EHJ June 2005, pages 12-13

Author of a new caterer's guide on food allergies, Michelle Berriedale-Johnson, explains the role EHPs can play in helping food allergy sufferers avoid potentially fatal attacks when they eat out

One of the best restaurants on your patch, which passed your most recent inspection only a month ago with flying colours, is up in court because a customer died of anaphylactic shock after eating a chicken korma. A verdict of death by misadventure is recorded. It emerges that the customer, who was allergic to peanuts, died from anaphylactic shock because the almond paste used in the korma sauce had included a significant amount of peanut.

This is not a "what if" situation - this is a real-life case quoted by Jackie Hall, an EHP in Rochdale who has been researching the awareness of food allergy among consumers and small-to-medium enterprises in her area. The death that she cites took place in the Midlands in 2003. In the files of the Anaphylaxis Campaign are records not only of deaths from food-related anaphylaxis (10-15 per year) but of the far greater number of "near misses", when the allergy sufferer realises in time that they have eaten one of their allergens and can give themselves a life saving shot of adrenaline.

WHAT IS A FOOD ALLERGY?

From an EHP's point of view (in medical terms the situation is more complex) food allergy or sensitivity comes in two forms. First, the potentially life threatening allergy - the kind that killed the girl who ate the korma. In this type, the tiniest contact with the food to which you are allergic can cause an immune system reaction in which your mouth, throat and lungs swell up so that you cannot breathe and your blood pressure plummets.

Unless you receive a shot of adrenaline within 10-to-15 minutes, you can die. There may be other symptoms such as severe itching, cramps or vomiting but these are not life threatening. The most common foods to cause this kind of allergy are peanuts, tree nuts and dairy products - although it is possible to suffer an anaphylactic allergy to almost any food.

Although not life threatening, there are also a wide range of other food sensitivities: celiac disease or gluten intolerance, sensitivity to wheat, citrus, night shade plants, food colourings and many others.

Eating these foods is not fatal, but it can cause illness - or, as in the case of, for example, hyperactive children, can cause immediate behavioural problems.

HOW MUCH FOOD IS NEEDED?

In the case of anaphylactic shock, the amount of the food needed to trigger the reaction is minute. The peanut dust left in the bottom of a dish, which had contained peanuts, a tiny residue of butter or milk left on a serving spoon, which had previously been used to serve a cream sauce, or buttered vegetables.

The amount needed to trigger symptoms in people with other sensitivities and food-related conditions will vary enormously and will depend entirely on the individual. For some, a tiny residue will be enough. For others they may need to eat a substantial amount of the relevant food before they are affected.

WHAT PROBLEMS DOES THIS PRESENT FOR THE CATERING TRADE?

Potentially, allergy can cause major problems for caterers. Although very few caterers or allergic people are aware of it, the law already provides pretty comprehensive protection for anyone suffering an allergic reaction in a catered situation, provided that they have informed the outlet of their allergy.

Under both the Food Safety Act and the new General Food Law Regulations (criminal law) and the Consumer Protection Act (civil law) the caterer is responsible for ensuring that the food that his customers eat is safe and of the quality that they should expect. If the caterer or staff feeds a customer an ingredient that they know to be unsafe, then they are liable and can be prosecuted.

This means that the caterer needs to understand (and ensure that their staff understands) exactly what foods can cause problems - not as simple as it sounds as those foods may appear under many different names.

Caterers need to ensure that those foods, or ingredients, are clearly labelled if they are intentionally included in a dish, ensure that they are not included accidentally, and be aware of the dangers of contamination.

HOW AWARE ARE CATERERS OF THE PROBLEMS OF ALLERGIC CUSTOMERS?

Judging by the experience of Foods Matter readers, awareness is very patchy. While a few outlets genuinely do understand the problems, the vast majority either know (and care) very little or are sympathetic but really have no serious idea of what they are dealing with.

Our impressions are borne out by Ms Hall's research in Rochdale. In conjunction with the Anaphylaxis Campaign, she surveyed 78 allergic consumers, 97 per cent of whom had suffered an allergic reaction to food, 29 per cent of which had been while eating out or eating a take-away. However, only 17 per cent of respondents avoided eating out which means that 80 per cent of those surveyed with food allergies are eating out regularly.

Ms Hall then surveyed 76 caterers - from nurseries and hospitals to fast food outlets. She found a general awareness of the existence of food allergy, but a very hazy understanding of what it was or of the risks involved: hidden ingredients as in the korma/peanut case, contamination and poor labelling.

HOW CAN EHPS HELP?

As the most regular visitors to many of these catering outlets, EHPs are ideally placed to monitor not only the risks of physical, biological and chemical contamination in the outlets that they visit, but the risks which could be faced by allergic customers.

There are five areas, which could be checked during a routine inspection:

1. Does the outlet have a detailed list of ingredients for every dish they serve, including any made up dishes that they buy in, which can be made available to an allergic customer?
2. Does the outlet have easily accessible instructions as to what to do if a customer suffers what they suspect to be a serious reaction to a food?
3. Is there always at least one person on-site who understands the issues involved in food allergy (contamination, hidden ingredients and so forth) and who understands what to do in an emergency.
4. Does the staff receive any training in food allergy?
5. Is the kitchen set up (or could it be set up) in such a way as would allow the preparation of food for an allergic customer without the risk of contamination.

If every inspection could include these areas, and if every EHP could carry at least basic information, which could be made available to the caterer, the dangers for the allergic person in eating out would be significantly reduced.

Michelle Berriedale-Johnson runs a monthly magazine, Foods Matter, for food allergics and she has recently published an Allergy catering manual (see book review, this issue page 19) as a resource and training guide for caterers. She looks at food allergy and how it impacts on the catering industry - and the EHPs who regulate it.