dark color of the broth made it impossible to see them mixed in the grain.

When this happens, she is pumped full of intravenous epinephrine, benadryl, steroids, and other drugs. An epipen is great as an emergency measure, but we still have to go in for the full treatment. She spends the next few hours puking her guts out, scratching every inch of her skin, shivering and shaking. The next few days are a total loss as her body struggles to recover from the onslaught of poison and antidote.

Having worked in professional kitchens, I understand all too well how these accidents can happen. Restaurants are busy places with competing priorities and many people responsible for the food that ends up in front of the customer. But these excuses aren’t going to mean much if you kill someone.

Besides peanuts and tree nuts, other common dangerous allergies include milk, egg, fish, shellfish, soy and wheat. Of course many people have much less severe reactions to some of the same foods, which is why it is so important to have a dialogue with the customer.

For the purposes of this article, we aren’t talking about the “it gives me gas” allergies (though I don’t mean to minimize how severe that can be, and it can be a precursor to something worse if the allergy escalates) or personal dietary preferences, we are talking about deadly serious stuff. Every restaurant has its own policy on how to deal with food preferences, and we can argue all day about the best way to handle that. But when a customer tells you they have a very serious allergy, there are only two ethical choices you can make. You can serve the customer, making every feasible effort to ensure their food doesn’t contain the allergen. Or you can refuse to serve them. Any other choice puts that customer at grave and undue risk. It also threatens your reputation, finances and insurance, and your ability to sleep at night. Do you really want to risk poisoning your clientele?

Assuming the answer is no, the rest of this article is divided into three sections, for chefs & cooks, front of house, and management / owners. You should read all three sections so that you can understand each other’s responsibilities. This is geared toward folks in the restaurant industry, but home cooks can learn important ideas for when they entertain guests with food allergies.

Although I am passionate about this topic, I’m not an expert and you can’t rely on this article to teach you everything you need to know. For more information, please visit foodallergy.org and see the additional links in the Owner / Manager section below.

Also, please take a moment to pass this information on, by emailing it to friends who work in restaurants, printing it out and tacking it up on the bulletin board, mentioning it on your blog, giving it a Thumbs Up or a digg or tweet or sharing on Facebook. Whatever you do to get the word out is a big help. There is a box with tools to help you do that at the end of the article.

And thanks for listening. The life you save might be my wife’s.

As you read through these guidelines, keep in mind that most mistakes are in two broad categories: communication failures and cross-contamination. If you learn to think in those general terms, you’ll quickly become aware of other risks besides the specific ones I call out below.

Food Allergy Safety for Chefs and Cooks

  1. Be aware when products change. I recently saw an instance where a smart prep cook noticed that a new brand of egg replacer had wheat flour in it and therefore wasn’t safe to use in dishes that were labeled gluten-free on the menu.
  2. Be aware of spills of common allergens in storage areas or during prep. Treat cleanup the same as if it was gasoline.
  3. When handling allergens, all utensils and equipment must be washed thoroughly between uses, including cutting boards. If there are machines or other tools that cooks wash themselves instead of putting them in the dish pit, be sure to do a thorough job.
  4. Wear gloves when handling allergens, then dispose of them immediately. This will greatly reduce the risk of cross-contamination.
  5. Bowls and tongs for tossing salads are a likely place for cross-contamination. When handling an allergy ticket, take the 10 seconds to grab a fresh set.
  6. If you have any allergens on the line, segregate them from other ingredients, preferably in a way that makes it unlikely to drop a stray bit into a normal ingredient. Never use the portioning utensil from an allergen pan in any other food.
  7. Most definitely do not reuse a saute pan that has had an allergen in it.
  8. Where possible, design your recipes so that common allergens are added at the last minute. That makes it much easier to accommodate guests that can’t have them. For example, you might have a butternut squash ravioli in brown butter; rather than adding hazelnuts to the saute, pre-toast them and simply sprinkle them on the final dish.
  9. Design recipes so that allergens are visible and obvious if at all possible. The most dangerous ones are invisible to the diner. See the story about the farro and pine nut dish above.
  10. During prep, follow the recipes; don’t make any substitutions without informing the rest of staff, especially of common allergens.
  11. Segregate allergy tickets and be mindful of them the entire time they are at your station
  12. I know you love to yell at the waitstaff, but if they are asking you a question about allergens in a recipe, or letting you know a table has a serious allergy, stop what you are doing for a second and be sure you give them your undivided attention. Even if you are in the weeds. Whatever you do, don’t make up an answer. If you don’t know, tell them to pass that on to the customer and have them choose a different item.
  13. Make sure that allergy tickets are picked up correctly by the food runners. What good is it if you make one pasta without the nuts if it goes to the wrong table?
  14. If a plate is ever returned to you because of an accidental allergen, make it over from scratch. Absolutely do not just pluck the allergen off and send it back out. The other food on the plate is already contaminated!

