Approximately 134,000 people in Ireland have a food allergy – ranging from mild symptoms to, for a small number, life-threatening anaphylaxis.
Symptoms of mild allergies are not pleasant, and people may feel wary about eating out as it could result in swelling, itchy rash, vomiting or abdominal pain if they unwittingly eat an allergen. However, for those with anaphylaxis, the stakes are much, much higher.
We have all heard the horror stories about people who have lost their lives following a lack of transparency on ingredients used. While this is, thankfully, not a common occurrence, ending up in A&E is not the outcome most people would like to experience after a meal out.
Louise McDonagh here recounts what happened after her daughter Sarah ingested some peanut in a local restaurant.
RM Block
“Both Sarah and I always carry an EpiPen on us because, although she’s really careful about what she eats, you can never be too sure,” says the Dublin woman. “But we were out for dinner to celebrate the end of her Leaving Cert exams last year and she ordered a spicy pasta dish with chicken. We told the staff about her peanut allergy and were assured that there were no nuts in the dish, but a few minutes after starting to eat, she began to feel strange.
“I called over the manager and asked if they were 100 per cent sure that the dish was nut-free, and she said she would go into the kitchen and check again. She came rushing out a few minutes later and said that the chicken had actually been prepared on the same surface as another dish which had a peanut paste on it.
“Sarah was in shock and got really upset, as she was terrified. I gave her a shot of her EpiPen and took her to A&E – and, thankfully, because it was only a small contamination, she was fine – but it could have been so much worse.
“I was naturally furious and went back to the restaurant a week later to complain, and said they were lucky we weren’t suing them. It is really terrible, as they didn’t seem to realise how serious it can be. I think it is because these days so many people say they have an allergy, but for the most part they aren’t serious ones, so restaurants, and society in general, think it’s just a fad or an attention-seeking thing – when actually it could cost someone their life.”
[ Death from anaphylaxis extremely rare and unfortunate, despite recent casesOpens in new window ]
My own son had a similar experience a few weeks ago when, like Sarah, he ordered a meal which, according to the menu, was nut-free. He also spoke to the waiter to confirm that this was the case and was assured that it was – they even made a bit of a production of bringing his food out separately, as it had been “personally watched over by the chef to ensure that no nuts went anywhere near it”.
However, within moments of the first bite, the reaction started.
He took medication immediately, and when we queried the waiting staff again, we were told, apologetically, that unfortunately there were walnuts in his dish.
Naturally we were shocked by this appalling breach of safety, and following the administering of his EpiPen, he was rushed to A&E.
Fortunately, both of these cases ended well, but the outcome could have been a lot different. Joyce Clegg, chief executive of The Allergy Clinic, says that despite serious slip-ups such as these, research is still key when it comes to eating out. She urges people with allergies to phone a restaurant in advance to ensure that everyone working there is aware of the situation, and to speak to the manager when you arrive to reiterate.
“The more conversation you have around the dish you are ordering, the better,” she says. “This should be a pleasant conversation, discussing the good food options for you or your child. Buying food in packets can be a lot trickier to navigate, as, while we should be able to trust that all ingredients are listed on the packaging, it is not always the case – so you must be hyper-vigilant around this for yourself.
“But never be afraid to use your EpiPen. It cannot harm you, and will save your life. As soon as you feel the symptoms of anaphylaxis coming on, use your EpiPen immediately. Call for an ambulance, and tell the paramedic that you have an allergy and you have used your Epipen.
“If you or your child [are] not feeling better after five to 10 minutes, use your second pen. Try and remain calm and know your EpiPen will do the job it needs to. Then make sure to get checked by a medical professional, knowing that you may even require an overnight stay in hospital for observation.”
Clegg says there “still needs to be a lot of education around food allergies and anaphylaxis and living with allergies in general in Ireland.
‘Unless you or a family member have experienced an allergic reaction, it can be difficult to understand how serious a reaction can be
— Dr Simon Bull, Allergy Ireland clinic
“This education should come from our schools, and we, at The Allergy Clinic, welcome school principals, teachers, school committees to reach out. We are happy to come in and give EpiPen demonstrations and allergy education to children to alleviate the stigma and hopefully empower our society to potentially save a life someday by simply knowing how to administer an EpiPen to someone in need.”
Dr Simon Bull of the Allergy Ireland clinic in Dublin says he and his colleagues are often asked about what protections are in place to ensure food safety, as it is a very important issue. “The primary body responsible for enforcing food safety [including ingredient/allergen labelling] in Ireland is the Food Safety Authority of Ireland (FSAI),” he says. “Their work is underpinned by a combination of Irish and EU legislation designed to protect consumers from inaccurate information. The Irish Consumer Protection Act 2007 makes it illegal for businesses to provide false or deceptive information about goods or services, including food.
