Missing out on great restaurant evenings with friends? Learn how you, too, can indulge.

Step 1: Before You Go

Know your condition: Do your homework: learn, in detail, what you can’t eat, where an offending protein hides, the multiple names for it, and names for it in key languages. If you have shellfish allergy, the French bistro menu may refer to fruits de mer. Hint: they aren’t fruits. Nuoc mam pha? Sounds lovely but it’s Vietnamese fish sauce. Sodium caseinate? Dairy. Durum? That’s wheat. (Look up specific allergies and celiac disease at Allergicliving.com, and see left panel links for “hidden peanut”, “hidden milk”, “hidden gluten”, etc.)

Carry your meds: Allergists recommend epinephrine as the first-line medication for a food allergy reaction. Having an auto-injector with you is especially important whenever you plan to eat, since anaphylaxis can come on swiftly after consuming the wrong food. Consider that restaurant reaction horror stories almost always occur because the patron did not have an auto-injector on hand. Also have a food allergy action plan on you: in your purse, backpack or as a pdf on your smartphone. (See American and Canadian plans.)

Restaurant card: I recommend bringing a chef or food allergy card. These explain your allergies and the types of foods they are found in. Top chefs have told me that these can mean the difference between clarity and confusion in the kitchen. Find them at Selectwisely.com or Allergytranslation.com.

The right attitude: Let’s get you psychologically prepared to dine out. Your mental equipment includes: an approachable demeanor, a genuine smile and lots of pleases and thank yous. These will get you far at a restaurant. Conversely, anger or threatening language or behavior will get you nowhere fast. You will be pleasantly surprised by what a positive frame of mind will bring.

Next Page: Step 2 – Deciding where to dine

My “oh woe is me” voice kicked in: “What a pain this is to deal with. Why does he have so many food allergies? And, why am I always the one asking about his food?” It was the last question that really hit home. I realized that, similar to reading ingredient labels, Julian had to learn how to ask questions himself about restaurant meals.

Kids learn best when you involve them, so my husband and I encouraged Julian to ask basic questions – “Are there peanuts in this?” We graduated to the more complicated questions as he matured: “Do you use the same grill to cook shellfish and steak?” “Do you make the French fries in the same fryer used for foods such as deep-fried shrimp?”’

We found that by taking precautionary steps, we could go to restaurants together safely. Following are the main points we found helpful when dining out with a food-allergic child:

Plan ahead. When possible, call the restaurant at a time that is convenient to speak to the chef or manager. They can point you to the safe meals on the menu. (Stick with simple items with fewer ingredients and fewer coatings, sauces and dips.) Try to dine at off-peak hours as staff will have more time (and patience) to check on menu items. The highlight of the meal – the dessert tray – will be off-limits for most food-allergic children. So to avoid disappointment, let your child take a special dessert or treat to the restaurant so he feels included.

Next: Teach your child

In a few short years, there have been huge strides in restaurant awareness of allergies and intolerances. Welcome to the brand new era of dining out safely.

One day in my early 20s, I went to brunch with friends at a new restaurant in a tony section of New York City. I didn’t call ahead to alert the manager to my food allergies, nor did I tell the server of my severe allergies to nuts and fish. My purse held a few antihistamines and my asthma rescue inhaler, but no emergency epinephrine auto-injector. It was the roll of the dice approach to food allergy management – and it didn’t pay off.

I ordered the plain pancakes. An inviting triple stack arrived, dusted with powdered sugar and a sprinkle of something quite unexpected. Pistachios had been artfully arranged on the plate and tucked between each layer. Immediately I flagged down the server, telling him I was allergic to nuts and couldn’t eat the pancakes. He whisked the plate away, returning it seconds later.

How did they remake an order of pancakes that fast? They didn’t. Peering under the top pancake, the pistachios were still there. The server had just scraped off the garnish and top layer. I flagged him down again: “I cannot eat this. No pistachios – anywhere,” I intoned, as my friends happily ate.

The same pancakes arrived a third time; between the second and third pancakes was still a sprinkle of pistachios. It was like the movie Groundhog Day: I kept getting the same wrong order over and over. The scene ended when the server stopped approaching our table. Instead, he glared at me, the “crazy” customer, from the safety of the bar.

I hailed the manager, who halfheartedly offered to make a fresh batch of nut-free pancakes. I declined. By now I didn’t trust the management, staff or kitchen to serve me anything safe. I left feeling demoralized, distrusting, upset with them, upset with myself and hungry. I never went back.