Food Allergy Safety for the Front of House

  1. You are on the front line of communication between the customer and the kitchen. Your diligence is critical to that customer’s safety. I can’t promise you this is true for everyone, but when we see that a server is taking the extra steps to be sure our food is safe, the tip is definitely bigger. (The opposite is also true!)
  2. Know the ingredients of menu items and specials in advance, so you are prepared to offer guidance to the customer.
  3. If you offer a bread basket and any of the breads have allergens, it is wise to mention it when you drop it off. “This is our olive-walnut bread”. And if a customer requests you remove a bread containing an allergen, don’t just go remove the offending slices because it may have cross-contaminated already. Give them a fresh portion on a clean plate.
  4. If a customer informs you that they have an allergy:
    • Ask them about the exact substances that cause the problem, and the severity. For example, “Is it all nuts or only some?”, “Are any seeds an issue?”,  “Do you need to avoid packaged foods with the made in a factory that processes nuts labeling?”. “Is this a very serious allergy or an intolerance? I want to be sure I understand so the cooks have the right information.”
    • If they have any questions about menu items, discuss them with the kitchen unless you are 100% sure you know the answer. In fact, even if you are sure, ask anyhow. See the farro and pine-nut story above!
    • Make your manager aware of the allergy so they can pass it on to anyone else that may be involved with the table.
    • Communicate back what you learned from the kitchen, and anything your management might require you to say. Some restaurants have a policy of saying something like “we’ll do our best, and the pancakes don’t have nuts in the ingredients, but of course we can’t guarantee your safety”. Fair enough.
    • Write “Nut Allergy” (or whatever it is) in big bold letters on the ticket, and make sure it is communicated to every station that will handle the order.
    • Double check when you pick up. “No peanuts on that one, right?”
  5. When running food, if there are allergens on the same tray, be sure nothing can cross-contaminate between plates.
  6. When you drop the food, confirm for the customer: “and this is the one with no peanuts, I double-checked with the chef”. This isn’t required for safety, but you have no idea how much you’ll put the customer at ease.
  7. If you ever do have a customer have an allergic reaction, immediately:
    • Get your manager
    • Offer to call 911
    • Apologize sincerely and profusely
    • Never under any circumstance argue with the customer. I’ve seen instances where a waiter, cook, or manager has tried to deny what happened and have a big discussion while my wife’s tongue is rapidly swelling.
    • Get the customer’s phone number so the manager or owner can follow up the next day

Food Allergy Safety for Restaurant Management and Owners

  1. Make sure that menu items specifically call out allergens in the description. Writing “Fettuccine with a basil-pine nut pesto” might save a life.
  2. Be sure your staff is aware of the issues listed above and have them trained by a specialist. Here is information about a new training program, and the Food Allergy Initiative.
  3. Be sure your staff is aware of any specific policies your restaurant has on these issues.
  4. Be sure your staff reports any incidents that do occur. For goodwill and to prevent future incidents, fully investigate what happened and why, then get in touch with the customer to offer an apology. You may also wish to offer them a gift certificate as a gesture that you are taking it seriously, but the most important thing is that phone call. Remember that this customer is very likely to tell others about their experience, so you want to do everything you can to minimize the damage and restore trust.

Thanks again for your attention, and please do pass this article on! (There are sharing tools to your left.)

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Posted by Michael Natkin on Monday, February 2nd, 2009 in Favorites, Miscellany, Theory and Rants.

77 Responses to “Understanding Deadly Food Allergies – This Post Could Save A Life”

  1. February 2, 2009 at 9:58 pm #

    Wow Michael, thank you for writing this up. Very intense stuff.

  2. February 2, 2009 at 11:21 pm #

    I loved your article! Awesome…four thumbs up. Two from me and two from my very allergic grand baby Simone.

  3. February 3, 2009 at 7:46 am #

    Thank you!!!!!!!
    If any of your readers are looking for a greater Seattle area support group, please visit http://www.washingtonfoodallergy.org

  4. February 3, 2009 at 7:49 am #

    Thank you for the helpful tips and for sharing your personal experience.

    I updated our article on Food Allergen Avoidance with a link to your post:
    link to allergycases.org

  5. February 3, 2009 at 8:10 am #

    Excellent article. One of my cousins has a severe nut allery and has come close to dying because of it. It’s scary stuff and the more that can be done to promote awareness the better. Well done.

  6. anita
    February 3, 2009 at 10:40 am #

    “Is this a very serious allergy or an intolerance?”

    I’d be careful with this question. If you communicate anything other than a serious allergy to the kitchen, they may not care.

  7. February 3, 2009 at 12:42 pm #

    This is great. I have a son allergic to peanuts all tree nuts and eggs. It would be so nice to feel more comfortable eating out. We do, but like you said, we have that fear with us always. I have been to a few places recently that really are starting to get it…

  8. February 3, 2009 at 1:04 pm #

    Fantastic article! I don’t myself have any serious allergies, but I’m a waitress, haven’t work much as one but I always try to ask what they use, for instance, I know a lot of Asian cooking use rice or other gluten free flour in the deep fried mix, and when working in an Indian restaurant they didn’t use wheat flour for deep frying or anything else there. Good to know!

    I do have IBS/irritable bowel, so certain things make me worse. The doctor even thought it could be celiacs at first, because I got so much better without wheat. So I know how to read labels! And have read a lot about several food allergies. It’s just ridiculus to give an answer without thinking, or the waiters don’t ask at all. They should be fired! Or forced to drive the person to the hospital, to wait there with them and see the agony. I get enough agony with “just” an irritable bowl. Luckely I know a lot about food and wheat is farly noticable. Only problems are sauces and stuff like that, but that’s not enough to make me really ill if I’m having one of those days.. Just avoid bread with the soup, and I’ll be fine.

    And by the way, you talk about peanuts like they are nuts. Peanuts are in fact a legume (look it up in wiki of you want!), so people with peanut allergy, can usually eat nuts. And the other way around. But some, like your wife, can’t eat legumes nor nuts. So that causes some problems and confusion. It’s a shame to avoid ALL nuts just because you can’t eat peanuts. And to then be scared to death when eating out. Remember that!

  9. February 3, 2009 at 1:28 pm #

    Thanks so much….the life saved might also be my son’s.

