Understanding Deadly Food Allergies - This Post Could Save A Life

When I was a sophomore in college, a woman in my class named Katherine Brodsky died because she never imagined that a bowl of chili at a local pub would have peanut butter as a "secret ingredient". She had the most severe form of food allergy, known as anaphylaxis. Her airway closed, and she died a couple of hours later. Although I didn't know Katherine personally, her tragedy stuck in my head.

Almost two decades later, I met my wife Sarina, and she has the same type of allergy. Peanuts and every type of tree nut are poison to her. Although we eat out frequently and with pleasure, there is always an element of fear. Will this be a normal meal, or one of those horrible nights we spend at the emergency room? Or, god forbid, worse. In the 5 years, I've known her, we've had far too many instances where she has ingested nuts at a restaurant or catered event.

Now mind you, we always explain the situation to the waitstaff. We tell them that she has a life-threatening allergy to nuts. We ask about every dish. If we sense any uncertainty on the part of the server, we ask them to double check with the kitchen, and if it still isn't clear, we'll change our order or even leave. In spite of all this caution, we've had at least 6 cases where we ended up at the hospital. Two cases of a stray peanut in the middle of a bowl of Vietnamese noodles. Something cross-contaminated onto a loaf of bread in a German health-food restaurant. Two cases of sweet-lupine flour (who knew?) in industrial pastry crusts. Pine nuts in a phyllo appetizer at a very high end restaurant that caused us to miss her Step-mom's 60th birthday party. Most recently, a dish of stewed farro and pine nuts. The nuts weren't mentioned on the menu, the waitress swore it was a safe dish, and the dark color of the broth made it impossible to see them mixed in the grain.

When this happens, she is pumped full of intravenous epinephrine, benadryl, steroids, and other drugs. An epipen is great as an emergency measure, but we still have to go in for the full treatment. She spends the next few hours puking her guts out, scratching every inch of her skin, shivering and shaking. The next few days are a total loss as her body struggles to recover from the onslaught of poison and antidote.

Having worked in professional kitchens, I understand all too well how these accidents can happen. Restaurants are busy places with competing priorities and many people responsible for the food that ends up in front of the customer. But these excuses aren't going to mean much if you kill someone.

Besides peanuts and tree nuts, other common dangerous allergies include milk, egg, fish, shellfish, soy and wheat. Of course many people have much less severe reactions to some of the same foods, which is why it is so important to have a dialogue with the customer.

For the purposes of this article, we aren't talking about the "it gives me gas" allergies or personal dietary preferences, we are talking about deadly serious stuff. Every restaurant has its own policy on how to deal with food preferences, and we can argue all day about the best way to handle that. But when a customer tells you they have a very serious allergy, there are only two ethical choices you can make. You can serve the customer, making every feasible effort to ensure their food doesn't contain the allergen. Or you can refuse to serve them. Any other choice puts that customer at grave and undue risk. It also threatens your reputation, finances and insurance, and your ability to sleep at night. Do you really want to risk poisoning your clientele?

Assuming the answer is no, the rest of this article is divided into three sections, for chefs & cooks, front of house, and management / owners. You should read all three sections so that you can understand each other's responsibilities. This is geared toward folks in the restaurant industry, but home cooks can learn important ideas for when they entertain guests with food allergies.

Although I am passionate about this topic, I'm not an expert and you can't rely on this article to teach you everything you need to know. For more information, please visit foodallergy.org and see the additional links in the Owner / Manager section below.

Also, please take a moment to pass this information on, by emailing it to friends who work in restaurants, printing it out and tacking it up on the bulletin board, mentioning it on your blog, giving it a Thumbs Up or a digg or tweet or sharing on Facebook. Whatever you do to get the word out is a big help. There is a box with tools to help you do that at the end of the article.

And thanks for listening. The life you save might be my wife's.

As you read through these guidelines, keep in mind that most mistakes are in two broad categories: communication failures and cross-contamination. If you learn to think in those general terms, you'll quickly become aware of other risks besides the specific ones I call out below.

