Dining Dilemma Restaurants Strive to Better Accommodate Food Allergies

Ralph Santaniello knows something about dietary trends. And he knows the difference between temporary fads and changes that seem more permanent.

“When we opened nine years ago, the big thing was Atkins, no carbs,” said the co-owner of the Federal Restaurant in Agawam. “Today, it’s gluten-free. Back then, we heard someone had a gluten allergy or celiac disease probably once every two or three months. Now it’s at least once a night.”

Dawn LaRochelle has also seen a significant uptick in food allergies. She operates Perigee Restaurant and Apogee Catering in Lee, and says a full 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of her catering clientele has restrictions based on celiac, a genetic disorder which typically manifests as intestinal sensitivity to gluten, a protein found in wheat and other grains.

“I have a tremendous interest in — and concern for — people who have food allergies, as well as with voluntary dietary restrictions, like kosher or vegetarian diets,” LaRochelle said. “I come from a family of physicians, and I’ve seen first-hand the effects of allergies on people and how devastating it is, feeling like they can’t go out, can’t do anything.”

But that’s changing, at least at some restaurants that put a priority on making people with food allergies of all types feel welcome and safe (more on that later). In the meantime, a state law that went into effect last year mandates a series of steps restaurants must take to educate their staff about the dangers of food allergies and avoiding reactions — which can be deadly — in patrons.

Dr. Jonathan Bayuk, an allergist and immunologist with Hampden County Physician Associates, founded the Western Mass. Food Allergy Network several years ago to help the food-allergic public navigate experiences like dining out. He noted that the Massachusetts law, in a way, follows up on federal guidelines for food packaging, which, in recent years, requires the presence of any of seven allergens — eggs, milk, wheat, fish, soy, peanuts, and tree nuts — to be prominently labeled; producers even warn consumers if a food product has been manufactured on shared equipment.

“Obviously, restaurant menus don’t come with that kind of packaging,” Bayuk said. “So the state has begun the process of making sure people know what’s in the dishes.”

This month, HCN examines what’s in the law, why it was implemented, and other ways in which restaurants are ensuring that guests’ experiences are safe, no matter what their allergy.

Something to Chew On

Ming Tsai, chef and owner of Blue Ginger restaurant in Wellesley and occasional television personality, worked with state Sen. Cynthia Stone Creem to craft the language of the bill and then lobbied on its behalf. A national spokesman for the Food Allergy and Anaphylaxis Network (FAAN), Tsai said he wanted the law to mandate simple, inexpensive measures that would be not only effective but realistic for restaurants of all types to implement.

“I’m so proud that Massachusetts is the first state to pass such comprehensive legislation,” Tsai noted in a statement on his Web site after Gov. Patrick signed the bill. “I’ve always said that, if you are in the restaurant industry, it’s your duty to serve everyone safe food.”

FAAN estimates that more than 12 million Americans, 3 million of them children, have food allergies, and that food-related anaphylaxis results in about 150 deaths and more than 50,000 emergency-room visits each year.

Such allergies are also on the rise, though doctors have not determined exactly why. One theory Bayuk has cited, known as the ‘hygeine hypothesis,’ posits that the immune system, which is designed to fight the parasites, worms, and other organisms humans encounter, has less to do these days and has become a bit, well, bored. The idea is that Americans — with their fixation on cleaning products, hand sanitizers, and reluctance to let kids play outside as much as in the past — have created an aseptic environment, and in the absence of those pathogens, our bodies have become oversentitized to allergens, typically proteins, that should pose no threat to humans.

Recognizing this sharp rise in food allergies and how such conditions could threaten diners, the state’s new law requires, among other things:

• The placement in restaurant kitchens of a poster providing general information on food allergies as they relate to food preparation;
• Menus to include a statement that the customer should inform the waitstaff of any food-allergy issue;
• Standard food-service courses to include the viewing of an approved food-allergy video; and
• The state Department of Public Health to develop a voluntary program for restaurants to be designated as ‘food-allergy friendly’ and to maintain a listing of restaurants receiving that designation on its Web site. In order to receive such a designation, restaurants would be required to make available to the public a master list of all the ingredients used in the preparation of each item on the menu. Tsai said this aspect of the law was inspired by the ‘Food Bible’ he keeps at Blue Ginger, detailing all the ingredients used in each menu item.