    Please consider submitting this post to the Living with Food Allergies Blog Carnival. I guarantee it will be passed around! Here’s the link: link to blogcarnival.com

    Thanks again!

  10. February 3, 2009 at 7:28 pm #

    Thank you so much for educating your readers. I have an allergy to walnuts that has gotten worse with age. I can usually tell within moments if I have eaten a walnut. I have an epipen but I pray that I will never have to use it. As a teacher I am trained in how to use one if I need to on my students. There is nothing scarier than having a reaction. I know that a lot of people miss eating the food that they are allergic to but I don’t miss the reactions one bit!
    Thanks again!

  11. Michael Natkin
    February 3, 2009 at 10:49 pm #

    Hey Anita – as you and I discussed via email, I appreciate your comment and
    I definitely take your point. There is no easy answer here. From my
    perspective, I want everyone’s health issues to be treated with respect, and
    on the other hand I know that it is difficult for most restaurants to
    function if every ticket involves special requests, so it is important to
    prioritize those requests that are very serious or life threatening over
    milder consequences. I think it basically comes down to individual
    conscience and comfort in the discussion you have with your server.

  12. Michael Natkin
    February 3, 2009 at 10:55 pm #

    Thanks Becky… and remember, reactions can get worse as you’ve had more
    exposures. Don’t be afraid to use the epipen – I’ve done it on Sarina and it
    really isn’t that bad. Not nearly as bad as having your throat close down,
    though at least in our case we still have to go to the hospital and do the
    whole IV thing as well.

  13. Michael Natkin
    February 3, 2009 at 11:08 pm #

    Veronica – I appreciate your perspective as a waitrees, and you are absolutely right that tree nut and peanut allergies are different, althoug there is a significant number of people who have both (including my wife). I’ve heard a number like 20% overlap, though I don’t know the scientific explanation.

  14. CVS
    February 4, 2009 at 12:02 am #

    Servers can cut down on cross contamination by washing hands before handling plates for special request tables. I have celiac sprue (gluten intolerance). There is one restaurant where I can order takeout but had contamination problems almost every time I dinned in. My best guess is that since bread baskets were routinely taken to tables by the servers that hands/plates were contaminated by touch.

  15. February 4, 2009 at 3:03 am #

    This is a great article…as always. Sorry to hear of your recent experience.

    For those with such life threatening allergies, a suggestion I have is to carry postcards/3×5 cards with the exact allergens on them to hand to the wait staff to be passed to the kitchen staff with the order for your table. It may also be possible to ask your doctor for a similar size card with the information on it and their signature in order to emphasize the point.

    With the electronic ordering systems in place, this may require a “special” trip to the kitchen, but would also aid in making the point and getting the attention needed to the order.

    Although I know many people who do not want to bring undue attention to themselves and their food allergies, I believe bringing attention to the situation in order to avoid the hasty departure/giving an epi shot etc. is the preferable route.

  16. Wendy
    February 4, 2009 at 4:41 am #

    As someone with many food allergies… I always ask questions before ordering out. It always surprises me how often the restaurant staff ignores what could be a life threatening situation.

  17. Chef Lady
    February 4, 2009 at 8:49 am #

    As a restaurant worker for the past 20 years both FOH and BOH, and someone with a (albeit minor)shellfish allergy, I have to say this is a great article! May I add a couple small points?

    When working as a chef, I have always, always really appreciated a customer detailing any allergy requirements when they make their reservation, if at all possible. The chef is much better able to make accomodations when they know ahead of time, and the customer can be much more secure in the special preparations of the dish if the cooks aren’t in the weeds when they prep for it. Even if a restaurant doesn’t make reservations, calling ahead to let the kitchen know you’re coming makes a world of difference in their ability to make accomodations. We want to make you happy, and keep you safe! Calling ahead helps us help you.

    For chefs: Set aside your egos and willing to make a dish differently. Sometimes a lot differently! If a customer brings in their own pasta and asks you to cook it due to a wheat allergy, for crying out loud don’t cook it the same water! Same goes for their veggies. You have no idea how many times I’ve seen chefs do things like throw veggies for a fish allergy ticket into a steamer previously used for lobster. Silly as it may seem to the cook, it is not silly for the customer.

    Thanks for this! I know that all too many of my peers don’t take allergies seriously unless they suffer from them also.

  18. February 4, 2009 at 2:12 pm #

    This is a great article! Personally I just don’t go out to dinner anymore, it just isn’t worth it to me with a corn allergy. Do you know how many times waiters just treat you like a freak because you ask if something is in the food or ask for them to keep something out? You know that by the end they’re ignoring you and you get sick and have to leave the restaurant without finishing the meal.
    This article is great. Hopefully people in the food industry will take it to heart! Thanks for writing it!

  19. February 4, 2009 at 2:21 pm #

    Great article and I will be passing it around. On another topic, if only people treated alcohol with the same seriousness as they do wheat and nuts. The myth that it cooks off still permeates the business and no one takes my wife’s deathly serious allergy (actual anaphylaxis reaction to alcohol itself, not anything in beer, whine or spirits) to it seriously. We’ve been outright lied to in the past by staff. Always a fun night when that happens.

  20. February 4, 2009 at 4:10 pm #

    Okay that “whine” slip was totally Freudian, I swear. :)

  21. February 5, 2009 at 5:08 pm #

    Thanks for the thoughtful post.

    I’ve had some scary moments with food allergies at restaurants with my family. Asking the right questions is the responsibility of the guest, but knowing the right answer and being aware of the issues is the responsibility of the restaurant.

