How safe is your curry? Food allergy awareness of restaurant staff

Background: Incidents of severe and fatal anaphylaxis to accidentally ingested food allergens are increasing. Individuals are more likely to encounter difficulties when eating away from home. In restaurants, front-of-house and kitchen staff may be called upon to provide information about ingredients or ensure certain food allergens are excluded from dishes. Following a series of reactions related to the accidental ingestion of peanuts in curries we assessed food allergy awareness and allergen avoidance practices amongst the staff of Asian-Indian restaurants. Methods: A questionnaire survey was administered by telephone to one member of staff in each restaurant. Results: Fifty percent (40/80) of restaurants participated. Responders included managers, owners, waiters and chefs. Most (90%) had received food hygiene training, but only 15% food allergy training. 25% could name three common food allergens. 3 in 4 listed nuts, but less than 1in 5 mentioned peanuts. Common misunderstandings included 60% of staff believing an individual experiencing an allergic reaction should drink water to dilute the allergen. A less prevalent, but perhaps more concerning, was the misunderstanding that cooking food would prevent it causing an allergic reaction (25%). Despite poor knowledge, all respondents were comfortable and 65% were “very comfortable” with providing a “safe” meal for a customer with a food allergy. 60% expressed interest in future food allergy training. Conclusions: Despite high confidence in their own understanding of allergy, many staff lacked the knowledge to provide “safe” meals for food allergic customers. Traditionally tree nuts are a common ingredient in Asian-Indian dishes cuisine and there was widespread, but not universal, awareness of tree nuts as a common allergen. Peanuts were less commonly recognised as a common allergen, an observation of extreme concern as peanuts are being substituted for tree nuts as they are cheaper and avoid having to inflate meal prices. Our data highlights the need for greater training of restaurant staff. In parallel, food allergic customers need to exercise vigilance when making meal choices and develop skills to order a safe meal. The management of allergy is multifaceted, and this study indicates the importance of health professionals working beyond the clinical setting to collaborate with colleagues in the hospitality industry, public health and environmental health in coordinated endeavours to improve patient safety.