Food Allergy Safety for Chefs and Cooks

• Be aware when products change. I recently saw an instance where a smart prep cook noticed that a new brand of egg replacer had wheat flour in it and therefore wasn't safe to use in dishes that were labeled gluten-free on the menu.
• Be aware of spills of common allergens in storage areas or during prep. Treat cleanup the same as if it was gasoline.
• When handling allergens, all utensils and equipment must be washed thoroughly between uses, including cutting boards. If there are machines or other tools that cooks wash themselves instead of putting them in the dish pit, be sure to do a thorough job.
• Wear gloves when handling allergens, then dispose of them immediately. This will greatly reduce the risk of cross-contamination.
• Bowls and tongs for tossing salads are a likely place for cross-contamination. When handling an allergy ticket, take the 10 seconds to grab a fresh set.
• If you have any allergens on the line, segregate them from other ingredients, preferably in a way that makes it unlikely to drop a stray bit into a normal ingredient. Never use the portioning utensil from an allergen pan in any other food.
• Most definitely do not reuse a saute pan that has had an allergen in it.
• Where possible, design your recipes so that common allergens are added at the last minute. That makes it much easier to accommodate guests that can't have them. For example, you might have a butternut squash ravioli in brown butter; rather than adding hazelnuts to the saute, pre-toast them and simply sprinkle them on the final dish.
• Design recipes so that allergens are visible and obvious if at all possible. The most dangerous ones are invisible to the diner. See the story about the farro and pine nut dish above.
• During prep, follow the recipes; don't make any substitutions without informing the rest of staff, especially of common allergens.
• Segregate allergy tickets and be mindful of them the entire time they are at your station
• I know you love to yell at the waitstaff, but if they are asking you a question about allergens in a recipe, or letting you know a table has a serious allergy, stop what you are doing for a second and be sure you give them your undivided attention. Even if you are in the weeds. Whatever you do, don't make up an answer. If you don't know, tell them to pass that on to the customer and have them choose a different item.
• Make sure that allergy tickets are picked up correctly by the food runners. What good is it if you make one pasta without the nuts if it goes to the wrong table?
• If a plate is ever returned to you because of an accidental allergen, make it over from scratch. Absolutely do not just pluck the allergen off and send it back out. The other food on the plate is already contaminated!

Food Allergy Safety for the Front of House

• You are on the front line of communication between the customer and the kitchen. Your diligence is critical to that customer's safety. I can't promise you this is true for everyone, but when we see that a server is taking the extra steps to be sure our food is safe, the tip is definitely bigger. (The opposite is also true!)
• Know the ingredients of menu items and specials in advance, so you are prepared to offer guidance to the customer.
• If you offer a bread basket and any of the breads have allergens, it is wise to mention it when you drop it off. "This is our olive-walnut bread". And if a customer requests you remove a bread containing an allergen, don't just go remove the offending slices because it may have cross-contaminated already. Give them a fresh portion on a clean plate.
• If a customer informs you that they have an allergy:
  • Ask them about the exact substances that cause the problem, and the severity. For example, "Is it all nuts or only some?", "Are any seeds an issue?",  "Do you need to avoid packaged foods with the made in a factory that processes nuts labeling?". "Is this a very serious allergy or an intolerance? I want to be sure I understand so the cooks have the right information."
  • If they have any questions about menu items, discuss them with the kitchen unless you are 100% sure you know the answer. In fact, even if you are sure, ask anyhow. See the farro and pine-nut story above!
  • Make your manager aware of the allergy so they can pass it on to anyone else that may be involved with the table.
    
