What should you do if a guest has an allergic reaction in the restaurant?

Food Allergy Week (26 May – 1 June 2019) — an annual initiative of Allergy & Anaphylaxis Australia that aims to raise awareness about food allergies, including potentially fatal food allergies — may have wrapped up this weekend, but the need for advocacy, awareness and education about food allergies in Australia is as urgent as ever.

Australia has one of the highest rates of food allergies in the world and these numbers are only going up; in fact, it's estimated that one in 10 babies born in Australia will develop a food allergy. With no known cure for food allergies, awareness and education is essential, as a severe allergic reaction or anaphylaxis can quickly become life-threatening.

It's important for all Australians to be aware of food allergies, but it is especially important for food businesses and food service workers, who, once informed of an allergy, are legally responsible for preparing food that does not contain the allergen or for informing the customer that they cannot guarantee an allergen-free meal.

When training staff in allergen management, food business owners/managers need to ensure that they:

• know the most common food allergens (peanuts, tree nuts, milk, eggs, sesame seeds, fish, shellfish, soy, lupin, wheat)
• are aware that any food can be an allergen
• know what goes into the food you sell / meals you prepare and which of these foods contain allergens
• are careful to avoid cross-contamination by changing gloves and preparing foods hygienically
• are comfortable reading ingredients or seeking clarification
• know who to ask when information is requested by a customer
• communicate to all appropriate staff involved when informed that a customer has an allergy

All employees should be trained to recognise the signs and symptoms of an allergic reaction, and at least one employee on the premises should be trained to act immediately if a customer has a serious allergic reaction.

What to do if a customer has an allergic reaction

An allergic reaction can happen within seconds of being exposed to an allergen. A severe allergic reaction or anaphylaxis can be traumatic for the person it happens to, and frightening for witnesses who do not know what to do. It is beneficial for your customer, your staff and your business to make sure that employees know their role in the event of an emergency.

RECOGNISE THE SIGNS AND SYMPTOMS OF AN ALLERGIC REACTION

The signs and symptoms of a food allergy can vary from person to person. An allergic reaction can happen within seconds or minutes after eating and can quickly become life-threatening.

An allergic reaction can involve any or all of the following symptoms:

• hives, swelling, itching, warmth, redness or rash
• coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, trouble swallowing, or hay fever-like symptoms (nasal congestion or itchy, runny nose, watery eyes, sneezing)
• nausea, stomach cramps, vomiting or diarrhoea
• changes in skin colour (pale/blue colour), weak pulse, dizziness, shock
• anxiety, headache, uterine cramps or a metallic taste in the mouth
• swelling of the tongue and/or airways causing difficulty breathing
• drop in blood pressure (causing dizziness, light-headedness or passing out)

If you notice that a customer is showing signs of an allergic reaction, it is important that you remain calm and act quickly. Keep in mind that an allergic reaction can start with mild or moderate symptoms which can quickly become severe so do not leave the person alone. Stay with them and call for help.

LOCATE EPINEPHRINE AUTO-INJECTOR

At the first signs of an allergic reaction, locate the customer's epinephrine auto-injector (e.g. EpiPen, Anapen). Both the customer and the food service business/worker have a responsibility to prevent an allergic reaction, so the customer should have an epinephrine auto-injector with them. Instructions for use should be stored with the epinephrine auto-injector.

It is a good idea to get this information from the customer immediately after they have disclosed a food allergy, before an emergency can occur. Ask the customer where you will find their epinephrine auto-injector in the event of an allergic reaction, and, if applicable, ask if anyone in their party has experience administering the shot. The more information you get upfront, the better prepared you will feel if you need to act quickly.

If the customer is having mild symptoms and can speak, discuss whether or not antihistamines can be taken to relieve their symptoms; however, keep in mind that symptoms of an allergic reaction differ with each reaction and can become more severe over time.

If symptoms progress, epinephrine is the only suitable medication so even if the customer believes that they are not in serious danger, you should encourage them to give themself a dose of epinephrine and continue to watch for any of the following signs of anaphylaxis:

• difficult or noisy breathing
• swelling of the tongue or throat
• difficulty talking or a hoarse voice
• wheeze or persistent cough
• loss of consciousness or collapse
• paleness, weakness (especially in young children)

If the customer is under the age of majority or dining alone, contact their parent/guardian or other emergency contact. If the customer's symptoms are worsening, take action immediately.

TAKE ACTION

If you see any one of the symptoms of anaphylaxis, you should do the following (in order):

• call an ambulance (000)
• administer the epinephrine auto-injector
• place the person in a position appropriate for the symptoms they are experiencing
• contact parent/guardian or other emergency contact
• stay with the person until medical responders arrive

The person should be placed on their back with their legs elevated and should continue to lie down until emergency responders arrive or until they have fully recovered. If the person feels nauseated or is vomiting, they should be placed on their side to keep the airway clear and prevent choking on vomit. If they are having difficulty breathing, they should be kept sitting up, preferably on the ground with their legs outstretched.

It is important to remember that a person who is experiencing anaphylaxis may not be capable of self-administering an epinephrine auto-injector; they may be physically incapacitated or confused. They may also be anxious about using a needle, may downplay the seriousness of the reaction, or they may not want to draw attention to themselves. Assistance from others, especially in the case of young children or teenagers, is extremely important.

Don’t delay giving epinephrine. This is one of the most common mistakes people make during anaphylactic reactions. Epinephrine is safe and must be used promptly. It can save a life — don’t hesitate to use it.

Allergy & Anaphylaxis Australia encourages food business to have an emergency drill using an epinephrine auto-injector trainer device (with no needle or medication) every 3 – 4 months. You can purchase an auto-injector trainer device from Allergy & Anaphylaxis Australia.

After treatment, the person should go to the nearest hospital, even if symptoms are mild or appear to have stopped, because the reaction could get worse or reoccur. Do not ask the person to sit up or stand immediately following a reaction (even if treated), as this could cause a dangerous drop in blood pressure or other complications — including death.

Preventing allergic reactions in your food business

Unfortunately, most fatalities related to a food allergy occur when eating outside the home, which indicates that some food businesses:

• do not have an effective process for preparing foods for customers with food allergies
• are not training staff about food allergens so they understand what information they need to provide to customers
• are not training staff to ask customers about food allergies
• are not training staff on food safety best practices to prevent cross-contamination
• are not effectively communicating allergy requests
• are not adequately prepared to handle emergency situations

Food-related anaphylaxis has doubled in the last 10 years; even in cases where anaphylaxis is not fatal, a life-threatening allergic reaction has a devastating effect on the individual's physical and mental well-being. A serious food safety incident can have devastating consequences for your customers, your business and your employees.

As a food business owner or manager, prevention should be your primary approach. Trained and certified Food Handlers help to minimise the risks involved when preparing, displaying and selling food products to customers and your Food Safety Supervisor will help to ensure safe food handling procedures are being followed.

The AIFS Food Safety Manager course covers food-borne illness and food allergies in depth and has been developed in response to demand for advanced food safety training that goes beyond what is covered by the VET Quality Framework.

For more information about preventing food allergy incidents in your food business, read this blog.

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