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Eating Out and About with Food Allergies

Compiled and written by A.

with input from FAST members

Edited by Melissa Taylor

Note
This article is intended to help food allergy sufferers make important decisions when ordering food in restaurants, through takeout, and from any other source away from home. It is risky in any situation where someone else prepares your food. It is important to remember that most cases of deaths from food allergies are caused by commercially prepared foods.
The details in this article have been gathered from the wealth of information from personal experiences of FAST members. While the information contained here is mostly from personal experiences, it in no way is an indicator or guarantee that all food is safe in all locations. Be sure to read labels whenever possible, and diligently check with your server or chef at any eating establishment--each and every visit.

Before We Begin

Most food allergy deaths in a recent study occured as a result of dining out in restaurants. You can read the abstract of "Fatalities due to anaphylactic reactions to foods" at http://www.foodallergy.org/Research/publishedresearch.html, a bit here: http://allergies.about.com/cs/anaphylaxis/a/aa012201a.htm, or look for the entire article at your local library. Here is the full citation:
Fatalities due to anaphylactic reactions to foods
Bock SA, Muñoz-Furlong A, Sampson HA
Department of Pediatrics, National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver CO
Journal of Allergy and Clinical Immunology 2001; 107(1):191-3.
This article mentions that only five of the fatalities studied occurred in the home--the rest were from eating food prepared by others.

Good Experiences


While the stories of loss can strike us all as horrifying, individuals with food allergies have also had wonderful experiences when dining out.
Participant Miriam Breslauer shares one: "My husband and I traveled to San Diego and stayed at a hotel with a restaurant. The waitress quickly discovered that I had food allergies. She made sure she had a complete list of my food allergies and took it to the cook. Nothing on the menu was safe. So the cook created new fancy recipes on the fly just for me. I really wish I had asked for copies of those recipes. One involved steak, portobello mushrooms, and a few other ingredients."
Rowan says, "There is a Mexican restaurant I was at with a friend who is allergic to pork and dairy, and gluten intolerant. We hadn't eaten in many hours. The waiter, who was apparently the owner, went out of his way to answer questions and point out that most of their dishes contained ground peanuts. It turned out that the only thing I could eat was boiled pinto beans, but I really appreciated his helpfulness."

Which Restaurants?

Some FAST members have discovered specific restaurants where they can eat. Some are ethnic food restaurants with non-traditional ingredients, while some are names we all know, with standard dishes. Because we all have different allergies and are in different locations, it is very important to double-check with your local server or chef about the ingredients in each and every food. Many chain restaurants use different ingredients in different location or on different days!
Here are some ideas, provided by members.
Miriam Breslauer finds ethnic restaurants to be helpful for her in avoiding her specific allergens, which she feels are more prevalant in American cuisine. "I also try to avoid restaurants that aren't clear on ingredients, are known for creating random marinades, or cook foods that have a high percentage of my food allergens. I do believe that most restaurants are not food allergy safe, but I have found a few safe types that I can depend on when I am desperate. It usually costs more. I order items on the menu with the fewest ingredients." Miriam is also careful about the way things are prepared. "Grilled, baked, and steamed are usually the safe words for me. I always ask the staff about marinades, butter, and oils that might be used."
Traci Thomas also asks about preparation; she orders, specifically "steamed veggies, baked potatoes, grilled chicken."
Unlike Miriam, another participant, who wished to remain anonymous, does not eat out in ethnic restaurants. However, there is an exception in the case of "kosher ones, because my serious allergen is not kosher, so anything kosher is safe for me."
Rowan says, "I try not to eat out unless it's unavoidable; no matter how careful you try to be, it's always a bit of a crapshoot. There are basically only three items in restaurants that are fairly consistently safe for me: plain salad (no dressing or croutons), pinto beans (the boiled ones, not the refried ones) in Mexican restaurants, and hamburger patties, depending on the specific restaurant, though these can be risky."
An anonymous participant shares about finding safe restaurants: "I also try to find 'safety' restaurants where I know I can always go, and where the food is inexpensive so I can go any time. For me, one place is a small barbecue joint, because they don't serve shellfish, and the other was an Italian place that served shellfish but always gave me a safe order and a large enough portion that I had dinner the next night too, and the food was good."

