Monday, February 7, 2011

Food Allergies in The New Yorker: What Restaurants Don't Know Can Kill You

I received my latest New Yorker magazine dated February 7 (with a caricature of Mayor Bloomberg on the cover) and it contains an article that is causing a lot of buzz around the food allergy community. "The Peanut Puzzle" explores theories on what may be causing food allergies and some of the research that is being done to desensitize allergic kids. (You cannot read the entire article online unless you are registered; you can find it at your local library or magazine stand, though.)

After a careful review of this article, I'm very mixed about it, mainly because it ends with a supposedly successful desensitization to milk and it gives the impression (if you don't know all of the research and details) that food allergies are pretty simple to cure. The article never explains that desensitization is not an actual cure, that is, removing the allergy. All that desensitization will do is raise a person's threshold.

The article does not reveal any brand new research: the "hygiene hypothesis" is mentioned, as is the low rate of peanut allergy in Israeli babies, the theory being that this is due to an infant food containing peanuts. Both of these theories have been out there for awhile. Leading allergists Hugh Sampson, M.D. and Scott Sicherer, M.D. are both quoted in the article. One striking thing that they both mention is that they don't know, and that no allergist really knows what is causing food allergies.

One thing this New Yorker article accomplishes, however, is that it brings home some startling facts about public perception of food allergies, especially with regard to restaurants. In a study that Dr. Sicherer conducted using 100 restaurant workers (managers, chefs, waiters) in the NYC and Long Island regions, whopping percentages of those surveyed had potentially deadly misinformation about food allergies. More than a third surveyed thought that food allergens can be "killed" by frying a food at high temperatures and a fourth believed that small amounts of food allergens aren't harmful. A fourth also were misinformed about cross-contact; they believed that simply removing allergenic foods from a finished dish (taking walnuts out of a salad and then serving the salad, for example) would not be harmful to an allergic person.

Despite being wrong on these accounts, 75% of the workers surveyed believed that they knew how to serve an allergic diner a safe meal. Wowsa. That scares me to the core, especially because incidents in restaurants account for about half of all fatal food allergy reactions.

Is it any wonder that I get more than a little antsy in restaurants? I share this information because many of you reading this right now are brand-new to food allergies. Because food allergies get so much media attention lately, you may wrongly believe that restaurants understand how to keep your allergic family member safe. Many don't. You need to be really cautious. For example, my family avoids restaurants where a lot of dishes serving nuts are on the menu. We won't allow our daughter to eat a salad if other salads on the menu contain nuts or nut dressings (the stats I list above back us up on this one.)

That's not to say that you can never eat in a restaurant. But don't shoot the messenger here, if you care for an allergic child or have allergies yourself, your carefree restaurant days of breezing in and out of establishments are over. Do your homework, read menus, make phone calls. If it doesn't feel right, don't do it. Learn to cook--it's safer.

I may not agree with everything in this article, but one thing I do agree with. The author states that "People with food allergies live under a constant threat in a society that is still poorly informed about the condition."

For information on handling food allergies in restaurants, please check out some of my former blog posts:

Check online menus before you eat

A great restaurant experience

A bad restaurant experience

Please also visit Allerdine and Allergy Eats for more helpful dining out info!


Susan Weissman said...

And if you ever speak to someone who worked in restuarants or went to culinary school you will get even more wary of restaurant food and food allergies. There are so many "tricks" used to enhance taste and texture that might involve unpredictable ingredients.

Anonymous said...

We were recently in Chicago at a very large mall when we decided to stop in at the Rain Forest Cafe. I stopped at the hostess desk and asked if there were peanut oil or peanut/tree nut products used in their kitchen or by the staff. The hostess didn't know, but put in a call to the Kitchen Manager. I was told the kitchen used vegetable oil to cook in, but the kitchen had several type of peanut/tree nut products used in other dishes throughout the kitchen. I was then told a Manager would bring out a peanut/tree nut free order.

I was certainly not comfortable with the idea of cross contamination in the kitchen and kindly thanked the hostess for her time. We turned and walked out of the restaurant and chose a to eat elsewhere. My child's life is just not work the risk!

Anonymous said...

Was wondering where you go the stats "incidents in restaurants account for about half of all fatal food allergy reactions." I was starting to think that I was being too paranoid about avoiding restaurants with my son but that sort of shocked me right back to where I started...