The year before the Massachusetts law was passed, FAAN produced a 60-page guide for restaurants that includes case studies, best practices, up-to-date research, food-labeling information, and practical strategies for avoiding cross-contamination of food items, as well as suggested procedures for keeping guests safe and steps to prepare for an allergic emergency. Restaurants are able to download and use the guide as a basis for their food-allergy-management programs.

“Studies show that reactions in restaurants are often caused by lack of staff education about food allergy,” said Anne Muñoz-Furlong, founder and CEO of FAAN. “In a number of situations, the guests did not inform the staff of their allergy. Serving guests with food allergies requires staff education and clear communication between guests and staff. This training program helps staff achieve those goals so everyone can have an enjoyable and safe restaurant meal.”

Bayuk sees the law as a good step forward, particularly considering that restaurants tend to vary widely in their treatment of the food-allergy issue.

“Most restaurants, I would say, are open to talking about it, but don’t want to give you any guarantees,” he said, adding that some national chains, like Chili’s, are diligent about posting all their ingredient information online, but other eateries have been slower to educate the public. “It depends on the server in back and the manager; it’s confusing if they don’t understand how foods can cross-react. Parents [of food-allergic children] are used to this, and if they don’t get the answers they want, they’ll just leave.”

Safe Havens

But they don’t always have to leave. LaRochelle, for one, wants every patron at Perigee to feel welcome and safe, regardless of allergy or other dietary restriction.

She told HCN that she got into cooking when she was 15. She had decided to become a vegetarian, but her mother didn’t want to cook separate meals for her, so she learned how to cook for herself. As it turned out, her family liked her food so much that her mother and sister eventually turned vegetarian as well.

LaRochelle, who has since gone back to eating meat, remembers vividly what it was like to go to restaurants as a vegetarian. “My only option was was either pasta primavera — which might have chicken stock in it — or extras of the side vegetables everyone else was getting with their main course. Or I can have X, but without the Y,” she said. “No matter what I did, I always felt like a second-class citizen, like the dinners being prepared for me weren’t as good as everyone else’s.”

So she made a point of producing a menu at Perigee that offers numerous items — clearly marked on the menu as such — that are appropriate in their unaltered form for kosher, vegetarian, and gluten-allergic customers. She’s also willing to alter dishes for diners with other food allergies — her staff is allergy-trained — and the menu, based on what’s in season in the Berkshires, changes regularly, so customers can return again and again without having to repeat the same meal.

“As a patron of the restaurant, you want to feel comfortable. You can grill my servers about anything; I want you taken care of,” LaRochelle said. “I’m in hospitality because I want to be hospitable. At the end of the day, no matter how great the food is, one week later, people aren’t going to remember what they ate or drank, but they will remember how they felt at your restaurant, and if your response to their allergy made the meal something special.”

The Federal’s Santaniello said servers will direct customers to allergen-free options — including a ‘you be the chef’ section where diners can craft their own combination of entrée, sauce, and sides — and said the menu is extensive enough that chefs don’t have to alter many dishes. “We don’t want to take too many things from the entrée, because if we take too much away, you won’t enjoy it,” he said.

Still, “we’re a little different than some restaurants because we’re fine dining, and we make almost everything from scratch,” Santaniello said. “That doesn’t mean there aren’t still some sauces and bases made at a different time, with ingredients in them you can’t take out, but we can tailor entrees to what a person’s needs are. If it’s a gluten allergy, we can make an entrée without gluten. Nut allergy is another big one. The key is to make sure that guests, at the end of the day, have as good an experience as they can despite their allergy to gluten or any kind of food.”

Bayuk is gratified that many restaurants do go out of their way to provide options and reassurance to food-allergic patrons. But the dining-out experience, he said, can still be a minefield.

“I haven’t heard an overwhelming sigh of relief from parents,” he said of the restaurant law. “Every day, I see parents of kids with food allergies, and they still struggle with this. There’s so much more awareness at many places regardless of the state law, so I’m optimistic. But you still need to be careful.”