Questions to Ask


After looking at a restaurant menu, you may feel that you have some choices to pick from, but there are a few things you need to know before ordering. Sometimes it is difficult to ask questions. How do you ask? Here some tips from FAST members.
  • Take along an understanding friend, or friends, who knows about your allergies and will back up your requests, as well as remind you when you are not being cautious enough. This is especially important in case of a surprise allergic reaction.
  • Talk to the waiter or waitress first. Miriam Breslauer recommends saying the following to him or her: "I would love to eat _____, but I have the following food allergy concerns. Could I please talk to the chef to find out if these ingredients are not in the dish? Thank you for this extra effort." Miriam says, "Be polite and friendly. Smile. Be apologetic. It really is a pain for them to look up all this information (even if it is part of their job description)."
  • Miriam Breslauer recommends talking to the chef as well. "That is how I find out how few dishes at any restaurant are likely to be safe for me."
  • An anonymous participant also adds that you be sure to "ask about the preparation areas. Do they have separate grills? How close are the sauté pans to each other (since oils and fat can 'jump' from pan to pan in high heat)? I've found that if I explain carefully what I need, and explain that I'm not doubting their competence but that I would rather be overcautious because of how sensitive and severe the allergy is, chefs and managers are very willing to spend an extra few minutes with me. They answer my questions and provide me with additional information and assurances. I've been to two restaurants where the managers were very honest and said, 'You know, the way our kitchen is designed, I can really only guarantee a salad will be safe. I'm sorry but I wouldn't want you to have a reaction.' It's always disappointing, but I'd much rather have that honest response than a reaction."
  • Traci Thomas has found that restaurants may even let you into their kitchen area. She checks kitchens in order "to assure there will be no cross-contamination. I have found that most--and I say most because we have come across those that do not understand the severity of food allergies--people are more than willing to accommodate us."
  • Another member, who didn't want to be mentioned by name, recommends speaking to the manager. "I've found I have fewer reactions when I do so. The way I approach this is that when the waiter takes our drink orders and says, 'I'll be back to take your orders,' I say, 'Actually, I have a food allergy and I'd prefer to order with the manager,' with a smile on my face. They never say no." One member has noticed that "I have fewer reactions when I order with the manager. Waiters and waitresses just take orders and attempt to explain what I have to the chef. Manangers know more about the food and kitchen, and they may have had some training about food allergies and understand what you're talking about."

    Other Tips

  • Carry an allergy card with you; member One member has found this to be very beneficial. "I modeled it after one I found for free on the Mayo Clinic Web site. It lists what I'm allergic to, including all the strange names for the foods. On the other side it explains how to prepare safe foods for me by using clean pans, clean utensils, etc. I laminated the cards and keep several in my wallet, because sometimes they don't get returned to me. I give the card to the manager as well."
  • An anonymous member recommends keeping a log of where you eat. She lists "what I ate, when I ate, where I ate, whether or not I had a reaction, and--if so--how severe, and any other notes. I'm hoping that after a longer period of time, I'll be able to pick up a pattern or two that will help me be even more reaction-free."
  • Even if you find out something sounds safe, remember that food in restaurants may contain "natural flavorings." According to Melissa, "restaurant workers don't know what the natural flavors are (that's one reason not to trust wait staff about what ingredients are in a food." Rowan also says that "it's rare for the staff to know what's in the food, and often they can't really find out."
  • Take note of the time you decide to eat out. According to one member, going to "a popular restaurant in the heart of the city at 8 PM on a Friday or Saturday night is a terrible idea. The staff and kitchen are too busy to give an allergen-free meal the time and attention it needs to stay uncontaminated. If I do expect to be there at a busy time, I always speak to the manager on the phone ahead of time and check to see if I can be accommodated at that time."

