Having a food allergy used to mean dining out was limited to carrying your plate from the kitchen to the porch or, at best, eating at the home of a close friend or relative who could guarantee your food offenders were nowhere in sight.
Today, however, eating out is a lot easier -- and safer -- for the 2 million Americans who suffer with a mild, moderate, or even a severe food allergy. One reason: Restaurants are more aware and more prepared.
"The awareness of food allergies has definitely increased within the food service industry, and many restaurants now take steps to not only train their staff about the need for accommodating those with a food allergy, but also train them on what to do if an allergic reaction occurs," says John W. Fischer, associate professor and restaurant manager of Escoffier Restaurant at The Culinary Institute of America.
Among the most important steps in this direction is a training program for restaurants introduced by the Food Allergy and Anaphylaxis Network (FAAN) and The National Restaurant Association several years ago.
Developed as both an educational and informational tool, the program not only helps make restaurants more aware of food allergies, but also what to do in the event that an allergy-related incident occurs.
Medical doctors caution, however, that greater awareness on the part of the restaurant doesn't mean you can let your guard down completely.
"The level with which you practice vigilance is obviously linked to the severity of your food allergy -- but everyone who is allergic needs to personally take steps to ensure their safety when dining out," says David Rosenstreich, MD, director of the division of allergy and immunology at Montefiore Medical Center and professor of medicine at the Albert Einstein College of Medicine in New York.
Where do you begin? Experts say it starts with a good understanding of your food allergy.
Food Allergies: Know What to Avoid
Clearly, the most obvious way to avoid having a food allergy reaction while eating out is not to order the offending food. But that's not always so easy. Sometimes you can’t fully see what you're getting on your plate.
"You really have to be aware of hidden ingredients. Your allergen could be lurking in breading, a salad dressing, baked goods, or sauces, then it might not be obvious when your meal arrives," says Jonathan Field, MD, director of the Allergy and Asthma Clinic at NYU Medical Center and Bellevue Medical Center in New York.
You should also know the other names for your offending foods. Sometimes, Rosenstreich says, products used by chefs -- such as mixes for sauces or dressings -- list ingredients by alternate names. That means if you're going to request that something be left out of a dish, it's vital to know all the terms, including derivatives under which your allergen may be listed.
The FDA considered this step so important it instituted the Food Allergen Labeling and Consumer Protection Act in 2004, which mandated that all food manufacturers clearly label product ingredients as they relate to eight major food allergies by 2006. Before the law, people with a dairy allergy, for instance, may not have realized that the ingredient labeled "casein" was really a protein from milk. Now the product must say "milk."
Still, experts caution this law only pertains to the eight most common food allergens: milk, eggs, wheat, soy, peanuts, tree nuts, shellfish, and regular fish. These are responsible for more than 90% of all U.S. food allergies.
Food Allergy Surprises: Hidden Sources
Here are the most likely places key food allergens may be lurking, according to the experts WebMD interviewed.
Hidden sources: hot dogs, canned tuna, some chewing gum, margarine made from corn oil (skim milk powder), granola bars, chocolate chips, desserts containing caramel coloring, brown-sugar flavoring, coconut-cream flavoring, natural chocolate flavoring, grilled steak (many restaurants rub steaks with butter after grilling).
Hidden sources: Milky Way or Snickers bars (nougat contains eggs); any baked good with a shiny surface, including bagels and pretzels; the foam on some coffee drinks; the pasta in prepared foods such as soups.
Hidden sources: Barbecue sauce, bouillon, chili (nuts are used sometimes as thickener).
Hidden sources: Hydrolyzed wheat protein is sometimes listed only as a flavor enhancer or binder in prepared foods and sauces, alcoholic beverages, hot dogs, ice cream cones, licorice, soup mixes, coffee creamer substitutes (grain based), butter flavoring, caramel coloring, some brands of butter, couscous.
Hidden sources: Caesar salad (anchovies); caponata (Italian relish/anchovies); foods fortified with omega-3 fatty acids (fish source), including some orange juice, baby cereals, and soymilk.
Choosing a Restaurant
While what you order is important, where you order it matters, too. That's because some restaurants are more likely to not only accommodate your food allergy, but also be better educated on how best to do that.
Not surprisingly, Fischer says that the larger and more established a restaurant is, the more likely it has dealt with food allergies in the past. So the staff is less likely to be surprised or thrown by your requests.
Other good alternatives are corporate chain restaurants -- places like Olive Garden, Applebee's, or Ruby Tuesday. Fischer says chains often have tighter controls on their menus and ingredients than independently owned restaurants, so the staff is more likely to know exactly what's in each dish.
Field agrees. "While a local mom-and-pop restaurant may be more likely to veer from the norm in an effort to please you, there is also more variability in these places, so the dish may not be cooked the same way twice, and that can be a problem," he says.
And while not every restaurant staff can tell you exactly what's in every dish (many chain establishments use precooked foods that are only heated on site), most of their corporate web sites provide either a menu listing major ingredients or an email address where you can access specific recipe information. Some, like Olive Garden, provide recipes online so you can find out exactly what is in the food on the menu.
Food Allergy: Preplanning Strategies
Phone the restaurant ahead of time and find out what its policy is on serving people with food allergies. "Ask if they have accommodated other people with food allergies and ask what they ordered, and how they went about letting the restaurant know about their problems," Field tells WebMD.
Tell the wait staff about your food allergy when you arrive. Having an allergy card to hand to your server may help, too. These small business-size cards feature your name and food allergy and all offending ingredients with a request that the kitchen leave them off any dish you order.
You could also try "Allernotes," preprinted sticky notes detailing your food allergy that the server attaches directly to your order. Allernotes sell for $8.50 for 100, while printable allergy cards are available free online.
If you'll be traveling to a foreign country, for $10 you can create a food allergy card in your native language that is then automatically translated into the language of your choice.
While they cards won't replace a discussion with restaurant staff, they can help you get your message across.
Make sure to have your food allergy medications with you such as injectable epinephrine and an antihistamine. A severe allergic reaction can be life-threatening, so it is important to have your emergency medication with you.