Wednesday, 17th October, 2018

To eat or not to eat? A step-by-step guide to dining out with a food allergy

Food allergies have been in the news of late - and with good reason.

The BMJ estimate that between 1% and 10% of adults and children in the UK have some sort of food allergy or intolerance. What's more, up to 20% of the population experience reactions to foods which make them believe they've got a food intolerance or hypersensitivity.

However, while food safety is paramount, being allergic to an ingredient doesn’t mean you have to miss out.

If an allergy to peanuts, seafood or dairy has made your past dining experiences stressful, this guide to eating out with a food allergy will leave you safe in the knowledge that you know exactly what you're sinking your teeth into. And if you don’t have an allergy, you might just learn a thing or two.

Choosing a restaurant


Finding a good allergy-friendly restaurant can be a daunting task. The whole rigmarole of scouring through menus, repeatedly asking waiters and turning down invites can be tiring - deflating, even.

Thankfully, there are several things you can do to make the process simple, and knowing where to check can empower you to make informed decision about where to eat:

  • If you’re really unsure, go to places you’ve visited before. Chains are always a good option because they uses the same ingredients across their restaurants and are likely to have allergen information readily in place. This restaurant list from Buyagift provides allergen information for a wide variety of the most popular chain restaurants in the UK.
  • Avoid set menus and buffets, bakeries and pre-made food. If you are tempted, ask to see labels to check for allergens.
  • If you have a nut allergy, avoid Thai, Chinese and Vietnamese restaurants - especially those that are not part of a chain. Nuts are a staple ingredient of East Asian and Southeast Asian cuisine, and traces can appear in meals even if the menu doesn’t include them.
  • If you’re feeling adventurous about expanding your foodie horizons, research cuisines that you’re not familiar with. This will help you get to grips with different ingredients and cooking techniques.

Before you go


Once you’ve chosen a fine dining establishment, bustling bistro or greasy spoon that seems suitable, call the restaurant ahead of your visit.

To ensure you’ll be spoken to, call at a less busy like mid-afternoon. Ask to speak to the manager, as they will be obliged to provide you with all the relevant information.

It’s also a good idea to take a look at the menu beforehand - if it’s not online then call up and ask them. Visiting the restaurant at a less busy time will also mean the staff will have more time for you.

A response of “I don’t know’ is unacceptable and if there’s any doubt, avoid.

If you’re met with a similarly unsatisfactory response, ask if they are comfortable serving you. They may say “no” - which is certainly safer for you. Again, if in doubt, avoid.

Arriving at the restaurant


Identify yourself as having called earlier and try to speak to the person you spoke to over the phone.

Once you’re sat down, make sure the table is clean to minimise any cross-contamination.

Here’s the important bit: tell the waiter about your allergy. Even though you’ve been through the other steps already, there’s always the chance that a communication breakdown can cause the person waiting on you to be unaware of your allergy.

Explain your allergy, and mention anaphylaxis if relevant. After doing so, ensure your waiter understands about cross-contamination. 

Chef cards are a great way to make the process easier (and potential less awkward!). Information about card size, clear, templates can be found here and here.

An example of a chef card from Make chef cards for when you go on holiday, as this will help overcome the language and cultural barrier - and save you a lot of hassle in the process!

It’s possible that the waiter may forget to tell the kitchen about your allergy - even if the allergen isn’t in the dish you’ve ordered. Ask them to inform the kitchen, because even the smallest traces can be harmful (obviously, this depends on the severity of your allergy).

Speak to the manager if your server can’t give you all the information you need. There’s no room for error, so be very clear in your explanation.

The Food Standards Agency give the following advice:

“If you ask for allergen information and the staff cannot provide this, ask to speak to the manager of the food business or the chef.

If you are still not given enough information to help you, you can report them to the local authority responsible for the food business. If you are not confident in the information you have been provided, it is better not to eat at the premises.”

Choosing your meal


Ask for the waiter’s help in choosing your food. Often restaurants have a separate menu that carefully outlines common allergens.

Always let staff know about your allergy - even if it’s not listed as an ingredient in the meal you want to order.