    Special Events/Catered Events

    It never fails: happy events, occasions, and holidays are always celebrated with food. How do you party without worry? Do you bring your own food? Get a "special" meal? Stay home?
    At some parties and events in restaurants you can bring things to supplement the main dishes. Have you ever been to a catered event where the desserts are all homemade? Try bringing along your own safe dessert. Parties in private halls often have food that is both homemade and catered or brought in. Check with the host and be sure to bring enough to share, perhaps posting a little sign that lists the ingredients. For all you know, other people may have diet restrictions for a variety of reasons, too. I bring guacamole. Who can resist homemade dips and a bowl of chips? Then you can join the munchers, too. Salads work great at potlucks, as well.
    Rowen has noticed this trend! "Lately, when I go to parties, I’ve had to start bringing enough to share with everyone, because the people I know have fallen in love with my cooking! Most of them don't even guess that it's not normal food. I often take deviled eggs, made from a recipe I've adapted for myself. It's gotten to the point that people have started demanding deviled eggs now! On Christmas Eve I went to a party where I brought smoked salmon and trout, rice crackers, fruit and vegetable trays, and some chocolate to share with all my friends. For Christmas day there was a potluck, and I brought roast lamb with garlic and herbs (so yummy!), salad with homemade dressing, and more deviled eggs."
    Miriam Breslauer takes along trays of sandwiches to the parties she attends.
    There is always the supplement trick. Order something safe and add a few things, such as homemade croutons, crackers, or safe bread. When my friends order from the good deli, I get a quarter pound of my favorite cold cuts or cheese, lettuce, and tomato on the side, and make a sandwich. Rowan says, "If there's an event at a restaurant, I will often order a green salad with no dressing or croutons (a bowl of lettuce, basically), as that seems to be the only thing on most menus that is likely to be safe for me. I bring my own dressing and some stuff to add to the salad so I get a whole meal out of it. Meats, poultry, beans, and such can just be marinated in the container of salad dressing to make a full meal."
    At catered events it can be difficult to get a meal specially prepared for you. Here is what some FAST members do:
  • "I ended up not eating anything at one large catered event. In the future I'm going to try calling ahead to make sure they save some fridge space for me. I'll bring my own food and let them hold it in the kitchen so I can then eat with everyone else," says one member.
  • An anonymous member says that, "For catered events that are not really big, I talk to whoever's hosting the event, get the name of the caterer ahead of time, and call. I recently went to a conference, and the chefs at each restaurant/hotel had a meal set aside for me that was prepared separately."
  • An anonymous participant recommends avoiding buffet-style catered food. "Other people mix things. Plus, with multiple large dishes there are too many cooks working on them for them to all know how to keep mine safe."
  • Anna Marie opted to just take her own food to a wedding reception she attended.
    Be sure to ask ahead of time if you plan on bringing along your own food to restaurants and events. Some companies, restaurants, and local guidelines may not allow it.
  • If You Can't Eat Out

    Due to multiple or severe allergies, eating out is not a safe or viable option for everyone. Nevertheless, you can still "eat out" and have fun doing so--no matter how you do it! Following is what a couple members say about not eating out the more "traditional" way.
  • Anna Marie doesn't eat out. Instead, she says, "I picnic wherever I go--no matter what the weather."
  • Melissa Taylor has a similar experience. "A lot of people on FAST had recommended getting a fun lunch bag. That sounded kind of silly to me at first, but now I have three--and they were right! Each one is a different style and size, with a different animal motif (can you tell I like animals?). One of my lunch bags holds enough for two people; I used to use it as a mentor, taking food along to the park with my 'little sister.' It was a lot of fun, and gave me a sense of normalcy. Instead of going through a drive-through when out, I have a bag full of goodies! I really like having a few lunch bags to choose from. Sometimes for me, making the food--or what it's held in--just a bit different helps so that it doesn't become mundane."

