Food allergy sufferers negotiate the minefields of dining out


Chestnut Doughnut Holes photographed in Washington, DC. Tableware from Crate and Barrel. (Deb Lindsey/DEB LINDSEY/FOR THE WASHINGTON POST)
November 8, 2011

An almost imperceptible reaction flickered across the waiter’s face when I broke the news: “I have a dairy allergy.” He seemed annoyed. I winced. But then he smiled and assured me, “Once I put the words ‘Dairy Allergy’ on this ticket, the whole kitchen will know, and no dairy will touch your order.”

Relief. “They get it!” I thought. And they should. After all, Massachusetts, where I live, is the first (and only) state to mandate allergen training for restaurants.

Then the fish tacos arrived at my table — drizzled with a sour cream sauce.

And so it goes. I once disclosed my allergy in a restaurant only to be told I should avoid a certain dish because it contained mayonnaise — and therefore eggs. (It’s a surprisingly common mistake, but when this server pressed the case, I finally asked, “What part of a cow does an egg come from?”) At a trendy burger joint, I asked whether a boutique hot dog contained dairy. The server’s response: “It’s all natural.” At a seafood place, I was told the calamari is probably okay because “it’s only a little buttermilk in the brine before it’s fried.”

Like a tightrope walker with a sudden case of vertigo, a food writer with newly acquired allergies faces a struggle. The girl who wanted to eat it all cannot. No more Tete de Moine, served with its own little rotary slicer, pulling ruffles of perfectly creamy cheese onto the plate. No more Greek-style yogurt, homemade each week with milk from a local dairy where you can see the calves being born in the nursing barn. No more of their ice cream, which I used to say was to die for, but not anymore.

I’m one of the estimated 12 million people in the United States who have food allergies — that’s one in 25, a number that the Centers for Disease Control and Prevention says is growing — and I can say from personal experience: We. Are. Misunderstood.

It’s not in my head. I’m not just a “picky eater.” I’m not lying about my allergy to disguise a simple dietary preference or, worse, an eating disorder. Everyone who has ever waited tables knows the diner who makes requests like, “Can you ask the chef to make this dish, but without onions?” “Can you tell the chef I want this, but prepared like that?” “Can you tell me which dish can be made gluten-free? My sister read an article once that said you could lose weight by eating gluten-free.”

I don’t want to draw attention to myself in a restaurant, but allergies are immune responses that I’m still learning to manage. And I am resolved: I will not let food become my enemy. I will not stop dining out.

I’m allergic to more than dairy, as it turns out. My most severe response — anaphylaxis, a life-threatening full-body reaction to an allergen — happens after I eat hazelnuts (formerly my favorite nut) but is prevented if I’m quick enough to inject myself with epinephrine. For me and others with allergies, dining out can obviously be fraught with anxiety. Will the kitchen really get my order straight? Will I have hives tonight? Eczema tomorrow? Or worse? Did I bring my EpiPen?

More than 200,000 people visit emergency rooms in the United States each year because of food allergy reactions, according to the Journal of Allergy & Clinical Immunology. Other research estimates that 200 to 500 people in this country die from food allergies every year, and that close to half of fatal food allergy reactions are triggered by something served by a restaurant or other food-service establishment. That number might be low, according to the Food Allergy & Anaphylaxis Network, because anaphylaxis codes are new and hospitals are still acclimating to the coding requirements. The network’s position: One death is too many.

Meanwhile, some restaurants don’t seem to understand that one uninformed line cook can kill a guest.

In a survey of restaurant personnel by the Mount Sinai School of Medicine’s Jaffe Food Allergy Institute in 2007, 90 percent of respondents said they were confident their restaurant could safely serve a patron who has food allergies. But one in four thought people with food allergies could safely eat a small amount of the trigger food (wrong); more than one in three believed that frying it could make it safe (wrong); and about one in four thought removing the allergen from a finished dish — like picking nuts off a salad before serving it — could make it safe (wrong).