  • Communicate back what you learned from the kitchen, and anything your management might require you to say. Some restaurants have a policy of saying something like "we'll do our best, and the pancakes don't have nuts in the ingredients, but of course we can't guarantee your safety". Fair enough.
  • Write "Nut Allergy" (or whatever it is) in big bold letters on the ticket, and make sure it is communicated to every station that will handle the order.
  • Double check when you pick up. "No peanuts on that one, right?"
• When running food, if there are allergens on the same tray, be sure nothing can cross-contaminate between plates.
• When you drop the food, confirm for the customer: "and this is the one with no peanuts, I double-checked with the chef". This isn't required for safety, but you have no idea how much you'll put the customer at ease.
• If you ever do have a customer have an allergic reaction, immediately:
  • Get your manager
  • Offer to call 911
  • Apologize sincerely and profusely
  • Never under any circumstance argue with the customer. I've seen instances where a waiter, cook, or manager has tried to deny what happened and have a big discussion while my wife's tongue is rapidly swelling.
  • Get the customer's phone number so the manager or owner can follow up the next day

Food Allergy Safety for Restaurant Management and Owners

• Make sure that menu items specifically call out allergens in the description. Writing "Fettuccine with a basil-pine nut pesto" might save a life.

• Be sure your staff is aware of the issues listed above and have them trained by a specialist. Here is information about a new training program, and the Food Allergy Initiative.
• Be sure your staff is aware of any specific policies your restaurant has on these issues.
• Be sure your staff reports any incidents that do occur. For goodwill and to prevent future incidents, fully investigate what happened and why, then get in touch with the customer to offer an apology. You may also wish to offer them a gift certificate as a gesture that you are taking it seriously, but the most important thing is that phone call. Remember that this customer is very likely to tell others about their experience, so you want to do everything you can to minimize the damage and restore trust.

Thanks again for your attention, and please do pass this article on!

Capsule Restaurant Reviews - Mainly In Seattle

For those of you in the Seattle area (or visitors to our fair city), I've started a page of capsule restaurant reviews. There is always a link over in the Categories side of the lefthand sidebar. I'll still put full reviews with photos in the main section of the blog, but if I just dash off a few paragraphs on a restaurant, I'll put it in the capsule section, since they are probably not of much interest to readers around the rest of the globe. Comments welcome as always!

What's In My Pantry Part 1 - "Quick Reach" Liquids

I thought it might be fun to do an occasional post of what I've got stashed away in different parts of the kitchen.

This first batch are the items I keep right on the counter, for sauteeing, deglazing, making quick sauces, and adding little hits of flavor. I put the Frantoia in the middle because that is my favorite high end extra-virgin olive oil. I reach for it for most raw uses, like vinaigrettes or to drizzle on pasta. The Whole Foods house brand is less expensive and I use it for cooking, along with canola oil that I keep in the fridge. (On Molto Mario, he uses Frantoia even to deep fry. Which is nice if you have deep pockets!)

Pride of place also goes to the little bottle of balsamico tradizionale - real balsamic vinegar, syrupy, sweet and incredibly complex, only for drizzling a few precious drops at a time. A recent purchase is the mosto cotto (a.k.a. saba, left of the Whole Food olive oil), which is the cooked grape must that would become balsamic if it was aged, but this stuff is immediately bottled. It is sweet and somewhat thick, but much less intense than the balsamico.

Behind the balsamico you will see a bottle of Banyuls vinegar, which makes beautiful vinaigrettes, and to the right in those tall bottles, artisanal apple and sour cherry vinegars from Acetoria. Rounding out the American / Euro ingredients, we've got apple cider vinegar, a half drunk bottle of red wine, and dry vermouth that I use when I want just a little white wine.

For Asian ingredients I've got quite a few kinds of soy sauce - light, dark, mushroom flavored, sweet (kecap manis), tamari. Cheap mirin I'll never buy again (pretty much just corn syrup, don't waste my time). Rice wine vinegar. Ume plum vinegar. Sake.

I can see this is going to be quite a project! This is just the stuff ready for a quick grab. I hate to think how many cabinets, shelves and drawers full of stuff there are. Sometimes I fantasize about not shopping for anything except vegetables and dairy for awhile and just using up every single staple I have. I wonder how many meals that would be?

Please add a comment below and let me know what stuff you keep close to the stove for last minute cooking. I'm curious to hear what everyone else thinks is essential.