That was then; this is now. Recently, out with friends, we settled on a restaurant that I know takes the needs of the allergic diner seriously. The online menu had at least three dishes that appeared safe; this was easy to confirm by phone with the restaurant manager. The manager assured me the chef would gladly handle my food allergic needs, and they would be happy to welcome me.

Next Page: Changes in the way allergies are approached

This can present a challenge to parents who need to place a child in a daycare. While most licensed daycares are today well-versed in allergy issues (particularly peanut allergy), not all will be free of hard-to-avoid allergens such as milk and egg.

Before completing enrollment, make an appointment to review allergy practices of the daycare where you’re applying. Can snacks be dairy-free or largely dairy-free (e.g. there are many brands of dairy-free crackers used as snacks)? What are the hand-washing practices following snacks and meals? What is the protocol for wiping down toys which are shared and could get smeared with, say, cheese residue?

The province of Ontario, a leader with school anaphylaxis legislation, now also requires anaphylaxis strategies and risk reduction measures by law at daycares. This is part of the Day Nurseries Act. It is worth lobbying for similar practices in other jurisdictions. See Section 36.1 of this act.

Baked Goods Findings

Milk and egg are among the more challenging allergies to learn to manage – because both are used extensively in packaged food and bakery items. But good news: there is promising, very new research that shows many allergic children are able to tolerate foods containing either milk or egg: as long as they have been cooked thoroughly at a temperature of 350 degrees or higher. The amount of the allergen also is important.

Speak to your allergist about whether your child is a candidate for trying a baked goods challenge (never just try this without the specialist consultation). Research at Johns Hopkins University has shown that many children tolerating thoroughly baked milk or egg can even progress to foods that are less extensively baked, such as pizza. For more, see Milk, Egg Allergy Breakthrough.

Next Page: Managing Tips

1. Refined Oil: When a peanut or nut oil is refined, the chances of the proteins of that food being in the oil are low. While pure refined peanut oil does exist, it is always safer to avoid peanut oil completely since there is no definitive way to tell how much protein is in that oil.

However, as Dr. Antony Ham Pong states, “if a peanut allergic person accidentally eats a food with refined peanut oil, the chances of having an allergic reaction are low because even there is peanut protein in there, it will likely be in very small amounts.”

2. Unrefined Oil: Peanut and nut oils that are cold-pressed,” “unprocessed,” “expelled,” “extruded”) peanut and nut oils are unsafe for peanut and nut allergic individuals. These are much more likely to contain peanut and nut proteins.

3. Where Peanut Oil is Found: It is also important to remember that peanut and nut oils are found in some cosmetics and body-care products. Pay specific attention to lip balms, lipsticks and lip glosses (some are even peanut-butter-flavored!) since those are coming in direct contact with your mouth.

In restaurants, be sure to  ask waiters specifically about the oil used in deep-frying or in sauces; sometimes it is peanut oil.

Sources include: Dr. Antony Ham Pong, allergist

1. Refined Oil: When a tree nut oil is refined, the chances of the proteins of that food being in the oil are low. While pure refined oils (various tree nuts and also peanut) exist, it is always safer to avoid nut oil completely since there is no definitive way for a consumer to know how much protein is in that oil.

2. Unrefined Oil: Nut oils that are cold-pressed,” “unprocessed,” “expelled,” “extruded” are unsafe for nut allergic individuals. These are much more likely to contain nut and/or peanut proteins.

3. Where Nut Oils are Found: It’s easy enough to avoid nut oils on your own shopping list, but also be mindful of them when eating out. In restaurants, be sure to  ask waiters specifically about salad dressings and sauces; chefs sometimes use nut oils to enhance flavors.

Nut oils are also found in some cosmetics and body-care products. Pay specific attention to lip balms, lipsticks and lip glosses since those are coming in direct contact with your mouth.

Sources include: Dr. Antony Ham Pong, allergist

Today, Sean Randall, a 43-year-old artist, thinks it’s in a drawer somewhere. I always ask him if he has life insurance since Sean has allergies and asthma, the combination considered the most high risk for life-threatening reactions. A severe asthmatic as a child, he spent time in the oxygen tents, and now takes the controller drug Advair daily.

He has been coping in his own way for years. As a student in boarding school in Winnipeg, he never ate toast because the knives had been in peanut butter as well as jam jars.

“You manage,” he says. “You learn breakfast is cereal, you learn self-discipline.” Sean once ate a peanut by accident in a restaurant with low lighting, and had an anaphylactic reaction. He added to his strategies: “be more vigilant when eating in darkly lit restaurants.”

