By Traci Badalucco
Restaurant workers need to know if a salad dressing has peanut oil or whether the pasta is made from eggs.
With food allergies on the rise in the U.S., experts and consumers want food handlers in restaurants to improve their knowledge and awareness about ingredients.
Allergy prevalence in the U.S. increased 50 percent among children 17 and younger between 1997 and 2011, according to a 2013 study released by the Center for Disease Control and Prevention (CDC).
Even young kids know a peanut allergy can be life-threatening, but they can’t always rely on food servers to protect them.
“I meet servers that just don’t take it seriously, and that puts me in danger,” said Jack Yonover, 13, of Wilmette, who is allergic to tree nuts.
Yonover has become somewhat of a spokesperson among the allergy community, after filming his documentary “That Bites.” The film, which debuted earlier this year, highlights people with food allergies and the challenges they present.
While there are no laws in Illinois requiring food allergy education in restaurants, the state is in the process of adopting the 2013 Food and Drug Administration Code to make it one. In the meantime, it’s working with experts to train food inspectors about food allergies.
“There is certainly more awareness about food allergies and the realization that there can be steps taken to prevent some of this,” said Melaney Arnold, public information officer for the Illinois Department of Public Health.
Food inspector trainees undergo eight hours of basic instruction, 30 minutes of which covers food allergies.
Julie Campbell, president of the Illinois Food Allergy Education Association, said she only spends 30 minutes covering food allergy education. That short time has to include symptoms and treatments, how to read labels, avoid cross-contamination, and accommodate certain allergies. She says that’s not enough time.
“We’re not saying every restaurant has to accommodate everybody, but to know what you can accommodate,” Campbell said. “A Thai restaurant might be able to handle some, but maybe not a peanut allergy.”
Two of the most important lessons are reading labels correctly and avoiding cross-contamination “so the peanuts you’re using on your sundae don’t get on your pasta,” Campbell said.
Yonover said going to restaurants is risky, because servers aren’t aware of 100 percent of a dish’s ingredients.
“People think I’m crazy or they just don’t understand that something can’t be made with nuts or even made near nuts,” Yonover said. “I think they sometimes get annoyed with me, and it’s not easy trying to explain to them.”
What are food allergies?
A food allergy occurs when the immune system, which normally protects the body from germs, mistakes food for a harmful germ, according to the CDC.
“These cells in other countries are used to fight parasites and things, but in our country, these cells end up causing these adverse reactions to food,” Fishbein said.
When a reaction occurs, food protein binds to mast cells, also known as allergens, and “release different products in the cells that trigger low blood pressure, hives, and swelling,” said Dr. Anna Fishbein, an allergist at Lurie Children’s Hospital of Chicago. Swelling in the throat can inhibit or even cut off breathing.
Reactions can range from mild to life-threatening, something known as anaphylaxis — when the reaction is so strong that the airways start to close up.
When anaphylaxis occurs, a shot of epinephrine must be injected in the upper leg. Most people use an EpiPen, which is a common self-injector that people carry with them at all times in case of severe reaction.
Milk, eggs, fish, shellfish, wheat, soy, peanuts and tree nuts cause 90 percent of serious allergic reactions in the U.S., according to the CDC.
The most common food allergies among children are milk, egg and peanut, and in adults they are shellfish, peanut and tree nuts, Fishbein said.
“About 80 to 90 percent of kids outgrow milk and egg allergies, about 20 percent outgrow peanuts, and only about 10 percent outgrow tree nuts,” Fishbein said.
Yonover discovered his food allergy after eating from a bowl of cashews his mom set out in the kitchen.
After a few minutes, strange bumps started popping up on his tongue and his mouth and throat swelled.
“I was freaking out, and my parents gave me Benadryl, so fortunately I was OK,” Yonover said. (Benadryl is an antihistamine that helps counteract allergic reactions).
Yonover’s parents took him to the allergist, who diagnosed his tree nut allergy.
“Looking back, I think he had a gut instinct that that wasn’t going to agree with him,” said Jill Yonover, Jack’s mother.
What causes food allergies?
Food allergies affect up to 15 million people in the U.S., including one in 13 children, according to Food Allergy Research and Education (FARE), a non-profit organization.
“Food allergies were not as prevalent two decades ago as they are today,” said Dana Morris, FARE’s Midwest regional development director. “In recent years, we have seen the number of children with food allergies in the U.S dramatically increase.”
Experts aren’t certain what causes food allergies, but there are some common hypotheses.
One idea is that as societies have moved from farming environments to urban settings, the immune system’s method to fight off an infection from harmless allergens has shifted, said Dr. David Stukus, a national spokesperson for the American College of Allergy, Asthma and Immunology.
“We also know that there is a strong genetic component, and there appears to be a link between early life and in utero exposures that may enter in at a predetermined exposure to lead to an allergy,” Stukus said.
The way Americans digest food might also play a role.
“In some societies, peanuts are used extensively, but are more boiled, whereas in America they are dry-roasted,” Stukus said. “Early introduction may promote tolerance.”
How do you test for food allergies?
Experts say the most important factor in determining whether someone has a food allergy is through a patient’s medical history because blood tests aren’t always accurate.
“There’s a lot of confusion and misunderstanding about proper ways to test for food allergy,” Stukus said. “A lot of people have these tests done, especially blood testing, and they are not interpreted correctly, and they’re told to remove things from their diet from a test result.”
Blood tests measure immunoglobulin E, an antibody that triggers food allergy symptoms, to specific foods, according to FARE.
Fishbein says some people carry more of these antibodies than others, causing them to have reactions to specific foods.
Other testing methods include skin tests and food challenge tests, where patients eat small amounts of food under medical supervision.
How are food allergies treated?
With no cure for food allergies, patients must avoid the food itself.
Stukus said food allergies account for about 150 to 200 deaths a year. “Every single one of those is preventable,” Stukus said. “As with anything, more information and improved understanding can lead toward empowerment and better self-management.”
The one most important factor associated with almost every death from food allergy is delayed injection of epinephrine, Stukus said. Yonover said he tries to carry his EpiPen whenever possible.
Yonover says he’s taking every initiative to educate both the allergy community and beyond about the dangers of food allergies, and hopes to get it into schools and doctors’ offices across the country.
“When people reach out to me and say how important this movie was and how they went through the same things I went through, I realize there are so many people out there like me,” Yonover said.
Yonover raised more than $10,000 for the documentary in a Kickstarter campaign in 2014.
“That Bites” will premiere at the Cayman Islands Film Festival and Manhattan Film Festival this month and the Trenton International Film Festival in New Jersey later this summer.
More than 300 people attended a “That Bite’s” screening last month in Winnetka, where Yonover raised more than $7,600, all donated to FARE.
Morris said she’s happy Yonover took the initiative to help educate those inside and outside the allergy community.
“One of the biggest misconceptions is that food allergies are not serious,” Morris said. “The reality is that food allergies are not only potentially life-threatening, they are life-altering.”