Food allergy. Risk prevention, communication and management in restaurants. Widespread illegality, life threatening for allergy sufferers. A study by the University of Düsseldorf, published on 24.4.19 on PLoS ONE, confirms the extreme gravity of the phenomenon. (1) An unacceptable public health risk that the European Commission and the competent authorities culpably continue to overlook.
Food allergy in Europe. Prevalence, ignorance and discomfort
The prevalence of allergy food in Europe is estimated at around 10%. (2) Symptoms can be mild (e.g. hives, nausea, dyspnoea) but also severe and instantaneous, leading to shock anaphylactic with life-threatening outcome. Most allergic reactions are found on a limited group of foods including peanuts, milk, eggs, fish and shellfish, wheat and soy. (3)
Prevention plays a vital role. Since there is currently no cure, those suffering from food allergies must absolutely avoid the ingestion of allergens. To this end, the European legislator introduced in 2003 the duty of specific information on the presence of allergens - even if only in trace amounts, or in derivative form - on food product labels. This duty was extended, in 2011, to all foods offered for sale (including those loose and pre-wrapped) is administered by communities. (4)
Ignorance of the rules in force for 16 years exposes allergic consumers to the serious food safety risks that these rules are supposed to prevent. As a result, avoiding exposure to allergens is particularly difficult in real life. Particularly when patients cannot exercise direct control over the foods they eat. As is the case in food consumption outside the home which represents 50%, on average, for the European population.
The discomfort that collective ignorance and social discrimination cause food allergy sufferers and their parents o 'caregiver'was highlighted in the recent APPEAL scientific study ('Allergy to Peanuts Impacting Emotions and Life'). (5) The research was conducted in 8 European countries with the contribution of national protection associations, including Food Allergy Italia, through a quantitative analysis of 1836 interviews online to as many consumers allergic to peanuts and their families. 39,9% reported a high level of uncertainty and stress of living with the allergy, with frequent or very frequent levels of frustration in 39,8% of cases, less frequent in 28,2%. 77% feel its diversity in negative terms, 43% have been bullied at least once.
Allergens in the restaurant, the study by the University of Düsseldorf
'Food allergy knowledge, attitudes and their determinants among restaurants'. Researchers from the University of Düsseldorf, between August and October 2017, conducted a survey in 15 districts of the German city (approx. 640 thousand inhabitants). 274 restaurants were randomly selected, with no exclusion criteria for type of cuisine (local, international, ethnic), cost levels and service hours. The staff of the premises - 295 individuals of age, mostly full-time workers (66%) with the role of waiter (48%) - were interviewed vis-à-vis. Average age of respondents 37 years, 12 years of work experience in the sector, higher education level (61%).
The level of knowledge on food allergies was assessed by asking participants to write the names of three common food allergens and answer five statements'true False':
1) small quantities of allergens can also be consumed by customers with food allergies (false, 82% correct answers),
2) cooking, frying for example, can prevent food from causing allergies (false, 83% correct answers),
3) an allergic reaction food can cause death (true, 90% aware),
4) cold water should be administered in case of allergic reaction, to dilute the allergen (false, 65% correct answers),
5) remove an allergen from a finished dish, removing dried fruit for example, may be enough to provide a safe meal for allergic customers (false, 82% correct answers).
Only 30% of the respondents managed to indicate 3 food allergens and 41% answered 5 questions correctly 'true False' above. The in-depth cognitive test confirmed the serious deficiencies. Although 94% of respondents share the need for close cooperation of the entire restaurant staff to meet the needs of allergic customers:
- only 67% of respondents consider that they are responsible for allergic reactions from customers in their establishment,
- 41% believe that some food allergies reported by customers are not true,
91% say it is the customers' responsibility to express their food allergy needs
- 19% would prefer not to serve customers with food allergies.
A training course on food allergies was followed by 46% of the interviewed staff. However, it is surprising how it was not possible to associate the level of knowledge with the previous training. Nor has ignorance been associated with a desire for more information on food allergies or how to provide safe meals. In Germany, training for restaurant staff and food workers is mandatory before starting work and must be repeated every two years. However, there are no specific references to allergies.