    I’ve noticed big improvements over the last few years as awareness of the issue has improved.

  22. Michael Natkin
    February 5, 2009 at 10:28 pm #

    Thanks Barbara – you are absolutely right – much better to bring a little extra attention to yourself than to get poisoned! There is a little company that will make cards like this for you in any language as well, if anyone is interested I can try to track down the link.

  23. Michael Natkin
    February 5, 2009 at 10:28 pm #

    That made me laugh!

  24. Michael Natkin
    February 5, 2009 at 10:30 pm #

    Asking the right questions is the responsibility of the guest, but knowing the right answer and being aware of the issues is the responsibility of the restaurant.

    Well said!

  25. February 8, 2009 at 11:38 am #

    Great post! I think the awareness about food allergies is increasing and things are definitely improving.

  26. February 8, 2009 at 3:08 pm #

    I love this post–my daughter has severe tree nut and peanut allergies like your wife does and I frequently worry in restaurants–though we still go to them.

    I like the chef’s suggestion that you mention the allergies when you make the reservation. Great idea! Also, I would suggest letting a manager know about it once you get there and also make sure either you or the manager talk to the chef.

    It may seem like a lot, but once you’ve done it a few times, it seems routine. And it’s a lot better than staying home all of the time or winding up in the ER if you can avoid it!

  27. Michael Natkin
    February 9, 2009 at 6:38 am #

    I completely agree. Don’t be shy about communicating with the staff. Most
    restaurants will be happy to talk with you, and if they aren’t, do you
    really want to be there?

  28. Lisa
    February 9, 2009 at 2:51 pm #

    This is a great article, many thanks for making such clear and careful points. While your article focuses mainly on nut allergies, the guidelines for restaurants need to be kept in mind for other food allergies such as shellfish (my mother’s allergy), and fruits. Having a severe allergy to cherries, it never fails to amaze me how prevalent these damned fruits can be. And since this is a really odd allergy, more often than not I’m given a weird look when I ask whether a particular dish contains cherries.

  29. February 10, 2009 at 12:39 pm #

    Very informative article. As someone who works in the food service industry, I always make it a point to address a guest’s allergies, if any.

    I also always ask market-goers at the Ballard farmers market, where I serve samples. Though our Almond Cardamom salt says it on the label, I am always surprised when someone dives right in, and then says something along the line of “oh, I didn’t know this had nuts in it.” Customers too, have a responsibility to inform others of their allergies.

    Like you already stated, communication is key.

  30. February 12, 2009 at 4:29 pm #

    Michael-so glad your wife is still with us. Sounds like she’s had some scary times. I want to thank you for your thoughtful and thorough article. As a mother of a child with multiple life threatening food allergies, I know how every challenging it can be. And it’s always work to get the non food allergic to see. I hope your article is helpful to the food allergic and non food allergic alike. And thanks for stopping by at Green Peony.

  31. February 21, 2009 at 9:45 am #

    Another place of hidden peanuts is vaccines. They use peanut meal in culture medium and peanut oil in vaccine adjuvants. This is a trade secret and there is no way you can find out which vaccines may be contaminated with peanut protein. This also is the main cause of peanut allergy and why there is an epidemic of peanut allergy among young children who are being heavily vaccinated these days.

  32. Michael Natkin
    February 21, 2009 at 8:34 pm #

    Interesting, I haven’t heard that before. Can you point me at a reference so
    I can learn more about it?

  33. bill
    March 8, 2009 at 7:57 pm #

    Pepole who have food allergies shouldn’t eat out.

  34. George
    April 8, 2009 at 8:57 pm #

    I’ve had very similar experiences, and found the recommended advice to restaurant workers very useful. At the moment I’m 24 hours into a pine nut allergy attack from being poisoned at a Spanish restaurant in Oakland where we discussed the menu and my allergy in detail with the waiter. My wife saw the pine nuts in a meatball dish after I’d taken a bite. We rushed to the hospital and were in the ER before the symptoms were serious. The symptoms struck twice with increasing severity two, and then three hours later, inside the ER. They had refrained from giving me epinephrine at first, because of a fear of endangering my heart. The result: the allergy progressed to a crisis phase with only the benadryl and prednisone treatment. After the second alarming rush of heat, perspiration, and inability to breathe, they did give me the epi, and things subsided. All told I was in the ER for ten hours before being released. Now 24 hours after first contact with the pine nuts, I’m still taking benadyl and still flushed.

    Also, I’m pretty furious at the waiter, who could have included the dish that got me when he listed the dishes containing pine nuts, but did not.

    I’m beginning to understand the wisdom of what Bill wrote above. Eating out is risky business.

    George, 61 in Oakland

  35. Michael Natkin
    April 10, 2009 at 10:19 pm #

    George – Thanks for sharing your story. That must have been a horrible
    experience. I can’t even imagine how much it must have sucked to keep all
    that poison in you without the epinephrine. Glad to hear you came through it
    ok.

    Michael

    Hi Michael Natkin,

  36. Geralyn
    April 30, 2009 at 2:37 pm #

    My advice as someone who has waited tables for 10+ years? Don’t trust the waitstaff. If you have an extremely serious allergy, go straight to the top and make sure that the manager and chef on duty know of your situation.

    An Asian diner I worked at had a string of people that would come in with claims of cilantro, onion, mushroom, and garlic allergies. Is it possible all these people had these allergies? Sure. Is it possible that some of these people had an aversion to these foods and claimed they were allergic for extra security to try and keep them out of their dinner? You betcha. Annoying. Translation: servers hear countless dramatic tales of food woe every day. They aren’t paid to take each one of these as their personal cause. Managers are!