    Bad Experiences

    Sometimes it is just not easy getting your point across. Or sometimes, no matter what the staff says, reactions happen. In fact, one kind visitor to the website shared an experience about losing her sister to a fatal reaction with FAST. You can read it at http://www.angelfire.com/mi/FAST/fatality.html.
    Here is what some members say about their less serious--but still dangerous--experiences. Perhaps their experiences will help you to be safe when choosing--or not choosing--a particular restaurant.
  • Sadly, no matter how hard you try, the wrong order may arrive. Sometimes kitchens are busy, servers are lax, and the dish is obviously prepared with ingredients you asked the staff to leave out of it. If the order is wrong, an anonymous member suggests that you "Keep the dish that's wrong at your table instead of sending it back, and say that you need a new one prepared correctly, and you'd like to keep that one in front of you until they bring the new one. That way you know they didn't just scrape something off." Be very careful; Melissa says, for example, that someone she knew asked for peanuts to be left out of a food, due to a peanut allergy. When he was served the food, it arrived with peanuts. Rather than return it, he went ahead and ate it after picking out the peanuts. This sends a bad message to the restaurant and may make eating there in the future more dangerous for you--or even for others with allergies, especially those with more severe reactions. Be aware of the message you send to the waitstaff in the way you handle a wrong order. Be firm that you need it replaced with new food and cannot eat something that has even been "touched" by an allergen.
  • During the day, Sue attends drop-in centers. "While they’re not actually restaurants, I have asked what is the food policy. Unfortunately, I have been treated like I have some sort of problem. I have not asked that people do not bring in their homemade food, but rather that there be a specific snack area. The fact that this is life-threatening should be taken into consideration. The teachers have reacted like I'm overreacting, and say they have asked people to stop letting their children walk around with food, but there is nothing they can do about it. Needless to say, I have to watch my daughter like a hawk.
  • In contrast to Miriam's positive experience, another member says, "my allergist told me to avoid ethnic restaurants." If there is a language barrier, it may be difficult to explain your allergies sufficiently. The member goes on to say, "It's often difficult to communicate what you need to restaurant staff; in this area many of them speak very limited English, and I'm not fluent enough to explain my allergies in another language." Ethnic restaurants may or may not be a good choice; they may work for some, but not others. Take into consideration the ingredients, preparation, staff, and size of the restaurant before making a choice. Foods from different cultures sometimes contain nontraditional ingredients that may work for some people, but are nevertheless not guaranteed to be safe unless you prepare them yourself.
  • Rowan feels that, "bad experiences are unfortunately the norm. Very few places actually manage to get a special order right. I've had to send things back two or three times. Sometimes I could see that they'd merely scooped off the part of the food that had been covered with cheese, and they acted like I was being unreasonable for saying I still couldn't have it. This happened so often that I pretty much gave up on eating out."
  • "I was at an upscale restaurant," one anonymous member begins the story, "because a family friend was in town on business and wanted to take me out to dinner to a place I wouldn't treat myself to. I ordered with the manager, and as I was explaining my needs he was like, 'Oh? Really? Um, OK, sure we can do that.' I got the impression that he had no idea what a food allergy was, but I thought with his emphasis--as well as the card I carry to be given to the chef--I'd be okay. The friend I was with ordered an appetizer for himself. Ten minutes after he finished and they took it away, a server brought him another one. This was a red flag, because the kitchen didn't know what they were doing! At this point, I was thinking this might not turn out well, but the order was in and I wasn't sure what to do about it. The food arrived, and it was delicious, but before I even finished eating it my neck got itchy and my tongue started swelling. The restaurant comped both our meals, but I would rather not have had a reaction and enjoyed the evening! What upset me was that the manager said it could be taken care of."
  • Miriam Breslauer shares another story of a bad experience. "Chain restaurants with typical American food tend to cause me problems. I got pressured into going to one, even though I said it wasn't safe for me. I tried to eat the safest thing on the menu for me, but it was marinated, bun grilled, and it seemed like something else was 'off.' I didn't refuse to eat it, because it had been over six hours since I last ate (including three hours of waiting to eat at the restaurant). I was going to pass out due to not eating and was in bad shape from a few other things. Anyway, I ate guaranteed trouble. Sure enough, 15 minutes later I had a bad allergic reaction. I then spent the rest of the day in the house. I didn't prepare in advance to actually bring safe food for me to eat. I treated this bad experience as a reminder to not count on others having allergen-free food available."
  • Whatever you do, don’t challenge your allergens (per allergist recommendation) with foods that you haven't prepared yourself. Tricky ingredients like natural flavorings may confuse you and your body. Melissa reacted to restaurant French fries when she "tested" potatoes. The restaurant in question later admitted that both dairy and wheat products are present in their fries.

