Dining Out with Food Allergies

Introduction
Restaurants and other food establishments play an important role in modern society, providing gathering spaces, community engagement and social connection. When you or a loved one has a food allergy, however, eating outside of the home can cause more stress than enjoyment. Dining out in restaurants and ordering takeout can still be possible for people with food allergies – it just takes a little planning. Here are some tips to make the experience safer and more enjoyable.
 
Be in the Know
Some allergens are more common in certain foods, cuisines and settings. For example, peanut, tree nuts and sesame are common ingredients in certain Asian and Middle Eastern cuisines. They are also common in desserts, bakery items and sauces such as Italian pesto and Mexican mole. Many breads and bakery items contain milk and egg. In seafood restaurants, fish and shellfish may be stored or prepared together, making cross-contact possible. Remember that foods, such as French fries, might be fried in the same oil as seafood.
 
Food allergens may not always be visible, and it is important to ask about the ingredients included in dishes. Simple dishes with clearly identified ingredients are safer choices than dishes with mixed ingredients and complex sauces or seasonings. When foods are processed or pre-made, the ingredient list may not be readily available. In such cases, it is safest to avoid these dishes. Foods that are made to order by the chef and kitchen staff are easier to customize by avoiding the use of certain food allergens from the dish as needed.
 
Some food settings, such as buffets, family-style service, bakeries and ice cream parlors are difficult to navigate safely due to cross-contact of containers, surfaces and utensils. It is best to avoid shared plates and utensils with co-diners. Consider dining at off-peak hours when fewer people are around, and the staff can provide more attention so you can enjoy your experience.  
 
Prepare in Advance
Being prepared in case of an accidental allergic reaction is key. If you or a loved one has a food allergy, remember to carry two epinephrine auto-injectors, or nasal epinephrine, with you at all times along with a copy of your food allergy emergency action plan. This can be as simple as taking a picture of a written allergy action plan provided by your allergist to bring with you when dining out. Make sure your epinephrine devices have not expired. An oral antihistamine, such as cetirizine, can help in the case of a mild allergic reaction, but remember that epinephrine is first-line treatment for an anaphylactic reaction. Bring wipes with you so that you can wipe down table surfaces and highchairs before eating. Just in case, bring safe food with you when possible, to ensure there is a safe alternative.
 
Communicate
Though the general public and the restaurant industry are aware of food allergies, many people underestimate the seriousness of food allergic reactions. It is important to communicate with restaurant staff that even trace amounts of allergens can cause life-threatening reactions. Before you go, check out the restaurant menu in advance, or ask around for restaurant recommendations from others with food allergies. If you are able, consider notifying the restaurant ahead of time of your food allergy and your dining plans. It might help to speak with the manager to plan for your visit and to request appropriate preparations such as thorough cleaning of the table surface and dining area.  
 
Once you arrive at the restaurant, consider providing written instructions about the food allergy for the staff through a “chef card” to reiterate your needs. When traveling abroad, consider having this information translated to the primary language used in the country you are visiting. Ask what ingredients are in your dish and how it is prepared. Ask about shared equipment and utensils during food preparation in the kitchen and notify your co-diners of your food allergy. Remember: it is okay to ask for a new dish if a mistake was made, and it is okay to leave the restaurant if you do not feel they can prepare food safely for you or your loved one.
 
View an example of a “chef card” from Food Allergy Research & Education (FARE).

Legislation  
Retail food establishments in the United States fall under state and local regulations. Laws regarding food allergy labeling vary across cities and states. It is important to note that the 2004 Food Allergen Labeling and Consumer Protection Act (FALCPA) and the 2021 Food Allergy Safety, Treatment, Education, and Research (FASTER) Act, which require that the nine major food allergens appear on labels of prepackaged foods, do not apply universally to unpackaged foods in restaurants.  
 
Certain states and cities may have more restaurant regulations than others. For example, in 2009, Massachusetts became the first state to pass a law related to food allergy awareness in restaurants, which required an approved food allergy poster to be posted in the staff area and for a food protection manager to watch a video about food allergies. Be mindful of regulations in your area and when traveling. With increased food allergy awareness and advocacy, things may change and hopefully help those with food allergies feel more comfortable with dining out.
 
Key Points
Dining out, either in restaurants or by ordering takeout, can be an enjoyable experience with advanced planning. Be knowledgeable about common sources of food allergens and prepare in advance for possible allergic reactions. Communicate with restaurants, staff and co-diners about your food allergies. If it appears there is limited understanding of your food allergy, consider finding another place to eat. With these measures in place, hopefully you can enjoy your allergy-friendly meal!

The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.
 
References
• Carter CA, Pistiner M, Wang J, Sharma HP. Food Allergy in Restaurants Work Group Report. J Allergy Clin Immunol Pract. 2020 Jan;8(1):70-74
• Stankovich GA, Warren CM, Gupta R, Sindher SB, Chinthrajah RS, Nadeau KC. Food allergy risks and dining industry - an assessment and a path forward. Front Allergy. 2023 Mar 29;4:1060932
• https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/food-allergy-stages-handouts
• https://www.foodallergy.org/resources/dining-out
• https://www.foodallergy.org/resources/food-allergy-chef-cards
• https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/food-allergy-anaphylaxis-emergency-care-plan
• https://www.fda.gov/food/fda-food-code/food-code-2022


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