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Characteristics of food allergic reactions in United States restaurants

Published online: April 1, 2021

Many food allergic individuals and their families are wary of dining out due to the risk for an allergic reaction. The risk for reactions while dining out is real, since restaurant staff are not mandated to be trained on food allergic issues, and allergen labeling on menus remains optional. To date, there is limited data regarding allergic reactions and effective strategies for reducing risk of allergic reactions in restaurants.

A recent study published by Oriel et al in The Journal of Allergy and Clinical Immunology: In Practice revealed characteristics of food allergic reactions in restaurants. The authors analyzed self-/parental-reported data collected from the Food Allergy Research & Education’s (FARE) Patient Registry over a 2-year period, from September 2017 to September 2019.

The authors found that dining out was a common location for allergic reactions to food in children (13%) and adults (31%), second only to one’s home (51% in children, 35% in adults). Cafes, fast food, Asian restaurants, and ice cream parlors were the most often cited places where these reactions occurred. Peanuts, tree nuts, and milk were the most common culprits, with tree nuts being the most common cause for epinephrine use while dining out. Other noteworthy findings include: more than 1 out of 4 reactions resulted in epinephrine use, 28% of allergic reactions required 1 dose of epinephrine and 6.2% required 2 doses of epinephrine. While fewer allergic reactions were noted when food allergic individuals chose restaurants that declare allergenic ingredients on their menu (27%) when compared to informing restaurant staff of their allergy (54%), allergic reactions still occurred despite best efforts by the food allergic individual. Fewest reactions occurred when both mitigation strategies were used (14%), which suggests that doing both is more effective at preventing allergic reactions.

Allergic reactions in restaurants are common and can be severe despite prevention strategies used by the food allergic individual. Results from the study help advance knowledge on allergic reactions while dining out. This in turn can help prevent allergic reactions in restaurants by: 1) providing healthcare professionals a framework for how to counsel patients and their families, 2) advancing advocacy efforts for mandatory declaration of allergenic ingredients on menus, and 3) highlighting the need for restaurant staff training on food allergic issues.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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