Ask for any dressings or sauces on the side. Some restaurants may sprinkle garnishes (e.g. sesame seeds or spring onions) over the top of your meal without stating so in the menu.

If you’re unsure, ask to see ingredient labels. Ingredients in the same dishes may vary from restaurant to restaurant so don’t assume a meal you’ve already had elsewhere is free from contamination. If in doubt, order a simple meal.

There are often unexpected ingredients in processed foods. Allergen labelling requirements also vary with country so be wary of imported foods.

Contamination is likely in:

  • fried foods (reused oil in deep fat fryers)
  • grilled foods (meat & fish contamination)
  • salad station (if they don’t change gloves/bowls/utensils)

Separate kitchen utensils, pots, pans and chopping boards should be used to prepare your meal. Some restaurants have designated equipment for this purpose.

In many restaurants, desserts are often ordered from elsewhere and not made in house - meaning the staff won’t always have the full allergen/ingredient list.

It is required by law for packaging to specify if food contains any of the major allergens, so look out for these in bold or underlined in the lists of ingredients. These are as follows:

  • Milk
  • Egg
  • Peanuts
  • Tree nuts
  • Soy
  • Wheat
  • Fish
  • Crustacean shellfish

When the food arrives


Again, miscommunication can occur during food preparation, so double check with the server when your food arrives.

Get a friend to double check as well. It’s always safer if the people you are eating with are aware of your allergy, so if you feel comfortable enough to let them know, have a conversation about it. This isn’t a foolproof method but may make you feel safer trying your food.

Now that’s all sorted, bon appetit!

After the meal


By reviewing your dining experience online and contributing to allergy networks, you’ll help other people and receive lots of help in return.

You can ask the staff how best to approach discussing it with them. Make sure to thank the staff, too, because it’s important to reinforce a culture in which food allergies are taken seriously. Besides, it never hurts to be polite!

Top tips

  • Always have your adrenaline auto-injector (Emerade®, EpiPen® or Jext®) at hand, or whatever medication you need. It’s the only way to truly ensure you’re safe at all times.
  • Make sure the people you’re with know how to use it. Teach them. It will keep you safe as you won’t necessarily be able to use it if you’re having a reaction.
  • Don’t be embarrassed to ask - it’s better to be safe than sorry. It’s your health, and you shouldn’t be embarrassed to want to preserve it.
  • If in doubt, AVOID or LEAVE.
  • Avoid medicines that contain peanut or soy-related excipients if you have an allergy to these types of food. Examples include Cerumol ear drops, Vertine® CFC-free Inhaler 25 micrograms, and Colpermin IBS Relief Capsules. Always check with your doctor or pharmacist.

What to do if someone has an anaphylactic reaction

1 in 1000 people in the general UK population experience anaphylaxis-type reactions. These are serious, life-threatening reactions which can be caused by any allergy - not just food.

If someone nearby is having an anaphylactic reaction, follow these steps:

  1. Use the adrenaline auto-injector if the person has one and if you know how it works.
  2. Call 999 immediately.
  3. Remove the trigger if possible.
  4. Lie them down flat (unless they are unconscious, pregnant, or struggling to breathe)
  5. Inject again after 5-15 mins if there’s no improvement, using a second auto-injector if available.
  6. Try to find their care plan or instructions if possible. This includes a medic alert bracelet, or a medical ID on their phone, written down on paper stored with medication.

Useful resources

  • Spoon Guru is an app which allows you to scan barcodes and see which allergens the food contains. Once you’ve inputted you dietary requirements, it can also suggest recipes for you that fit your needs.
  • As mentioned earlier, this Buyagift link has an extensive list of restaurants and their relevant allergen information.
  • This is the NHS Choices page for food allergies.
  • Allergy UK is a charity providing support and advice for those living with allergies, and their helpline number is 01322 619898.
  • Here’s a useful link from Food Allergy Research & Education (FARE) for learning how to properly read food labels.

Clinically reviewed by Ana Ciubotaru MRPharmS: 10/10/18