While food allergies were once thought to be more common in children, they are now more prevalent in adults. With 1 in 20 adults in the UK with a confirmed food allergy (Food Standards Agency 2024), we hear from the food allergy community what they would like businesses to do to create more inclusive and safer dining experiences.

My name is Claire McGuigan and I am a nurse lecturer at The Open University based in Northern Ireland. I have developed a passion and specialist interest in food allergy research, born out of necessity. Like many parents I speak to, I knew very little about food allergies before my daughter was born with a long list of them, including cow’s milk protein allergy and eggs! 

At that time, I knew how dangerous nut allergies could be, but I was shocked when I discovered that my baby might die from drinking milk. This seemed crazy! 

Research on food allergies is emerging swiftly yet we still hear that people are dying in the UK from food-induced anaphylaxis. One death caused by a food allergy is one too many! 

A demographic study carried out in the United Kingdom from 1998 to 2018 revealed that food-induced anaphylaxis was the cause of 152 deaths and that over 30,000 hospital admissions were linked to the condition (Baseggio Conrado et al., 2021).  From this work, it seems that nuts and tree nuts are the most common cause of death in young adults while cow’s milk is the most common single cause of death in school-aged children.

Data from the USA states that those at greatest risk of death are those under 35 years old. Adolescents and children carry a bigger risk as they depend upon others to keep their food choices and environments safe. This seems to be the case in the UK too. 

For example:

• In 2016, 15-year-old Natasha Ednan-Laperouse suffered an anaphylactic reaction to the hidden sesame seeds, baked into the dough of the baguette, she ate onboard a BA flight to NICE and died later that day.
• In 2017, recently turned 18-year-old Owen Carey was celebrating his birthday with family and his girlfriend on a day out in London on 22nd April 2017 when he died after developing an anaphylactic reaction to something he ate.
• In 2018, 18-year-old Shanté Turay-Thomas died following an anaphylactic reaction after eating hazelnut.

Tanya Ednan-Laperouse and Emma Turay are two mums who have suffered every allergy parent’s worst nightmare: the loss of their daughters to anaphylaxis.

In 2016, Natasha Ednan-Laperouse (15yrs) suffered an anaphylactic reaction to the hidden sesame seeds, baked into the dough of the baguette, she ate onboard BA flight to NICE and died later that day. In 2018, Shanté Turay-Thomas (18yrs) died following an anaphylactic reaction after eating hazelnut.

The Owen Carey family outside Southwark Coroner’s Court, holding a large portrait of their son who died from anaphylaxis.Show description In 2017, Owen Carey had just turned 18 and was celebrating his birthday with family and his girlfriend on a day out in London on 22nd April 2017 when he died after developing an anaphylactic reaction to something he ate.

The number of people living with food allergies is increasing globally with no cure in sight. Currently, the best way to manage this condition is to avoid known allergens and to always have access to emergency medication.

To help businesses, this research and knowledge exchange project explains what a food allergy is, and how living with food allergies can impact all aspects of a person’s life. It also shares some experiences of how current business models are excluding people from eating out of the home safely. It offers some ideas on how they can become more open to meeting the needs of those with food allergies. With 1 in 20 adults estimated to have a food allergy in the UK, it makes good business sense to do just that.

Project Outcomes

• A UK-wide public health awareness campaign on food allergies is needed. Food allergy is not the same as food sensitivity. Food allergy is not a choice. Food allergy is a medical condition.
• This invisible condition of epidemic proportions needs to be normalised in conversations, supported in policy, and visible in everyday practices. 
• Some people with food allergies have told us that they often go hungry if they forget their ‘safe snack’, as they don’t have access to suitable convenience food on planes, boats, trains places of work, and hospitals. They call for more choice and access to safe foods, and clearer food labelling which is essential to keeping this community of people safe. 

• There is a call for the current practice, where some restaurants are asking those with food allergies to sign indemnity waivers when eating out, to stop immediately, and for a more inclusive approach to be found. 

• This project identified that the current  ‘may contain’ and ‘vegan labelling’ is further reducing, what is already a limited choice of food for many of those with food allergies. They call for more work on the accuracy and reliability of food labels for their safety.
• Participants reported an astounding lack of knowledge among food servers and called for a mandatory level of food allergy education for all staff working in the food service industry. 
• They go further suggesting that this education should be regulated by the UK Foods Standards Agency and would like to see a visible image that indicates which food establishments have a high level of food allergen safety practices in place. 
• They suggest a simple way to do this is by changing their hygiene rating score to purple to show the allergy community that those serving food on these premises have acquired the right level of food allergy education. They feel such an initiative has the potential to create cultures of safety, create inclusive practices, offer more choice, and uphold their social freedoms to dine out of home safely. Additionally, they see that businesses could potentially increase their profit by targeting this market.

Businesses currently play an important role in enabling or denying those living with food allergies the opportunity to eat out of home safely. The call here is for businesses to know their food allergy community and adapt their business models to safely include them. Explaining how the quality of life and social activities of those living with food allergies are influenced by business is also important.

