People with food allergies need to be vigilant when dining out because few restaurant workers are knowledgeable about the risks, a study finds.

The British study in the journal Clinical and Experimental Allergy showed there is no relationship between a restaurant worker's knowledge of food allergy and his or her confidence in being able to provide a safe meal to a customer with a food allergy. 

si-peanut-no-220cp9230396

Bryce Blaylock, who has a peanut allergy, eats popcorn inside the peanut-free suite section of Nationals Park, at a Philadelphia Phillies versus Washington Nationals game in Washington last July. Few restaurants and retailers are knowledgeable about the risks of food allergies, a British study finds. (Jacquelyn Martin/Associated Press)

"There's a huge need" for better awareness and training, said Marilyn Allen, a consultant on food safety and food labelling with Anaphylaxis Canada.

Estimates are that food allergies affect as many as five to six per cent of young children and three to four per cent of adults, according to Health Canada.

Many children with food allergies have grown up and are now in the three to four per cent of adults, Allen said.

"They're people who do need to go out and eat. We live in a society that needs to frequent food service operations as part of their life."

Allen is developing an allergy course for food service and retail handlers in conjunction with TrainCan, which already offers food hygiene and sanitation courses.

But those food safety courses are too basic about preventing food allergy incidents and aren't mandatory in much of Ontario, Allen noted.

In the British study, Prof. Helen Smith of Brighton and Sussex Medical School and her colleagues telephoned 90 table-service restaurants to assess staff knowledge about food allergy and determine how comfortable they felt providing meals to customers with food allergies.

False reassurance

The responses showed gaps in knowledge, such as:

  • In one out of three kitchens, common food allergens such as eggs, peanuts, wheat, milk, nuts and fish were not separated from other foods.
  • One in five staff members thought that an allergic customer consuming a small amount of allergen would be safe.
  • 21 per cent said removing an allergen from a finished meal would make it safe.
  • 16 per cent thought cooking food prevents it causing allergy.
  • 12 per cent were unaware allergy could cause death.

Yet 80 per cent of those surveyed said they were confident they could provide a safe meal for customers with food allergy.

"Staff with high comfort and low knowledge are potentially dangerous, as they may convey an exaggerated sense of competence to their customers, giving them false reassurance," the study's authors wrote.

"Food-allergic patients need to be aware of this and adapt their behaviour accordingly. Our data challenge the impact of current food allergy training practice for restaurant staff, and support the need for more rigorous and accessible training," the study's authors concluded. 

Mandatory food hygiene

Basic food safety courses that cover sanitation and hygiene, but not food allergies specifically, are mandated in:

  • British Columbia.
  • Alberta.
  • Saskatchewan.
  • Winnipeg, but not the rest of Manitoba.
  • Toronto, Hamilton and Brantford, Ont., but not elsewhere in the province.
  • Quebec.
  • Nova Scotia.
  • New Brunswick starting April 2012.

The findings are similar to those of a 2001 study of allergic reactions in restaurants by U.S. researchers. That team found in 78 per cent of those 106 reactions, someone in the establishment knew that the food contained peanut or tree nut as an ingredient.

Where mandated, food hygiene courses are required for one staff member per shift, which may not be enough if they cannot communicate the information to workers who may not have strong language and literacy skills.

"Communication between the patron and the restaurant is absolutely essential," Allen said. "Communication between staff is imperative."

For patrons, that means apply the "show, don't tell" principle of not only inquiring about food allergy policies but also delving into the details, she suggested. For example, diners could ask to have a meal prepared on a clean grill or pan, but also check what's done to mitigate risks along the supply chain, such as what ingredients are in baked goods that are not prepared in the premises.

With files from CBC's Amina Zafar