“In addition, EU Regulation No 1169/2011 (Food Information to Consumer Regulation) mandates that food information must be accurate, clear, and easy to understand. It also stipulates that information must not be misleading, especially concerning the food’s nature, identity, composition, and origin, [and] any special characteristics the food may have and the presence of a particular ingredient when it has been substituted.
“In terms of allergen information, food companies have a legal obligation to provide this for both pre-packaged and non pre-packaged foods. For pre-packaged foods, allergens must be clearly listed and emphasised (in bold or a different colour) in the ingredients list. For non-pre-packaged foods, such as those sold in restaurants and cafes, the information must be provided in writing at the point of sale.”
Dr Bull says that if someone encounters an issue with food safety or a misleading label, they have the right to complain and report the incident to the FSAI – this can be done via an online complaint form, which is confidential.
It is vital for people with serious allergies to always be prepared and to carry essential medication with them at all times - and when faced with a reaction to an allergen, to seek medical help immediately.
[ Childhood allergies: ‘We could see our little girl slipping away’Opens in new window ]
“Anyone who suffers from food allergy should carry an allergy pack with them at all times containing two adrenaline pens and a rapid-acting antihistamine such as cetirizine,” he says. “Those with asthma should also carry their blue salbutamol inhaler. If an individual begins to develop symptoms they should follow the Allergy Action Plan provided by their doctor, and for mild symptoms use antihistamine immediately.
“However, for moderate to severe symptoms, they will need to use their adrenaline pen. They will need to ensure that they communicate what is happening with their family, friends or colleagues or by calling an ambulance, if alone. It is essential that once an adrenaline pen has been used, an ambulance is called. They may also require an additional adrenaline pen after five minutes, should their symptoms not resolve, as delaying treatment can be fatal.”
The allergy expert says that some people do not understand the potential severity of anaphylaxis, but hopefully this situation is beginning to change with awareness campaigns. Dr Bull urges anyone who has any concerns about the possibility that they or a loved one may have a serious allergy to speak to their doctor.
“Unless you or a family member have experienced an allergic reaction, it can be difficult to understand how serious a reaction can be, and the tremendous fear and worry that individuals and their families carry,” he says. “Fortunately, there has been a gradual increase in education for the public – although it is essential that allergy awareness and management are further promoted to the public.
“In contrast, should anyone suspect they have an allergy, it is important to seek medical attention to confirm and identify the allergy and to prevent misdiagnosis and resultant unnecessary food avoidance. The first port of call would usually be your GP, who can then refer you to be seen by an allergy specialist.”
Adrian Cummins, chief executive of the Restaurant Association of Ireland, says that, “as per Food Safety Authority of Ireland regulations, all food businesses must declare the presence of food allergens used as ingredients in their foods. This is done by having an allergen handbook on display which is easily accessible for the customer.”
He says that, if someone does not feel confident they can eat a meal exactly as described on the menu — especially when allergies are involved — the safest approach is to take a proactive, step-by-step stance, as given here.
1) Speak up clearly and early
Tell your server about your allergies before you order – don’t wait until the food arrives. Use plain, direct language: “I have a severe allergy to X. Can you confirm if this dish contains any?” If needed, ask them to check with the chef, not just to rely on memory.
2) Ask for ingredient-by-ingredient clarification
Menus can be vague, and recipes sometimes change. Request to see an allergen chart or ingredient list if the restaurant has one (many in Ireland are required to keep them).
3) Confirm how the dish is prepared
Even if a menu item doesn’t contain your allergen, cross-contact in the kitchen can still be dangerous. Ask: “Is there a risk of my food coming into contact with X during preparation?”
4) Trust your instincts
If the staff seem unsure, dismissive or unable to confirm, it’s safest to choose something else – or another venue. No meal is worth a trip to A&E.
5) Carry your safety net
If you have an EpiPen or antihistamines prescribed, keep them on you at all times when eating out.
6) Consider calling ahead
For serious allergies, phoning the restaurant before you go allows them time to prepare, check with suppliers, and ensure your safety.
There are 14 allergens that must be declared by law:
- Cereals containing gluten - wheat (such as spelt and Khorasan wheat), rye, barley, oats. Note: The cereal name eg, “wheat”, must be declared and highlighted, not merely “gluten”.
- Crustaceans eg, crabs, prawns, lobsters
- Eggs
- Fish
- Peanuts
- Soybeans
- Milk
- Nuts (almonds, hazelnuts, walnuts, cashews, pecan nuts, brazil nuts, pistachio nuts, macadamia/Queensland nut). Note: The name of the nut, eg, “almond”, must be declared and highlighted, not “nuts”.
- Celery
- Mustard
- Sesame seeds
- Sulphur dioxide and sulphites (at concentrations of more than 10mg/kg or 10mg/L in terms of total sulphur dioxide) – used as a preservative
- Lupin
- Molluscs eg, mussels, oysters, squid, snails
