British study reveals “worrying gaps” in restaurant staff knowledge of food allergies

A recent study published in the British journal Clinical & Experimental Allergy generated a good deal of buzz in the online food-allergy community and even in the more general press. (Bailey, Albardian, Frew, and Smith, “Restaurant staff’s knowledge of anaphylaxis and dietary care of people with allergies”) Headlines asked if it was safe to dine out with food allergies and warned that consumers must be wary of unprepared staff.

Given that many restaurants have been rated as food allergy-friendly by you, the food-allergic and intolerant dining community, on AllergyEats (www.allergyeats.com), I felt that a personal review of the study would be informative and valuable to share.

(One point to note from the outset is that this was a small study, which surveyed only 90 restaurant personnel. Thus, I wouldn’t call it ‘definitive’ by any means. Nonetheless, as I think you’ll see, the study was still large enough to give us much to think about.)

And much of what we need to think about is truly quite concerning!

First, an important fact. According to the study, those surveyed were almost universally aware of food allergies – only one waiter was unaware. In fact, 43% “had a personal friend or acquaintance with a food allergy.” The conclusion I drew when I read this was that the results may be somewhat biased in favor of food allergy-friendliness.

If that was in fact the case, you wouldn’t know it by looking at the data.

Respondents (of which chefs/managers/owners were 78% and wait staff only 22%) were given 5 statements for which they had to respond ‘true’ or ‘false.’ They were as follows:

v Customers with food allergies can safely consume a small amount of that food

• Answer: False
  • 23% answered this incorrectly

v Cooking, for example frying, can stop food from causing allergies

• Answer: False
  • Thankfully, only 16% answered this incorrectly (though chefs were the WORST, at 20%)

v A food allergy reaction can cause death

• Answer: True
  • Again, thankfully, only 12% answered this incorrectly (though this is obviously serious enough that anything greater than 0% is concerning)

v If a customer is having an allergic reaction they should be served cold water to dilute the allergen

• Answer: False
  • 38% answered this incorrectly!

v Removing an allergen from a finished meal, e.g. removing the nuts, may be all that is necessary to provide a safe meal for a food allergy customer

• Answer: False
  • 21% answered this incorrectly; worse, this number was 30% amongst wait staff!

Clearly, these answers raise red flags on their own. However, consider the following as well:

v 33% of respondents claim to have received food allergy training (even though only 3% went through a specific course) – 16% received formal or informal in-house training

• The biggest concern here is that 1/3 of the respondents answered these questions with the belief that they have been properly prepared

v Only 64% were able to recognize two features of an anaphylactic emergency

v 87% were aware that anaphylaxis warranted urgent medical attention – a high number, but clearly too low given the potential consequences

By this point of the study, I was somewhat disappointed, though not entirely shocked, at the results (personal restaurant experiences tempered my surprise). However, I was about to become quite intrigued and mildly disturbed by some of what I read next.

v “Respondents who had participated in training did not demonstrate any greater knowledge on objective testing except in one aspect; they had greater understanding that a customer experiencing a food allergy reaction needs urgent medical attention.”

v “Those who performed most poorly in the knowledge questions, those who were most uncomfortable in serving food allergy customers and those working in restaurants where potential allergens were not separated from other foods [68%], were no more likely to identify future food allergy training as desirable than those who performed better and were more comfortable about serving customers with food allergies. This suggests that the respondents who pose the most risk to food-allergic customers may not perceive their own learning needs.”

• The study authors rightly conclude that this fact is the key reason that “learning [about food allergies] cannot continue to be an optional activity.” “All restaurant staff need to receive food allergy training as the strength of the chain is only as great as its weakest link.”
• “Until this [mandatory and appropriate food allergy training] occurs, food-allergic customers will not be able to dine out in safety and will continue to be put at risk by restaurant staff’s poor knowledge, inappropriate confidence and low desire for further training.”

But my choice for “winner” of the “most alarming fact award” was the following…

v “There was no association between the respondents’ knowledge and their comfort level in providing a safe meal to food-allergic customers.”

• …basically suggesting that a confident staff member is not necessarily a knowledgeable one!

94% of respondents stated they “were comfortable serving food-allergic customers.” 65% were “very comfortable.” These numbers combined with the above statement seem to be a very dangerous cocktail. The report stated it best: “Staff with high comfort and low knowledge are potentially dangerous, as they may convey an exaggerated sense of competence to their customers, giving them false reassurance.”

We, as food-allergic individuals or parents, learn dining tips very quickly if we want to continue to enjoy the pleasures of eating out. We learn to check menus, ask about ingredients, and inquire about restaurant protocols. We also learn that a key factor is gauging the level of confidence of the restaurant staff. What this study tells us is that this last critical component can be misleading!

So, should we cease dining out until there’s mandatory training? Are the risks too high? If I thought the answers to these were ‘yes,’ I wouldn’t be running AllergyEats.

What I see as the true teachings of this study are to reinforce the fact that food-allergic individuals should always have their epinephrine with them whenever consuming food away from home, consider speaking to more than one staff member during each restaurant visit (maybe waiter and manager, or chef), and be diligent in learning all they can about the restaurant in advance.

AllergyEats was formed to help address the fundamental question that remains after reading this study: How can a food-allergic individual dine out more comfortably? While the site includes links to important restaurant information such as menus (including gluten-free), allergen lists, certifications, and more, there is no replacement for the peer-based restaurant ratings that only AllergyEats has. These are the ratings of real-world diners sharing their real-world experiences. These ratings do not negate the need to take other precautions when dining out, but they do help objectively convey the ability of a restaurant to handle food-allergic diners, despite what staff may say on their website, on the phone, or face-to-face.

With this all in mind, I strongly encourage you to go to AllergyEats (www.allergyeats.com) and rate any recent restaurant experiences you have had. Each new rating makes AllergyEats an even more valuable tool for our community. Further, we have made the rating process easy. Just answer 3 multiple choice questions, add additional comments if you wish, and click ‘submit.’ It can take less than 1 minute to join our ever-growing community of restaurant raters making dining out a little more comfortable for all of us.

And of course, we want to hear your thoughts on this study and blog post. Do I seem overconcened? Underconcerned? Are you surprised or not? Should training be mandatory? Are you more concerned now about dining out? Please share your thoughts by clicking on Comments or Reply below.