The catering industry

So far I have concentrated on food sold in supermarkets, but it has to be accepted that the greater risks for people with severe allergies lie in catering establishments, where the owners are under no legal obligation to label allergenic ingredients. Most of the known deaths from food-related allergies have occurred when the food was eaten away from home. Although information on near-fatalities is largely anecdotal, it is almost certain that most of these incidents happen when food is eaten in hotels or restaurants or bought from a takeaway.

Dr Richard Pumphrey, of the North West Regional Immunology Service, studied 52 cases of fatal food-induced anaphylaxis and found in 75% of cases that the food that triggered the fatal reaction was either eaten out, bought from a takeaway or eaten at a party.

No example is typical, but the following account of a near-fatal reaction has particular force because two allergy sufferers were affected. A family went into a restaurant and made their choice from the menu. Because the two daughters were allergic to nuts, the waiter was questioned directly about the ingredients of the food they had selected. The waiter looked busy, harassed and a little annoyed, but he disappeared into the kitchen briefly and returned with an assurance that the food was nut-free. But the information proved to be inaccurate and what had started as a pleasant family evening out ended up with both girls being treated at their local hospital's accident and emergency department.

A far more tragic case involved a 13-year-old Aylesbury girl who was allergic to peanuts. A family friend offered to go to the local Chinese and collect a takeaway and the youngster ordered a portion of chips with curry sauce. When the friend returned, the girl took one bite of the chips coated in sauce and decided she didn't like it. It transpired that the chef had used peanut butter to make the sauce. The girl died of anaphylactic shock. The restaurant staff had never heard of peanut allergy and did not state on the menu that sauces were made with peanut butter.

In a more bizarre case, thankfully not tragic, a 14-year-old boy from Kent was eating in a restaurant with his family. The waiter was questioned carefully and when it came to dessert the ice cream packaging was brought to the family and all seemed fine. The boy was asked if he would like nuts on the top and he said yes, he had no problem with nuts. Unfortunately the nuts were coated with albumen and sugar to make them separate and crunchy, and the boy suffered a severe reaction for which he required an adrenaline injection. The boy is allergic to egg and had reacted to the albumen.

Caterers writing to the trade press have occasionally appeared uncooperative in their approach to allergies, plainly motivated by the extreme difficulties involved in giving absolute guarantees that meals are free of nut traces. The view of some is that it is not their problem, it is the customer's. To some extent I would agree. People known to be at risk from severe reactions must take responsibility for their own safety. They must have their allergy assessed by an NHS specialist or a GP with an interest in allergy, and must always carry their prescribed medication so they can treat themselves in an emergency. They must learn to be direct with waiters, even if it means stating that a certain food could kill them, and learn to say no if they are not confident a particular dish is safe. It might also be argued that they avoid high-risk situations, such as eating out in Oriental restaurants where nut products are used liberally in the cooking. But they deserve assistance and understanding from catering staff. And there have been many examples where caterers have adopted sensible policies to minimise risks.

In 1997, the Ministry of Agriculture, Fisheries and Food produced detailed written guidance on allergies for caterers, but many restaurants had taken voluntary action long before then. It was in a Debenhams restaurant that my daughter ate her lethal dessert, and Debenhams reacted positively, immediately and, indeed, compassionately. The company introduced a system whereby customers with allergies can find out exactly what they are about to eat. Prominent signs invite customers to enquire about any dish on the menu, and once such an enquiry is made, staff produce a comprehensive product information book. This lists every meal, and every ingredient on the menu.

Chartwell, the school catering company, has devised a code of practice for its catering managers entitled 'A positive approach to managing food allergies in educational establishments'. This eight-page document explains in depth what anaphylaxis is and what causes it. More importantly, it outlines a series of steps that managers are expected to take, including collecting information from students or parents, recording this information and reviewing it regularly, communicating thoroughly with all staff, and identifying and training key members who will be responsible for having a full knowledge of recipes and ingredient information.

The MAFF initiative was launched in November 1997 by Jeff Rooker, who announced that an information pack would be sent to 175 000 catering establishments across the UK, including restaurants, cafes, hotels, pubs and takeaways. The pack contained a bright blue and yellow poster, information booklet, telephone sticker with emergency protocol, and 'allergy aware' sticker to display in the window. The pack gave clear messages that tiny traces of certain foods can kill, catering staff must give accurate information, and there must be positive measures taken to avoid cross-contamination. Caterers were urged: Think before using nut and seed oils, salad dressings and seafood sauces; don't let nuts, seeds and shellfish touch food that shouldn't have those ingredients; clean your hands, work surfaces and utensils after handling nuts, shellfish and seeds; think before cooking with oils that have been used to cook other foods.

Unfortunately, a follow-up by MAFF found that its project had been only moderately successful; some catering outlets actually displayed the material, others did not. The risks for allergic customers increase dramatically when they reach their teenage years and 'fly the coop'. New-found social freedom means they are having meals out with friends; they are often reluctant to follow advice; and their social environment (e.g. pubs, clubs and restaurants) may bring them into contact with peanuts and nuts more and more. The risks are manageable, but many people have a resistance to confronting the problem.

Returning to the cold reality, we have the case of a young woman with nut allergy who died after going out for a meal with colleagues in a top hotel in 1995. She was unaware that the butter contained nuts. We have the case of the 18-year-old economics student who died when she suffered an overwhelming allergic reaction to nuts in a dessert during her first night at Cambridge University in 1998. We have the 19-year-old man who died the same year after eating nuts in an Indian takeaway. And we have the well-publicised case of the athlete Ross Baillie, who died in June 1999 after taking a few bites from a coronation chicken sandwich containing nuts.

Such tragedies are rare and may become rarer if allergy sufferers are able to benefit from what amounts to a three-way partnership. First and foremost, it is vital that the sufferer seeks medical advice; second, the medical profession must ensure that such people are able to carry the appropriate medication so they can protect themselves; and third, sufferers have the right to expect the cooperation of caterers.

Rooker said in the House of Commons in June 1999 that he was now considering a Code of Practice for catering establishments which would seek to put allergy awareness into a tight framework. This is currently being discussed by the new Food Standards Agency.

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