Rather than carrying an auto-injector, he figures a call to 911 will save him in a crisis. “It’s less of a decision and more of laziness. If you don’t use something for 20 years, it doesn’t seem necessary.”

Largely, he relies on avoidance: no peanuts are allowed in their house in Regina, and he doesn’t go to restaurants, such as Thai eateries, that use peanuts in the kitchen. He also avoids bake sales and has learned “the hard way” which chocolate bars will set off a reaction.

Still, my sister and I hope to wear him down yet, and finally get that prescription refilled.

Reprinted from Allergic Living magazine.

Related Reading:  The Allergy Deniers

There’s just one problem in paradise: Koentges is allergic to tree nuts. While he’ll sometimes let restaurants know that he can’t have nuts in meals he orders, mistakes happen about once or twice a year.

“I think, ‘Oh crap’,” he says of recognizing the flavor of nuts. He knows the next hour or two will be filled with intense stomach pain, hives and swelling.

His strategy? To wait it out. Cautious parents of food allergic children will be stunned to learn that Koentges does not own or carry an epinephrine auto-injector. He admits that if a food looks particularly intriguing and tasty, he’ll take a chance and try it. “It’s a pretty stupid approach to it, I am a stupid person,” says Koentges. “I’m kind of cavalier about things.”

In fact, he’s savvy, talented – and in good company. There are large numbers of adults with potentially life-threatening food allergies who do not carry auto-injectors, are not vigilant food label readers and are unlikely to be found wearing MedicAlert jewelry. Almost everyone knows someone – a colleague, a friend – who has been diagnosed with a food allergy but believes that he or she doesn’t need to carry an auto-injector because the allergy is “mild” or “moderate”.

These people lack the understanding of the disease to appreciate that symptoms are not consistent; that a mild reaction today could mean full-on anaphylaxis the next time (complete with problems breathing and a dangerous drop in blood pressure). So they go about their lives taking few precautions for the condition, blithely ignoring or dismissing the fact that they are standing on the precipice of a few mistaken bites or a sting, and unprepared if a big reaction does arise.

Surveys reveal that adults with food and stinging insect allergies are far more likely to take risks than parents would take with an allergic child. “We don’t see this behavior from parent to child. It seems to be an adult phenomenon,” says Anne Muñoz-Furlong, the former CEO of the Food Allergy & Anaphylaxis Network (FAAN), who has been involved in allergy research. “We often say that teenagers are risk-takers, and they feel like they’re invincible. But I hear more stories of risk-taking from adults than I do from teens.”

New studies on adults with food allergies are telling. The qualitative research firm Fresh Squeezed Ideas Inc. last year examined patient attitudes about anaphylaxis for King Pharmaceuticals, the makers of the EpiPen auto-injector in Canada. The firm surveyed 650 participants, dividing them into two main groups – those a physician had diagnosed as food or sting allergic and those who were labeled “at risk”. The latter group had experienced symptoms clearly consistent with such an allergy, but had not been formally been diagnosed.

In the “at risk” group, only 4 per cent owned and carried an auto-injector, compared to about half of the diagnosed group. As well, 65 per cent of those “at risk” believed an antihistamine would always clear up allergy symptoms.

In FAAN’s 2004 survey of seafood allergy prevalence, auto-injector findings mirrored that “at risk” group. Only 8.6 per cent of those with a seafood allergy, which affects over six million Americans and is largely an adult affliction, had an auto-injector.

Fresh Squeezed Ideas’ research revealed a shortlist of the reasons for not carrying an auto-injector:

• Most of the “at risk” group thought only people with “severe” allergies required one, and distanced themselves from that label;
• A significant majority (in both diagnosed and at risk groups) also believed strongly in their ability to avoid allergens.
• A lot counted on their family physician’s advice and if the doctor hadn’t mention a prescription for an auto-injector, the patient didn’t ask whether one was needed.
• Several also expressed confidence that there was good awareness about food allergies in society in general and at restaurants – and drew the assumption that this was adequate protection.

Next: Life on the edge of a dormant volcano

Situation: There’s a friend at work you’ve often had lunch with. Lately, he’s decided it’s funny to tell the waiter “just bring her some water – she’s allergic to everything else.”

How to handle: Before your next midday meal with Don Rickles, prepare a sarcastic retort along the lines of “while my incredibly sensitive friend finds the idea of me doing a faceplant in my soup hilarious, I think I’ll just tell you about my life-threatening allergies instead.” If that doesn’t get the point across, ditch buddy boy and find a new lunchmate; preferably one who doesn’t find your serious health condition such a thigh-slapper.

