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New Study: Food Allergy Knowledge and Attitudes in Restaurant Managers and Staff

A study by a team of federal, state and local environmental health specialists finds that most restaurant employees can recognize symptoms of allergic reactions and know to call 911 if a customer’s symptoms are severe. However, more than 10 percent of the servers, food workers and restaurant managers reported the false and hazardous belief that customers with food allergy can safely eat small amounts of the food to which they’re allergic.

The survey was conducted by the Environmental Health Specialists Network (EHS-Net), a collaborative project of the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the U.S. Department of Agriculture, and selected state and local health departments. By assessing what restaurant staff know and believe about food allergies, the study sought to identify factors associated with above-average scores for food allergy knowledge and attitudes.

Of the 278 restaurants that agreed to participate, most were independently owned (60 percent) and served American cuisine (64 percent). Restaurant managers were interviewed on site and were asked to choose a food worker and a server to be interviewed as well. Since the servers and food workers were recommended by their managers rather than selected at random, survey respondents may have been more knowledgeable on average than their colleagues.

Less than half of managers and food workers and only one-third of servers had received training on food allergies in their current restaurant. These percentages are lower than results from an online survey by researchers at Auburn University, published in 2015 , which found that about 70 percent of restaurant managerial staff (owners, managers and chefs) had provided food allergen training to their employees.

More than 70 percent of restaurants surveyed by EHS-Net had a plan for answering questions from food-allergic customers. About half of the restaurants typically have a specific person available to handle food allergy questions and requests. In contrast, a smaller percentage of restaurants provide written information about food allergy. Less than one-quarter of menus mentioned allergens, and food allergen documentation was available in one-quarter of dining areas and one-third of kitchens.

Most restaurant staff – 93 percent of servers and food workers and 87 percent of managers – agreed or strongly agreed that their restaurant could easily meet the special requests of a customer with food allergy. Most staff members were able to identify four major allergens in a list of seven foods, although egg was named less frequently than peanut, milk/dairy or shellfish.

More than 95 percent of interviewees recognized trouble breathing, hives, and swelling of the tongue and throat as symptoms of a food allergy reaction, and more than 98 percent knew to call emergency services in case of severe symptoms. A smaller number, ranging from 71 percent (managers) to 76 percent (servers), agreed or strongly agreed that coworkers would know what to do in case of a serious food allergy reaction.

About 7 percent of managers and servers and 10 percent of food workers believed incorrectly that removing an allergen from a prepared meal would make the meal safe for a food-allergic customer. Likewise, about 12 percent of respondents in each of the three occupations were mistaken that individuals with food allergies could eat small amounts of their allergen without harm. (In fact, ingesting small quantities of allergen can lead to anaphylaxis and death.) By comparison, in  the Auburn University survey, 18 percent of restaurant managerial staff reported that small amounts of allergen are safe to eat, and about 40 percent thought that removing walnuts from a prepared salad would make the salad safe for a customer with a tree nut allergy. While a larger percentage of the EHS-Net interviewees indicated that cross-contact with an allergen makes food unsafe for food-allergic customers, both studies suggest that a significant fraction of restaurant workers – more than one in ten – do not understand that small amounts of allergen can be deadly.

In drawing conclusions from the EHS-Net survey, the CDC found that having a restaurant plan or a designated staff member to answer food allergy questions is associated with higher scores in food allergy knowledge and attitude. Food allergen training was not linked to greater food allergy knowledge but did improve manager and server attitudes regarding food allergy. The study authors encourage restaurants to adopt these three practices.

FARE’s SafeFARE program has comprehensive resources for diners and restaurant staff. Visit safefare.org for more information on food allergen training for restaurants.

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