Barriers to Disclosing a Food Allergy at Restaurants

A flawed food allergy awareness poster depicts two unregulated food allergens above a text description of safe foods.
A flawed food allergy awareness poster depicts two unregulated food allergens above a text description of safe foods.

Always tell the server about your allergy has become dogma in the food allergy community. This has always been deeply problematic to those of us with unregulated food allergies: we’d like accommodation too, but awareness training steers the conversation away from our needs and sometimes actively misleads food service personnel about unregulated allergens.

Case in point: a dangerous educational poster published by the leading United States food allergy educational nonprofit. To a casual eye it looks like good information, yet the icon at lower right which depicts “safe” ingredients includes two unregulated allergens known to medical science as causes of life threatening allertic reactions. Front and center in this graphic is my worst allergen: an apple.

Now how on earth am I supposed to overcome this level of institutional misinformation?

Apples and watermelons are both known to medicine as causes of life threatening anaphylaxis.
Apples and watermelons are both known to medicine as causes of life threatening anaphylaxis.
Apples and watermelons are both known to medicine as causes of life threatening anaphylaxis, yet this educational poster depicts them in a description of safe foods.

People who suffer life threatening allergies to watermelon are done a comparable disservice by this type of “education.” By implication, this poster throws doubt on all anaphylactic fruit allergies. Those of us who live with this medical diagnosis certainly wish we didn’t have it. Yet we exist. Collectively, severe fruit allergies aren’t even particularly rare.

Better information was already available before FARE published that poster. Quoting a publication from the US National Institutes of Health:

It continues:

A Tineye Reverse Image Search dates that FARE poster to 2017, which is four years after the NIH published that 2013 report. FARE continued to publish it for at least two years: the Internet Archive captured the poster in December 2019. Although FARE recently deleted the page from their website, to the best of my knowledge FARE has never attempted to recall that poster or to publish a clarification about its problems. There is no way to know how many copies of this poster were made because it existed as a downloadable and printable PDF. It probably remains on the wall in the back end of many restaurants.

FARE isn’t the most responsive organization to feedback. My inbox this morning contained a legislative update that they asked me to support. When I tried to write back with a suggestion how they could modify it to make the bill more inclusive, it pulled up a noreply email.

A noreply email from Food Allergy Research & Eduation; they don’t make it easy to suggest improvements.
A noreply email from Food Allergy Research & Eduation; they don’t make it easy to suggest improvements.
FARE isn’t particularly receptive to suggestions for greater inclusion.

People who undergo professional training about food allergies often remember that training and believe it is still accurate long after circumstances make their training obsolete. Although Congress amended the ADA in 2008 to specifically include life threatening food allergies, I often meet people who were trained on food allergy law in the early 2000s who still insist that people with food allergies have no right to accommodation. No one told them the law had changed. At least those people received information that was correct at the time they were trained.

With that in mind, how many years do people with life threatening fruit allergies need to wait before servers and cooks stop mistaking us for picky eaters? Many workers in the restaurant industry are good people who adapt to new information. I don’t mean to denigrate their profession. Yet when authoritative organizations mislead them and then take no corrective followup measures, problems are to be expected. Anaphylaxis can result from any mistake in the chain of service: one lemon wedge removed from a glass instead of getting a new glass of water, one cherry removed from a plated dessert, one head of lettuce cut with the same knife that sliced an apple, or even one sprig of parsley garnish prepped on the same surface that prepped a fruit salad. That’s life with life threatening fruit allergies.

Restaurant staff aren’t to blame for this dilemma. They have demanding jobs and it isn’t their bailiwick to fact check reputable charities against NIH technical documents. Even if all copies of that FARE poster were taken down from restaurant back room today, thousands of food service professionals may remember its iconic presentation of apples as not an allergen for years to come. And regardless of how widespread that poster is, no food service training program in the world covers adequate precautions for life threatening allergies to unregulated allergens.

I have never met a server who was proficient in precautions for heat labile anaphylactic food allergies before they took my order. Why should they be? I’ve met medical doctors who weren’t aware that no laboratory has ever measured how much cooking is necessary to fully denature an OAS allergen. While giving a medical history before general anesthesia I’ve had to remind surgeons that factory cross-contamination on shared equipment with raw apple is a risk to apple sauce. Hospital kitchens have erred even when they were fully apprised of my dietary restrictions. No one has ever written a white paper on the topic of anaphylactic OAS accommodation in a medical setting. The average corner restaurant can hardly be expected to know better.

The service industry juggles competing demands. Other waitstaff may have called in sick so the person who comes to one table may be serving many patrons and pressed for time. I don’t want to make that person’s shift more difficult than it needs to be. And I do hope food service professionals take sick time when they need it . Employer flexibility is a timely consideration too and I hope we all recognize that with a new virus in the news.

Yet none of that implies I’m too shy to tell a server what my allergens are. When I can be reasonably confident of getting appropriate accommodation I do disclose it. That bar is higher than it ought to be for reasons beyond my control, and the broader food allergy community could remove those barriers if they chose to.

A social media post from AllergyEats that preaches at people to always tell restaurant servers.
A social media post from AllergyEats that preaches at people to always tell restaurant servers.
This AllergyEats social media post presumes the only barrier is activating food allergy protocols.

Despite feedback from people who endure life threatening allergic reactions to unregulated food allergens, the dominant narrative in the advocacy community continues to pretend that we have no significant unmet needs. A recent social media post by AllergyEats presumes the only barrier to initiating food allergy protocols is customer communication. I wish it were that simple. Yet for ten percent of people who suffer life threatening allergies to foods, adequate protocols do not exist. What little training restaurant staff do have can sometimes make them worse at serving our needs than no information at all.

Here’s wishing I weren’t in the position of needing to fact check the organizations that publish advice on this topic.

Of course most of the food allergy community is better served when they do disclose their allergens to servers. Ninety percent of people with life threatening food allergies get adequate coverage from food label disclosure laws and food service training courses. Yet the published advice about disclosing allergies doesn’t consider those of us who fall between those regulatory cracks. Dogmatic insistence often results from shallow reasoning and faulty research.

I’ve lived with life threatening fruit allergies since before AllergyEats existed, since before FARE existed, since before the ADA was first enacted thirty years ago. I know from experience that a sprig of parsley garnish on top of a rice pilaf could be cross-contaminated from shared equipment with my allergens, and in the real world it could be less risky to see it there and not eat the rice pilaf than to tell the server the truth about my dietary restrictions and get a rice pilaf with no parsley sprig on top: a cross-contaminated rice pilaf might still send me to the ER after somebody thought I was fibbing and removed the parsley from the plated meal before it left the kitchen.

If you don’t like this reality (I certainly don’t) then stop shouting at the part of the community who aren’t getting proper attention from the organizations who claim to advocate for us. Tell those organizations they need to do better.

science-based writing about food allergies