    I saw countless waiters/aspiring actors/college coed fellow employees of mine edit tickets with NO CILANTRO or NO PEANUT at which point the kitchen staff/recent immigrants/college coed back of the house would prepare the dish as per usual and then leave of the cilantro or peanut or whatever that was PART OF THE GARNISH. Never mind the cilantro and peanuts that were cooked into the soup, spring roll, etc.

    Personally, I would never deliver a plate to a guest with the claim that it was ‘allergen free’ despite what I may have been told about it. If I didn’t make it, I’m not going to make any promises about it. Do you wanna know how many times I’ve delivered a steak that I was told was ‘well done’ that was sent back bloody? Same principle.

    In my current position I hear my fellow employees incorrectly describe menu ingredients to their guests EVERY DAY. I’m sure I’ve unintentionally done it myself on occasion, and I consider myself to be very food savvy. BE WARY!

  37. Natalie
    May 17, 2009 at 10:00 pm #

    This is an awesome article! I have a 3 year old son w/ severe food allergies to tree nuts, dairy, soy, eggs, and oats. I have learned to always speak to the manager. I used to feel like that pesky person asking to talk to the manager, but I know it is a matter of life and death for my son and so I don’t care. I carry a card w/ his allergies written out and ask the manager to talk to the chef to see what they recommend. In some of the restaurants (such as Disneyland) the chef will come out and talk to us and give my son options. Then after deciding we talk about cross contamination. Thank God I have had good experiences. And attentive people. I live near Six Flags Magic Mountain and my son loves to eat their French Fries, there is only one restaurant there that has a dedicated fryer for them and the manager there knows us and always makes a fresh batch of fries for him.

    I am going to print this article and distribute it to the managers of the restaurants that I freqently go to! Thanks for writing it!

  38. Michael Natkin
    May 17, 2009 at 10:34 pm #

    Wow Natalie – good for you for taking such good care of your son! I
    know it isn’t always easy to put yourself out there, but as you say,
    when your child’s life is at stake, who cares if someone misjudges you
    for pesky? I really appreciate your willingness to pass this article
    on to restaurants that you frequent, and I hope it helps them to
    understand your situation better and keep their staff up to speed.

  39. Karen
    May 20, 2009 at 10:25 am #

    My sister has some pretty severe food allergies so we printed up business cards that list not only the allergy (wheat for example) but all the ingredients that are made of wheat (monosodium glutamate, graham, durum, etc). That way they wait staff doesn’t have to try and memorize a list of ingredients and doesn’t miscommunicate to the chef. We did this after she told a waiter she was allergic to wheat and he told the kitchen she was allergic to the noodles and she ended up getting really sick from some chicken that was marinated with a wheat product. The cards are small and easy to carry, it clearly communicates the allergies to the kitchen. It is worded in a way that conveys the seriousness of her allergy and also thanks them for accomodating her. We recently started printing the same thing in Spanish on the opposite side since there is a lot of kitchen staff who don’t speak English fluently.

  40. Anne
    June 1, 2009 at 1:14 pm #

    My best friend has celiac disease. While it’s not immediately life-threatening, ingestion of any gluten causes her to go into a rheumatoid arthritis flare. For that reason, she only eats at restaurants which specify they have a gluten-free menu. If more restaurants catered to allergic customers, they’d probably get more business.

  41. melinda
    July 1, 2009 at 2:59 pm #

    Excellent article. My daughter has a severe wheat allergy and an egg allergy, and we hold our breath when she starts to eat at a restaurant. We never 100% trust what is being served, even if we have taken precautions and questioned the heck out of the staff. I always wonder if my husband and I are just really paranoid people, but seeing your article and the many comments from others who feel the same way, I am so comforted. With all the people with food allergies these days, surely restaurant staff will start to become more attuned to meet our needs. Keep up the great work!

  42. Virginia
    January 12, 2010 at 1:26 pm #

    Wow, I am really in awe of how brave people are in eating out, particularly allowing their kids to eat out, when they have severe allergies. It is a normal part of life, and it would be a pity to miss out. Kudos for all the brave souls!

    I just want to throw out one problem that I have run into as a chef. Every restaurant gets at least some product whose processing they can’t vouch for. When I do my absolute best to make sure that allergens are not served to allergy sufferers, that means I won’t be able to use some ingredients. Is the flour we use for the pasta processed in a plant that also does nuts? It isn’t labeled as such, but who really knows? Did a farm worker or delivery guy eat a peanut butter sandwich before he loaded up our order? I get very nervous serving ANYTHING, especially to nut allergen folks, because I can’t guarantee the chain of processioning and distribution.

    Happily in 13 years, I have never had a problem.

  43. Michael Natkin
    January 15, 2010 at 10:28 pm #

    < !DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
    @Virginia – You raise very goods points. I think every eater with severe allergies has to decide for themselves whether they can eat food with the "processed in a facility that also…" type labels. I think the fact that you do your best with the materials you work with in-house is the most important thing, and very commendable.

  44. Kirsten
    January 20, 2010 at 9:25 pm #

    Thanks very much for your article. Several people in my family have wheat allergy — such that they have debilitating “food poisoning” for weeks after eating it because the immune system overreacts. The worst was a fancy restaurant that swore up and down that the chocolate mousse had no wheat at all. The next day, my mom, extremely ill, called the restaurant back and finally tracked down the head chef who admitted the mousse did have flour. Despite the best intentions of waitresses, I think it’s easy sometimes for them (or the chef) to not think of something as being “wheat”.