Conclusions and reflections. It is time to take action on food safety
'Until gaps in knowledge and unsuitable behavior will persist [by managers and staff in restaurants, ed] it is advisable for people with food allergies who eat outside [home] to be aware that knowledge about food allergy among staff can be deficient. Even when the staff seem, or say they are, knowledgeable. It may be useful in this regard to equip patients with strategies that increase the likelihood that their requests will be properly understood and considered. Additionally, patrons with food allergies should be aware that common allergens are not necessarily listed on menus (e.g. allergens were only listed in 28,1% of the restaurants in our study), despite the fact that EU regulations require 'indication of common allergens'. (1)
The authors of the study emphasize that 'every single misconception is a cause for concern among professionals handling food for an allergic client. ' It is unacceptable to expose allergic people to allergens, and it is even more serious not to know how to care for them following allergic reactions. Since delaying medical treatment can irreparably aggravate the crisis.
Food Allergy Italy - through the voice of its president, lawyer Marcia Podestà - shares the concerns expressed by the Düsseldorf researchers. 'Unfortunately, this study is a dramatic snapshot of reality experienced by allergic consumers every day. Not only in Germany and Italy, but also in other countries in Europe, and in the world. People with severe food allergy can develop an allergic reaction on contact with the offending allergen that can lead to anaphylactic shock and even death. Allergic consumers who consume meals away from home must be able to trust in the competence and rigor of the catering staff, to receive precise information about the ingredients contained in the foods offered, in order to decide safely what to order. And it is therefore necessary to equip the operator with the knowledge and skills necessary to manage this type of clientele. The training of all food business operators on allergen management must be mandatory and verified. The restaurateurs and their staff must be sensitized and educated in an adequate way, in order to understand first of all the diffusion and potential seriousness of this pathology. To enable them to sell and serve safe food for the entire population, developing an adequate allergen management strategy. The European Commission and national health authorities should issue specific guidelines for catering, monitor their application and ensure compliance.. '
#DetectiveFood is the bottom-up survey promoted by Food Allergy Italia in collaboration with GIFT (Great Italian Food Trade). We invite all readers to actively participate by following the instructions offered in ours previous article.
Thank you!
Dario Dongo
Footnotes to the story
(1) Adrian Loerbroks, Susanne Julia Tolksdorf, Martin Wagenmann, Helen Smith (2019). 'Food allergy knowledge, attitudes and their determinants among restaurant staff: A cross-sectional study '. PLoS ONE 14 (4): e0214625. https://doi.org/10.1371/journal. pos. 0214625
(2) Sicherer SH, Sampson HA (2018). 'Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. ' J Allergy Clin Immunol. 2018; 141: 41–58. https://doi.org/10.1016/j. jaci.2017.11.003 PMID: 29157945
Nwaru BI, Hickstein L, Panesar SS, Muraro A, Werfel T, Cardona V, et al. (2014). 'The epidemiology of food allergy in Europe: a systematic review and meta-analysis'. Allergy. 2014; 69: 62–75. https://doi.org/10. 1111 / all.12305 PMID: 24205824
(3) The National Academies of Sciences, Engineering, and Medicine, Washington DC, USA (2016). 'The National Academies of Sciences, Engineering, and Medicine. Finding a path to safety in food allergy: assessment of the global burden, causes, prevention, management, and public policy'
(4) See dir. 2003/89 / EC, repealed by the subsequent reg. EU 1169/11. Regarding the responsibilities of operators in the food sector, distribution and restaurateurs, see the articles https://www.greatitalianfoodtrade.it/salute/sicurezza-alimentare-abc-responsabilità-operatori, https://www.greatitalianfoodtrade.it/etichette/le-responsabilità-della-gdo, https://www.greatitalianfoodtrade.it/idee/igiene-nei-ristoranti-l-abc
(5) Montserrat Fernandez Rivas, Helen R. Fisher, Mary Feeney, Frans Timmermans, Lynne Regent, Sabine Schnadt, Marcia Podestà, Angel Sanchez, Pascale Couratier, Betina Hjorth, Fiona Kenna, Ram Patel, Andrea Vereda, Tessa Lush, Katharina Blümchen . (2019). 'APPEAL (Allergy to Peanuts ImPacting Emotions and Life): Pan-European Results on Peanut Allergy Impact on Allergic Individuals, Parents and Caregivers'. The Journal of Allergy and Clinical Immunology, Feb. 2019. https://doi.org/10.1016/j.jaci.2018.12.165
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