Situation: Your new in-laws are desperate to have you two over for dinner, but you’re highly allergic to cats, and their beloved Mr. Tinkles is definitely the lord of the manor.

How to handle: You might as well be honest. Tell them about your allergy, and suggest that a meal in their beautiful garden would be a better option. (Hey, kissing up to the in-laws early is a good idea, especially if you’re planning to have kids.) It doesn’t hurt to lay some ground rules early either, in preparation for all those years and years of visits ahead. Ask if Mr. Tinkles could be confined to one room while you’re there, and suggest that, while you know your mother-in-law’s house is always spotless, maybe running the vacuum quickly before you arrive would, however, help your breathing. Bring a treat for the ball of allergenic fluff to show you don’t hate cats, really. And get your husband to agree to a late arrival and early departure, lest he bear the brunt of your coughing, snoring and wheezing all night.

Situation: A close friend asks you to be in her wedding party, but option two on the reception dinner menu is salmon – and you’re at risk of anaphylaxis to fish.

How to handle: Tell her that you’re willing to wear the seafoam green taffeta bridesmaid dress, but you’ll have to put your foot down when it comes to your ability to breathe unassisted. Speak
to the caterer ahead of time: can he assure that if you pick one of the other options, there will be no cross-contamination in the kitchen? If in doubt, bring your own meal and ask the caterer to have it served along with the others. Give a trusted friend the task of overseeing the handling of your food in the kitchen.If even a good whiff of fish has you reaching for the Epi or Twinject, tell the bride that, while you will be thrilled to precede her down the aisle, you’ll have to arrive at the reception after all fishy scraps have been cleared.

Situation: You’re out at a restaurant on a first date with an attractive, interesting fellow, who orders something you’re allergic to. Later, he leans in for a goodnight kiss.

How to handle: First of all, a kiss on the first date? OK, I’m old- fashioned, but a handshake or a hug should suffice. If your heart is already aflutter, best to be upfront. Calmly tell Dreamboat that he’s eaten something you’re allergic to, and that it’s just not safe for you to lock lips so soon after he’s eaten. Thank him for a wonderful evening and suggest getting together soon for a non-food date.

First published in Allergic Living magazine.
(c) Copyright AGW Publishing Inc.

To subscribe or order a back issue, click here.

Dory Cerny plays Miss Manners for those awkward allergic moments.

Situation: A female aquaintance gives you a gift that includes your allergen, such as chocolate-covered nuts or a food basket full of potentially lethal goodies.

How to Handle: If you don’t know the woman well, just say a gracious thank you and promptly “re-gift”. If it’s from someone you do know well, however, she has no doubt forgotten about your allergy, and is about to be mortified. Thank your friend for the thought, remind her of your allergy and while she slaps herself in the forehead, gently suggest that, as you won’t be able to enjoy this lovely gift, she may want to give it to someone else.

Situation: A relative insists that “a little bit won’t kill you.”

How to Handle: When it comes to family, sometimes subtlety is a lost cause. If your Aunt Tilda’s idea of a “safe” meal for you involves picking the shrimp out of the pasta, gently but firmly lay down the law. Explain that yes, it could kill you and as much as you love spending time with auntie, from now on you’ll come by for tea or invite her instead to your house. That way, you’ll have control over what is served.

Situation: A good friend is so anxious that you will have a reaction that you no longer get invited over or out for dinner.

How to Handle: If friends are uncomfortable preparing meals or eating out with you, take the lead. When going to a dinner party, offer to bring your own food or to eat at home and arrive after dinner, so that you can take part in the social aspects of the evening without putting any burden on your host. When eating out, suggest a restaurant where you know the kitchen or call ahead to someone else’s choice to ensure there is a safe meal option.

Situation: You encounter someone who thinks “allergies are in your head.”

How to Handle: If this is a person you will be in contact with on a regular basis and not just some jerk at a party, you will be forced to offer remedial education. First off, if you’ve had an anaphylactic reaction, you might mention that the doctor running with the epinephrine needle at Emerg. didn’t think you had “psychological issues”. That and the words “life-threatening” usually get taken seriously. Calmly offer to bring by some materials to explain the medical science of allergy and immune system over-response. You can find such materials at the websites of Anaphylaxis Canada, the Allergy/Asthma Information Association, the Food Allergy & Anaphylaxis Network and the Food Allergy Initiative.

Published in Allergic Living magazine.
© Copyright AGW Publishing Inc.

To subscribe or order a back issue, click here.