    Convenience Food/Desk Drawer Stuff

    Sometimes our desire to eat out is because we don't have convenient food readily available. As some members have discovered, owning a lunch bag or other picnicking supplies can be very beneficial to those with allergies. However, you can also stash away supplies for when all else fails and you forget to pack a lunch! Keep an emergency stash at work, in your car, or other places you might be when the munchies hit. Here are some suggestions; adapt them as needed to fit in with your own allergies. Especially look for any products that have a long, extended shelf life.

  • Breads
  • Baby food
  • Canned fruit
  • Cheese snacks
  • Corn chips
  • Crackers
  • Granola bars
  • Oatmeal
  • Potato chips
  • Rice Chips
  • Members have found this type of stashing away to be very beneficial. An anonymous participant carries around granola bars, finding "the right brand can be filling enough to hold me over till I can get more food." Rowan says, "I'll have rice crackers, or jars of baby food meat (there's one brand that doesn't have cornstarch in it), oranges or grapefruit." Miriam Breslauer recommends canned fruit, which she says "stays good in your work drawer for a long time. I have done this for years." Anna Marie's husband keeps heatable cups of soup "in his desk at work. Maybe you can find some that doesn’t have your allergens. There are also a lot of canned soups that don't require having any water added and are one serving."

    Resources

    If you can check menus online you will know ahead of time what you can order--or be prepared with questions (be aware that not all ingredient listings are complete, and may only be geared toward those with the eight most common allergens). Always double-check with your server or chef to find out if the ingredients differ from what is posted at restaurant websites.
    One member says, "I always search the Internet ahead of time for ingredient listings. Sometimes I can tell by looking at the prevalence of my allergen on the menu that it's too risky to go. Online menus are a great gauge for me. For places that don't list ingredients, I've been known to ask to look at a menu before being seated, just to make sure I'm comfortable staying there."
    Before beginning your online search, there are some things you may wish to know:
  • The new labeling guidelines in the United States are only for packaged foods, and restaurants do not need to comply. Ingredients may be in the food without your being informed, such as in the case of natural flavorings or cross-contamination. You can never be 100% sure in a restaurant that your allergens are not in a food you eat.
  • The Gluten-Free Restaurant Awareness Program (GFRAP), developed by the Westchester Celiac Sprue Support Group (WCSSG), is a great resource. Participating restaurants will be able to prepare gluten-free meals in addition to their regular meals. To access a database of restaurants participating in the program, visit: http://www.glutenfreerestaurants.org/.
  • In Canada, restaurants are encouraged to list their ingredients. Here is a newsflash article about it at Allergic Living website: http://www.allergicliving.com/newsflash.asp?nf=5 (Contributed by Anna Marie).
  • News about pending legislation and new laws in the United states regarding restaurants and food allegies can be found at: http://www.foodallergy.org/Advocacy/restaurants.html.