Chef Ming Tsai, host of public television’s “Simply Ming,” has become a national spokesman for the Food Allergy & Anaphylaxis Network and helped spearhead passage of Massachusetts legislation mandating food allergy training for restaurants. Tsai, whose son, David, grew up with food allergies, puts it bluntly: “Molecules can kill,” he says.

To prove his point, Tsai sometimes asks cooks whether they would wash down their kitchen with a raw chicken. “The cross-contamination issue can be tough to convey,” he says, “but once they get it, they’re on board.”

Tsai’s experience with his own family still stings. He remembers entering a deli once and being told by the owner, in front of his kids, “We don’t want to serve you.” They were turned away because he’d told the proprietor that David, then 4, had severe food allergies. David reacted to seven of the eight major allergens, so dining out became virtually impossible. (Now 13, he no longer suffers from allergies.)

“So much important socialization goes on in restaurants,” Tsai says. “Kids learn how to act, how to eat out. I’ve had mothers crying with relief, telling me they’ve never felt they could take their 10-year-old or 14-year-old out to eat safely.”

He knows that being treated well can mean the world to customers. In 13 years of serving diners at Blue Ginger, his restaurant in Wellesley, west of Boston, he has become a leader in safe service. “It’s a bonus for me that we are building customer loyalty by giving these families the opportunity to enjoy the simple pleasure of a meal out together,” he says.

Blue Ginger has always used what he calls “the bible,” a breakdown of every recipe into every component, with check boxes for the eight major allergens — milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat — to help flag potential problems for servers and cooks.

With the incidence of allergies on the rise, you’d think more restaurants would be following the lead of Tsai and Massachusetts. But the National Restaurant Association has no data about how many of its members might be training staffers or how many have availed themselves of the training and resources available on its Web site.

At the local level, New York City has approved a proposal to require a food-allergies poster in restaurants. The City Council of St. Paul has approved a similar measure, and the University of Minnesota Extension is offering a new one-hour online course that teaches food handlers — whether they work in schools, restaurants or grocery stores — facts about food allergies and how to protect customers. The Food Allergy & Anaphylaxis Network points to New Hampshire and Hawaii as two states that have introduced, but not yet passed, legislation nearly identical to that in Massachusetts.

This is new territory for diners and restaurants alike. To me and others with food allergies, it seems obvious that we must be clear about our needs. And given the increasing frequency of food allergies, restaurants would be wise to arm themselves with information, training and a systematic approach.

Jose Andres’s restaurants in the District, including Oyamel and Jaleo, also break down every menu item by ingredient, says chef Joe Raffa, director of culinary operations for Andres’s ThinkFoodGroup. To instill confidence among diners, each restaurant has a separate menu for those who react to each of the eight major allergens. And once an allergy sufferer orders, their meal is required to be handled only by a manager or server, not a food runner who might mix up dishes. “You can’t mess around with somebody’s well-being,” Raffa says.

Even the best intentions can fall short, though. A barbecue joint recently served me pulled pork on a baked potato after we discussed my allergies and decided I should avoid their buns, which contain dairy. Even so, I ended up with a mad case of hives. I’m not sure what happened, but it might have been cross-contamination: Someone might have shredded the pork on a surface where they had earlier sliced cheese, for example.

I operate on the “if it were me, I’d want to know” theory, so I told the owner what had happened. He was grateful and told me that his own family had ended up in an emergency room more than once because of his brother’s food allergies.

In the case of the restaurant that served me the sour-cream-drizzled tacos, when I complained, the server immediately replaced the dish. Later, when I got back in touch to offer feedback, the place invited me back for a complete do-over. That time, there wasn’t a molecule of dairy to be found: just good food, a healthy dose of customer loyalty and, hopefully, a lesson learned.

RECIPES:

Buckwheat Tabbouleh

Chestnut Doughnut Holes

Turkey and Cranberry Meatloaf

Church is a Boston-based writer and photographer. She can be reached through her Web site, www.jacquelinechurch.com.

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