    What are the best experiences for us? There are so many “hidden” sources of wheat that be difficult for someone else to do an exhaustive search for them (ex. soy sauce, food starch and bran are all usually wheat-based). It’s hard to expect someone else to know how to search food sources if they haven’t dealt with a food allergy. They’ll say the sauce is fine, even if they haven’t looked — because why would there be wheat in barbeque sauce or soy sauce or salad dressing? (Unfortunately, it’s in a large number of processed foods) If a restaurant has the sauce bottles for the dishes we’re considering or a book that lists ingredients for the dishes, we can scan it in a matter of seconds and say, “Perfect!” or “These aren’t safe for us. Can you just make a salad with balsamic vinegar instead, no croutons?” I think it’s a lot less running for the waittress if there’s an updated binder of ingredients for each of the dishes they serve… and also a lot less scary for people who are allergic.

  45. Michael Natkin
    January 22, 2010 at 8:09 pm #

    @Kirsten – Thank you for your note. I understand all too well what you guys go through. I think celiac must be even harder than nut allergies in terms of finding hidden ingredients. I'm glad there are most restaurants that are specifically offering gluten-free options.

  46. Nath
    January 27, 2010 at 1:10 pm #

    Great article! I can relate and I share the same stress every time we go out to eat; my boyfriend is anaphylactic to every kind of tree nuts. I’m always more stressed about it than he is; he is used to the whole ER process by now! I do miss my cashews and nutella but my boyfriend’s life is worth so much more.
    Way too often people are unaware how serious this is and or just don’t care; they don’t want to put the extra effort into assuring the meal is nut-free or even verify if a dish has nuts in it or not. We never really had any problems with the kitchen itself or cross-contamination but rather bad waiters. A few times the waiters didn’t even want to go check with the cook about the frying oil or the salad garnishes and bluntly told us to choose something else that isn’t fried or a salad. I met a waiter who argued with us that pecans are not real nuts and therefore we can eat the dessert that had them. On another occasion we had to rush to the ER because a waiter assured us the dish was nut free but it contained hidden pine nuts in a pesto-type sauce. In his mind pine nuts were not really nuts like peanuts since it came from a pine tree, so he didn’t mention them even after we insisted on being allergic to all and every nuts.
    We had some wonderful waiters too over the years but the bad ones leave a more durable impression. And yes, the tips are much bigger if they make even the smallest efforts. When we notice a waiter makes real efforts we usually take his/her name and ask for that waiter the next time; so the tips keep coming too!

  47. melinda
    January 27, 2010 at 5:48 pm #

    i have a friend with severe food allergies to a number of different things. she has these special cards made up with her picture, the foods she is allergic to, and a note explaining exactly how serious her allergies are. She makes up these cards in, like, 15 different languages and hands them to the waiter at restaurants to give to the chef.

  48. Michael Natkin
    January 27, 2010 at 10:04 pm #

    Thanks for relating your stories… pesto *absolutely* is one of the most common danger items. We’ve had one ER visit and numerous close calls due to
    it.

  49. February 2, 2010 at 4:07 pm #

    link to the-health-gazette.com

    In an earlier post someone mentions ingredients such as peanut oil in vaccines. It is an interesting concept as I wonder why it seems there is almost an epidemic of people now with allergies that are life threatening. The above link has some information for anyone who might want to explore it further. I used two words in my search – peanuts vaccines

  50. Nath
    February 8, 2010 at 3:54 pm #

    Here’s a link I found that is useful if you travel and don’t know the local language very well. You select your allergies in the list and the language you want, then it translates them all for you in a card you can handout when needed.

    link to allerglobal.com

  51. February 25, 2010 at 11:46 am #

    Great post! As a mom of a peanut allergic child – thank you!!!

  52. May 14, 2010 at 12:12 pm #

    Thanks for this informative post. I hope restaurant staff everywhere read and take it to heart.

    One suggestion: include sesame in your future posts on the subject. We found out the hard way that our daughter was severely allergic to all forms of sesame after feeding her tahini at 9 months. The ER staff told us that sesame allergy is on the rise in the U.S. and that it won’t be long before it’s in the top 10.

    Now that she is a toddler who eats and enjoys most everything we give her (though of course we haven’t tried peanuts, nuts, or any other seeds), we’re beginning to navigate the restaurant scene and finding that wait staff sometimes have no idea that sesame is used in oil form and paste form (tahini) as well as in seed form. People aren’t nearly as aware or as careful with sesame as they are with nuts or peanuts, which scares the crap out of me. We made the mistake of eating at a Korean place a couple weeks ago (one of my absolute favorite foods), and after extensive discussions with the owner and the chef, ordered a sushi roll for our daughter. After she was halfway done with it, I noticed sesame seeds embedded in the rice on one of the remaining pieces. I’ve never felt fear like that in my gut. I guess we won’t be eating at Korean restaurants ever again!

    There’s still hope she’ll grow out of it, though a recent skin test came back very, very positive for the allergy still. In the meantime, we will definitely take your and your readers’ advice to be unapologetic in our questioning.

  53. Michael Natkin
    May 14, 2010 at 2:12 pm #

    @Jessica – thanks for sharing your story. I wasn't aware at all about a rise in sesame allergy or even that it was a major allergen, so I appreciate you passing that information on. I sympathize with the difficulty in eating out with your daughter, that can be a huge challenge.