    Menus and Ingredients Online

    Please note that, because URLs change, I have listed the homepages of restaurants. You may have to search for the ingredient information--but these are restaurants that do disclose at least a bit of ingredient information online. Also, in the case of regions, be sure to check that you are reading lists from your area, as ingredients differ--especially in different countries (the below are basically US websites). Inclusion does not imply an endorsement or recommendation.

    BD's Mongolian Barbecue - http://www.bdsmongolianbarbeque.com/
    Biaggi's - http://www.biaggis.com/
    BJ's - http://www.bjsbrewhouse.com/
    Burger King - http://www.bk.com/
    Carrabba's Italian Grill - http://www.carrabbas.com/
    Chick-fil-A - http://www.chickfila.com/
    Cold Stone Creamery - http://www.coldstonecreamery.com/
    Famous Dave's - http://www.famousdaves.com/
    International Dairy Queen, Inc. - http://www.idq.com/
    In-N-Out Burger - http://www.in-n-out.com/
    Jamba Juice - http://www.jambajuice.com/
    Long John Silver's - http://www.longjohnsilvers.com/
    McDonald's - http://www.mcdonalds.com/
    McGrath's Fish House - http://www.mcgrathsfishhouse.com/
    Mimi's Cafe - http://www.mimiscafe.com/
    Outback Steakhouse - http://www.outbacksteakhouse.com/
    Pei Wei - http://www.peiwei.com/
    P.F. Chang's China Bistro - http://www.pfchangs.com/
    Rockfish Seafood Grill Restaurant - http://www.rockfishseafood.com/
    Ruby Tuesday - http://www.rubytuesday.com/
    Subway - http://www.subway.com/
    Taco Delmar - http://www.tacodelmar.com/
    TCBY - http://www.tcby.com/
    Texas Roadhouse - http://www.texasroadhouse.com/
    Thaifoon - http://www.thaifoon.com/
    Wendy's - http://www.wendys.com/
    Ztejas - http://www.ztejas.com/


    A Final Note

    The FAST website's official stance on eating out is that it is not safe, especially for individuals with multiple allergies, severe and/or life-threatening reactions, and those newly diagnosed who are still unfamiliar with labeling practices in their country. Why is it not safe?

    * A study (as mentioned elsewhere in the article) showed that most food allergy deaths occur as a result from "eating out" (in restaurants or other food service). Like you, most of these individuals also likely thought they were being careful.

    * Even if you feel 100% positive that food is allergen-free, it may still contain allergens, even potentially life-threatening allergens.

    * Vague ingredients like "natural flavorings" and "secret sauces" are unknown by the food staff, and they will not necessarily--unlike you--realize that all ingredients--no matter how minute--need to be disclosed to an allergic person.

    * Think back to before you knew anything about food allergies. Would you have trusted yourself to prepare food for someone with food allergies?

    * Even basic/"plain" foods that you would not believe would contain anything other than the obvious (like fries, a baked potato, beans, or rice) commonly contain allergens, such as dairy, wheat, soy, and nut products. One can never assume that there is any "basic"/bare bones food in a restaurant.

    * A well-known restaurant admitted in 2006 that its ingredients in a food product contained highly allergenic substances--this product was originally declared to be free of these allergens. The ramifications of this are quite obvious. No matter what a restaurant says--even in its printed materials--the food you eat may still contain your allergens.

    One member of FAST says, "it amazes me that people with food allergies do eat in restaurants." The FAST founder also--though begrudgingly, and with a real sense of loss--gave up eating in restaurants about 10 years ago, and noticed a big change in her frequency of reactions as a result.
    Choosing not to eat out is a difficult decision to make, but is nevertheless one many individuals with food allergies have made, with their health and safety in mind. FAST advocates that you thoroughly discuss this issue with your allergist, and weigh the risks with great care.

    FAST, the author of this article, and its participants are not responsible for any decisions you make or experiences you have if you decide to eat out.

  • This website is for personal support information only. Nothing should be construed as medical advice.