Jen said...

Well said. Thank you. In full disclosure, I haven't read the whole article, only the available abstract. I was struck by the idea strict avoidance was the way to not have a peanut allergy, but now early exposure may prevent. My oldest child (6) has a severe peanut allergy. I didn't eat peanuts after the first trimester or nursing. With my second child (now 4), we were a total nut-free house by then--so no exposures, no allergies. Now, I have my third, who is 6 months old, you just can't convince me to expose him to nuts via nursing or otherwise. It makes me really nervous though--I do see the point of early exposure, but I just can't bring myself to do it.

Jenny said...

Yes, Susan that is a great point!

Julie, we avoid Rainforest Cafe for the same reason. That menu is just too "nutty" for us.

Regarding the stats, they were in the actual New Yorker article but you can probably get them from as well.

Thanks for the comments!

Jenny said...

Jen, don't worry. I totally sympathize as I felt the same way. The complete article did not say there is conclusive evidence to avoid exposure. They still don't know what is the real allergy trigger. It would be a great point to bring up to you allergist. In our case, our youngest child tested negative for nut allergies and we occasionally give her peanuts or tree nuts just to give her that exposure. We didn't begin doing this, though, until our allergist gave us the go-ahead and that was after she tested negative at age 3.

As an FYI to anyone else, with any medical questions, it's a good idea to speak to your doctor b/c they know your specific case.

Martin said...

Julie, i had the same experience at the red lobster, when my wife specifically told the waiter not to put any peanut related foods in my nephews meal.and they did the complete opposite.That's why the safest way is to order specific meals, and double check especially when kids are around.
I had to call my brother abroad and calm him down.

conference call


Poker Chick said...

Great summary and an excellent point. We live in NY many places are great but it is scary how many places don't "get it" and it's VERY hard to explain to people why you think one place gets it and one doesn't when they say the same thing (sort of).

Regarding the Israeli kids the article mentions - our family is from there and I believe that stat is misleading. For example, sesame is a huge part of middle eastern diet and sesame allergy there is one of the top few allergies - it's rampant. So that counters the theory posited in the New Yorker.

Jenny said...

That is so interesting about sesame allergy in Israel. The anecdotal evidence you give would support the theory that exposure may cause allergies.

To be honest, at this point I don't think they know what is causing food allergies. Still, these stories and findings give me hope that someday, a cause will be found.

Connie said...

And to put a totally different light on the questions of dining with food allergies.. you should read Allergic Girl's new book "Allergic Girl: Adventures in Living Well with Food Allergies" Sloane has nut and seafood allergy, and dines out 5 nights a week. It's a very different perspective to mine (my 7yo has PN/TN allergy, and I have been very conservative with dining out). It's making me question whether I'm being too protective. Food for thought :)

Susan said...

I guess we're pretty lucky living in MA. Not that we take anything for granted, but as of February 1, all restaurants are required to have a certified food protection manager on staff. Thank you, Ming Tsai!
My son has celiac disease (his first "food" diagnosis) & peanut & tree nut allergies. A few years ago the thought was that not breast feeding, or not doing it long enough, contributed to celiac. Now they're saying that prolonged nursing & delaying solids can cause celiac.
What are we to do?!

Jenny said...

Connie, I still think you should be conservative when dining out. Most restaurants are not that adept at serving allergic diners.

I know about Sloane's book and am very excited for its release. She even quoted me in it and I'm so honored. Her approach to food allergies is an inspiration to me. But she's been navigating this stuff for years and just based on the many posts and articles of hers that I've read, I don't think she would say to throw caution to the wind and bring an allergic child out to eat every night of the week to a different restaurant. Reading her blog, she's walked out of many an establishment. Being careful is different than being overprotective, IMHO. :)

Anonymous said...

I completely agree, eating out can be dangerous. My brother and I have both worked many years as servers in restaurants (the one I worked at is respected by some allergy parents). We have witnessed the amount of cross-contamination that goes on and do not trust restaurants to safely accomodate food allergies. Most kitchens have limited work spaces. Servers I worked with WERE NOT trained about allergies and many didn't even wash their hands after touching used plates.
Plus, even if you check the ingredients at a restaurant, how do you know that the food manufacturer has safe procedures without contacting them too?
You're playing Russian Roulette if you fool yourself into believing it's safe.