  54. May 17, 2010 at 5:45 pm #

    As some one with a severe allergy to strawberries, you would be surprised to hear how many people look at me like I am nuts when I try to explain that I am really allergic to strawberries. Most people can understand nut allergies but not that you can be allergic to a very common berry. And what is funny is that after you explain that even a tiny bit of it could possible kill me, they go ‘oh so-and-so is allergic to strawberries too but they eat them anyway.’ For me the issue is when desserts are ordered because strawberries are often used as a garnish.

    There is one chain that my whole family can go out to eat and I can safely eat the dessert. The kitchen staff there is always happy to either leave off the sauce or use something else to garnish the plates with. And one new chain restaurant in town was super accommodating. The waitress made a special note on the order and went into the kitchen to make sure that the kitchen knew that it required special attention.

    I think the message is getting through in many places. But I am still very careful. I have a few favorite places where I can safely go out to eat and not have to worry about it.

  55. June 1, 2010 at 1:37 pm #

    Hi Michael,

    Great article! I have a family member with a severe nut allergy too. While we have learned to work around his allergy and live a normal life, traveling continues to be a nightmare. We travel a lot to visit family and the feeling of helplessness when you are trapped on a plane over a vast ocean is overwhelming. Regarding restaurants, Ming Tsai has done some great work educating restaurant staff in Massachusetts.

  56. Michael Natkin
    June 1, 2010 at 1:40 pm #

    Yes indeed, Ming Tsai is a hero to anyone with a food allergy, whether they know it or not!



    Hi Michael Natkin,
    Veggie (info@veggiesvillage.com) has left you a comment:

    Hi Michael,

    Great article! I have a family member with a severe nut allergy too. While we have learned to work around his allergy and live a normal life, traveling continues to be a nightmare. We travel a lot to visit family and the feeling of helplessness when you are trapped on a plane over a vast ocean is overwhelming. Regarding restaurants, Ming Tsai has done some great work educating restaurant staff in Massachusetts.



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  57. June 12, 2010 at 11:30 pm #

    I have a non-life threatening allergy to corn and I can’t imagine eating out. I don’t even buy processed foods because of the hidden allergens and cross-contamination issues. Trying to avoid a miserable reaction (ingesting corn does not result in anaphylaxis but it does make me extremely miserable for days) requires diligence and control of my surroundings. I can’t imagine how anyone with a life-threatening food allergy could work up the nerve to eat out. There are so many possibilities for cross-contamination and the allergic have zero control in a restaurant situation, it seems a little too much like playing Russian roulette to me. I would like to be able to go to restaurants or buy something quick and easy for dinner occasionally, but I don’t think I could ever want it enough to risk my life for it.

  58. Michael Natkin
    June 15, 2010 at 10:19 am #

    I can only imagine how hard a corn allergy must be. The Omnivore's Dilemma really opened my eyes to how corn is in everything.

  59. Elise
    July 25, 2010 at 8:53 am #

    My 7 year old son has life-threatening peanut and tree nut allergy along with asthma and our family eats out often with him. We pick high end restaurants where the chef uses fresh ingredients and it’s easier for the chef to prepare a safe meal for my son. We also never order desserts at any restaurants. We will also stay away from the salads too if we see they have a salad on the menu that contains nuts. We would never eat at an Asian restaurant because the risk of cross-contamination is too high. We have a restaurant card that we always give the chef and we when we make a reservation we always let them know about his allergy.
    My son always orders meals off the adult menu too because he loves fine foods! The chef’s generally enjoy cooking for him because he loves their food! We always tip a minimum of 20% and are repeat customers to great restaurants.

  60. Michael Natkin
    July 27, 2010 at 9:14 am #

    Thanks for the note, Elise! Sounds like you have developed a very sensible approach to eating out with your son that still let's you enjoy good restaurants.

  61. August 7, 2010 at 12:16 pm #

    Wow, this is more thorough than I could have ever hoped to convey the message. It’s well-written, and ought to be required reading for anyone who works in a restaurant, cafe, deli, road-side-stand, or even a snack bar.

    About the tip thing… I tell you, it’s true. Ha ha ha. I spend a ridiculous amount of time trying to find “safe” restaurants and form that safe menu items. I barely make enough to pay my bills… but when I go out to eat, have a good time, and don’t die… I tip like a madman. Especially if I have to ask the server about any allergens and then talk to a manager or cook from there. It’s a certain level of embarrassing/awkward to bring up… even if it shouldn’t be. Anything that you do as a server to make it less awkward is REALLY appreciated, and I try to convey that in the gratuity.

  62. August 7, 2010 at 12:22 pm #

    Re:”…’oh so-and-so is allergic to strawberries too but they eat them anyway.'”

    I HATE that! Ha ha ha. It’s so frustrating because of the so many levels of “allergic” and the “intolerant” people usurping “allergic” as a synonym… it waters down the seriousness. I often use the phrase “deathly allergic” but get looked at like I’m being over-dramatic.

  63. Michael Natkin
    August 7, 2010 at 1:24 pm #

    Yes. When we are explaining my wife’s nut allergies to a server we’ll say “very serious nut allergy, like epipen, straight to the emergency room”. Which is completely true, and gets their attention. The hardest cases are where there is a language barrier.

  64. February 15, 2011 at 1:19 pm #

    I’m really glad to see someone write about this. I think that too frequently people overlook food allergies. My little brother, like your wife, is deathly allergic to all tree nuts, shellfish, cats, dogs etc. We have to be super careful eating out and too many times there has been an unknowledgeable wait staff and I’m usually the one to notice something is a little off about his food.. (He’s 10 years younger than me, and for whatever reason I’ve become the ultra paranoid big sister!)

