1. + Experiences of Consumers with Food Allergies Module 5

2. + Module Content  General feelings and perceptions about dining out  Reported behaviors when dining out  Past dining experiences reported by adults and children with food allergies  Past experiences of food allergy reactions  Consumer expectations from foodservice establishments

3. + General feelings and perceptions about dining out Customers with food allergies and parents of children with food allergies often: Feel a strong sense of personal responsibility about being safe when dining out Experience anxiety and/or fear when eating outside the home, especially when going somewhere for the first time, due to complications of identifying and explaining allergens Feel like others don’t understand what they have to deal with or go through to avoid allergens

4. + General feelings and perceptions about dining out Perceived causes of allergic reactions when eating out: Cross-contact Hidden ingredients Poor communication between “front of house” and “back of house” Inconsistent and insufficient product labeling Unknown change of ingredients and/or supplier Allergen-free dish switched with the unmodified version of that dish Staff member told them a dish or item was allergen-free when it really wasn’t (staff member was not thorough or made a mistake when considering ingredients and preparation)

5. + General feelings and perceptions about dining out Perceived barriers for establishments to provide allergen- free food Lack of employee training, knowledge, and awareness Inconsistency from location to location for franchises and other restaurants with multiple locations Frequent changes of product

6. + General feelings and perceptions about dining out Perceived risks of food allergy reactions and characteristics of food service facilities High risk Ethnic restaurants, due to potential hidden food allergens in sauces Buffets, due to potential cross-contact Specialty restaurants with complicated food ingredients Up-scale restaurants, due to ever changing chef recipes Small establishments (e.g., ice cream shops, snack shops), due to the common use of nuts and potential cross-contact National chain franchise restaurants, due to the minimal training level of employees

7. + General feelings and perceptions about dining out Perceived risks of food allergy reactions and characteristics of food service facilities Low risk National chain franchise restaurants, as preparation is simple and allergenic ingredients are handled separately (i.e., in pre- portioned packages) Establishments where food is prepared from scratch, as they avoid pre-prepared food, which has a high risk of cross-contact Overall clean establishments Establishments with allergy-friendly practices (e.g., specific policies, rules, and food allergy training) Establishments where staff shows concern about ensuring the safety of customers with food allergies and accommodating special requests

8. + Reported behaviors when dining out Consumers with food allergies choose places that have the following qualities: Have been safe in the past Do not have an individual’s allergen on the menu Accommodate special orders or requests Provide allergen information, especially online Have knowledgeable staff in terms of food allergens on the menu Have a good reputation among the allergy community

9. + Reported behaviors when dining out Before going out to eat, consumers with food allergies do the following: Call the restaurant ahead of time Check online menus, ingredients, and allergen information when available Seek food allergy-related information through extensive investigation Take advice from members of the food allergy community, such as Food Allergy Moms (http://allergymoms.com/index.php) and AllergyEats (http://www.allergyeats.com/) Parents of food-allergic children often bring “back-up food” for situations when doing so is easier than explaining needs or when they feel a service cannot provide safe food for their child

10. + Reported behaviors when dining out When ordering food, do the following: Try to keep orders simple Notify the server and/or manager of allergens and avoid embarrassment or unwanted attention

11. + Past dining experiences of individuals with food allergies Positive Experiences Pleasant experiences due to accommodating/cooperative staff when special requests were made Staff exhibits a good attitude, understanding, and/or empathy when it came to meeting their needs

12. + Past dining experiences of individuals with food allergies Negative Experiences Frustration when staff exhibited a lack of understanding and empathy regarding needs Staff appeared frustrated when a special request was made. Staff did not attempt to accommodate consumers’ needs. Staff did not take consumers’ requests seriously. The server or other staff members did not believe food allergies to exist or did not think reactions would be severe. The consumer had an allergic reaction (requiring antihistamine, epinephrine, and/or a hospital visit/emergency medical attention) to the food served.

13. + Past dining experiences of individuals with food allergies Reported consequences of children’s food allergy reactions: Child reactions Become upset and terrified during the reaction Feel shaky, panicky, and agitated for several days after the incident Limited what they ate after the incident

14. + Past dining experiences of individuals with food allergies Reported consequences of children’s food allergy reactions: Parental reactions Frustration Anxiety Frightened for child’s life (during the reaction) Anger/infuriation Helplessness Sad because of child’s experience Recognized the need to educate others Decided to homeschool children if food allergic reactions occurred at school

15. + Past experiences with food allergy reactions Establishment response to food allergic reactions Negative Staff immediately or continually denied their fault Apologies seemed insincere Staff appeared unsympathetic Staff did not grasp the severity of what had happened Customers were charged for a meal even though the meal was not completed Staff was impatient, not knowledgeable about food ingredients, and did not know where to locate allergen information, etc. Negative Staff immediately or continually denied their fault Apologies seemed insincere Staff appeared unsympathetic Staff did not grasp the severity of what had happened Customers were charged for a meal even though the meal was not completed Staff was impatient, not knowledgeable about food ingredients, and did not know where to locate allergen information, etc. Positive Staff apologized sincerely The restaurant paid for medical costs of the food allergy Staff members handled the situation professionally Positive Staff apologized sincerely The restaurant paid for medical costs of the food allergy Staff members handled the situation professionally

16. + Consumer expectations from food service establishments Management practices Establish procedures to prevent dishes from being contaminated by allergens Identify the top eight major allergens on menus Use specific allergen symbols Use “contains” statements Have specific allergen-free menus

17. + Consumer expectations from food service establishments Management practices Provide allergy safety training for staff on the following topics: The increasing number of individuals with food allergies Consequences of food allergy reactions Common food allergens (The Big 8) Ways allergen exposure can happen Reading labels for potential allergens How to prevent cross-contact How to communicate with customers and restaurant staff about food allergies How to recognize allergic reactions

18. + Advice from AllergyEats founder, Paul Antico (Walkowiak, 2011) Prepare foodservice staff, particularly managers and servers, to be able to confidently answer the following consumer questions: “What protocols do you have in place to serve food-allergic individuals?” “Which items on your menu are not safe, given my specific food allergies?” “How are diners’ allergies communicated to the kitchen and other staff?” “How is the kitchen set up to prevent cross-contact?” “Is separate equipment used to prepare orders for food-allergic individuals?” “What kind of oil will be used in the preparation of my order, and is it safe, given my allergies?” “Can I see the list of ingredients for a given menu item?”

19. + Consumer expectations from food service establishments Communication Provide allergen information online. Have relevant and up-to-date food information on hand, such as recipes, ingredient lists, preparation methods, etc. If applicable, market as an allergen-friendly restaurant. Use signage to make the use of common allergenic ingredients clear. For example, “We use X allergen in our facility” or “We have X allergen-free products” Give full, honest, and straightforward disclosure regarding what can and cannot be accommodated and when answering questions or providing any other information. Do not be afraid to say “I don’t know” when unsure. Do not assume or pretend you know the answer when you are not sure about it.

20. + SUMMARY Customers with food allergies and parents of children with food allergies often feel a strong sense of personal responsibility about being safe and experience anxiety when dining out Consumers with food allergies should seek food allergy- related information before going out to eat. Various consumer food allergic reactions and establishment responses to the reactions were reported. Food service establishments should put management effort and enhance interactive communications for consumers with food allergies.