  65. Jared
    September 22, 2011 at 8:25 pm #

    Getting emotional reading this. My wife had very severea allergies to peanuts and tree nuts (almonds are her worst). We live in a foreign country and it’s frustrating because the locals just don’t understand allergies.

  66. Jared
    September 22, 2011 at 8:26 pm #

    oops, sorry, I meant to write “has” severe allergies.

  67. falconoverlord@hotmail.com
    October 8, 2011 at 1:07 pm #

    I really appreciated the article. I see this from the viewpoint of the kitchen and I know how difficult/impossible it can be to guarantee a safe dish.
    For that reason, at least in the middle-class establishment I work for, I think we should absolutely refuse to serve patrons with severe food allergies. To do otherwise is simply irresponsible.
    For those fine establishments that can strive to provide an allergen-free dish, the suggestions of this article are excellent.

  68. Stephanie
    January 16, 2012 at 1:17 pm #

    I was glad to read this article but did find it a little frustrating as someone with a severe allergy, who has worked in food service for many years. As a waiter I am never willing to tell a customer that I am 100% sure their food does not contain an allergen. As a customer I realize I am risking my health every time I eat in a restaurant that serves the food I am allergic to (mussels). Heck, I risked my health every day I went to work at a restaurant that serves them.

    I have had customers who claimed to have an “allergy,” but when they learned that meant that we would not only leave off the offending item but also be unable to serve them the sauce they wanted, the allergy mysteriously dissappeared. I have also had customers who, when they learned I could not 100% guarantee that their food was safe, refused to accept that answer and also refused to leave. I am going to do everything in my power to make sure your food is safe – but as an above poster said, I didn’t harvest the food myself so I dont really know for sure. Take the risk or eat at home! At least I’m not lying to you.

    • January 16, 2012 at 1:28 pm #

      I agree with you completely. No restaurant can ever make a 100% guarantee that any given allergen isn’t present; even if they don’t buy any product with a given allergen, cross contamination is always a possibility however remote. So you are quite right to tell a customer “the kitchen is aware of your allergy, and we use good food handling practices, but of course we can’t absolutely guarantee it.”

  69. March 27, 2012 at 5:56 am #

    We have nut allergic nieces on both sides of our family and know how important your comments are.

    While I get very sick for a few days if I’m “glutened” because of kitchen mistakes; it’s nothing compared to deadly food allergies.

    I wish this could be forwarded to every restaurant and read by every old new employee.

  70. August 2, 2012 at 4:44 am #

    Thanks for the information here.

    I had anaphylaxis last November, due to ant bite. About a month after that I started to have hives every evening. Then I discovered I am allergic to meat, especially chicken and beef. Even a sunny-side-up fried with oil that was previously used to fry chicken also triggered hives in me.

    I am very careful with what I eat nowadays. Whenver possible I would go to vegetarian restaurant. If I am at a non vegetarian I would inquire carefully. If I have doubt, I’d rather go hungry than to have hives outbreak.

  71. Saul clamen
    November 18, 2012 at 11:45 am #

    I would like to commend you on the services you do for your community .You are more than just a chef you are a mensch

  72. Mary Beth Flynn
    December 25, 2012 at 3:04 am #

    Last night, Christmas Eve, i attended a party at my aster,s with my two kids,,,Kathryn being the one who has a severe nut allergy. first o noticed two salads with nuts and then on the dessert table , as i was passing by, i heard the word, peanut butter cookies” and i froze. I approached my sister who said…” I am not having two separate tables at Katie is 13 and should know better.
    But someone could have told me, quietly , as her mom, these are the dishes to avoid, let me show upi, instead she said if you do not like the set up,,,then do not eat at my table .,w
    Your daughter, who is in 8th grade, can handle it and figure it. My very own sister…..hlp

  73. Mary
    March 17, 2013 at 9:57 am #

    Another allergy less known, but just as deadly, is a tick-borne allergy to anything mammal. This allergy is caused by the the bite of a seed or deer tick. Several years ago, I woke up during the night scratching all over from the bites of almost microscopic seed ticks. In appearance, they resemble chiggers, but they are black instead of red. Over the course of several months, the titer levels in my body increased resulting in an anaphylactic response about three hours after eating catered food at a banquet. It took quite a few months of tracking everything I ate and several anaphylactic episodes with accompanying trips to the emergency room to narrow down the culprit as anything with four legs and fur. I traveled to the University of VA for further testing and to participate in a mammalian allergy study where my suspicions as to the cause of the reaction were confirmed. Basically what happens is that if I ingest meat, it takes about three hours to go through the digestive process. After this amount of time, all that is left is a sugar chain called alpha-gal. Alpha-gal so closely resembles the tick venom in chemical make-up that my body goes into anaphylactic shock. Eating at restaurants can be very tricky, especially since so many people are unfamiliar with this allergy. Interestingly, I can eat milk products, but cheese is an issue if it is made with animal rennet. So just because a restaurant may say a dish is vegetarian, the cheese can still be a culprit. Sometimes, my biggest challenge has been convincing restaurants to prepare my fish on a separate griddle from other meats. At home we primarily eat a vegan diet now, but as there are few vegan options at most restaurants in my hometown, I am very limited in the restaurant options in our hometown.

  74. Cw
    February 18, 2014 at 5:36 pm #

    Yo man, this is on point! Yeah allergies can take u out. Be safe!

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    […] be to go and read a very sobering post written by Michael at Herbivoracious (and which you can read here) on understanding potentially deadly food allergies, such as those that some people have to nuts. […]

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