The three episodes in this ‘Making Food Allergies Your Business’ podcast series have been created to help those working in the food service industry learn more about food allergies and encourage them to think differently about how they can make more inclusive practices to support those with food allergies to eat out of home safely. Change starts with us! One person at a time! Be the change others need!

The contents of this podcast series are for educational and informational purposes only. They are not intended to be a substitute for professional medical advice. Listeners are advised to consult with appropriate medical practitioners for advice on the diagnosis, treatment and ongoing supportive management of food allergies.

Podcast 1: Catriona Walsh              

Always ASK about food allergies

In this first podcast, Claire meets Catriona Walsh, a former paediatric medical consultant, now a Belfast-based Nutritionist, to talk about what food allergies are and research that has identified how and when food servers should ask dining customers about food allergies. The call to action here is for everyone to take food allergies seriously. The recommendation is that as a society we need to make it everyone’s business to learn more about food allergies and how to keep people safe when eating out. Always ASK about food allergies!

Note: Please be aware that research and guidance on how to administer EpiPens may change over time so be sure to follow the most up-to-date guidance.

Transcript

• Find out more about Catriona here.

Podcast 2: Claire McGuigan              

Inclusive food allergy practices

In this interview, you will hear from Claire; about the raft of emotions such as fear and anxiety people experience when eating out of home. People have told us that they have been asked to leave restaurants because they cannot be catered for while others have been asked to sign indemnity waivers if they wish to stay and eat! 

The widespread lack of staff knowledge of food allergies and limited food choices are cited as ways in which business practices exclude people with food allergies. This sense, that the needs of customers with food allergies are being disregarded by businesses, has led to the call for mandatory food allergy education for all staff and inclusivity across society. 

Transcript

• Find out more about Claire here.

Podcast 3: Jeremy Chan              

Businesses can do more

In this final interview, Claire McGuigan meets Jeremy Chan, owner of Sinley Chinese Takeaway Restaurant in Cookstown, Northern Ireland. This family-owned business has been serving the local community for over 50 years and he is now exploring ways to include and serve those with food allergies. They discuss how he is currently adapting his working practices and menus so his business can make safe food for those with food allergies. 

Transcript

• Find out more about Jeremy here.

Useful resources

Feel free to download and use these poster images from the project as educational resources, but please include our OU reference.

Always ASK about food allergies

Show descriptionThis illustration guides how to handle customers with allergies in a restaurant setting. The image is divided into three sections, each depicting a different stage of interaction between staff and customers, emphasizing the importance of communication about allergens. ASK: In this section, a male waiter is shown asking two standing female customers about their allergies. The text advises always asking about allergies and allergens. ASK AGAIN: Another waiter is depicted explaining the menu to a seated customer and asking again about allergens. The text emphasizes the importance of speaking up to keep everyone safe. COMMUNICATE: In the final section, a chef stands in front of cooking stations, informing a waitress about dish ingredients. The text advises that if there’s any doubt, the staff should tell the customer and avoid serving the dish. The image uses steps connecting each section to show progression in communication regarding allergies.

This is how people with food allergies feel when eating out of home

Show descriptionThis image illustrates the feelings of exclusion and discomfort that people with allergies can experience in social settings, particularly in restaurants. It is divided into two contrasting scenes. On the left side, a lone individual sits at a table with a red top. Surrounding texts express feelings of exclusion: “Worried,” “Singled out,” “Anxious,” “Marginalized,” “Misunderstood,” and “Embarrassed.” A bold caption reads: “I FEEL EXCLUDED.” The right side shows a busy restaurant scene with customers at tables and counters. People are engaged in conversations and enjoying their meals. Texts express the need for inclusivity: “WE NEED TO BE MORE INCLUSIVE,” “On alert,” and “Cautious.” At the bottom, a call to action reads: “Making Allergies Your Business.”

What can you do to help?

Show descriptionThis illustration provides a visual representation of a dining area and kitchen, aiming to educate on the importance of being aware of customers’ allergies. The image is divided into two main sections: On the left side, there are five numbered steps listed vertically: Design your menu simply to make it inclusive, source and check ingredients in the supply chain; label and store ingredients safely. Demonstrate effective leadership for safety and accountability, and ensure all staff know how food is prepared and cooked, communication is key to safety—advocacy, inclusion, safety, and caring staff values. Kitchen staff are shown preparing food. In the centre, diners are seated at tables with phrases like “SAFETY CULTURE” and “CUSTOMER EXPERIENCE” nearby. Text asks, “How do you know who has an allergy?”. On the right side, various allergens such as “NUTS,” “MILK,” “PEANUTS,” “SULPHITES,” “GLUTEN,” “SESAME,” “SHELLFISH,” “MOLLUSCS,” “MUSTARD,” “EGG,” “SOY,” “FISH,” and “LUPIN” float above diners’ heads. A phrase at the top reads: “Making Allergies Your Business.”

Further resources

Here are some other helpful resources:

Anaphylaxis UK Adult allergy poster 562.7 KB

https://www.sparepensinschools.uk/teaching-videos/

Top 14 Food Allergens | Allergy UK | National Charity

EUROPEAN FOOD ALLERGEN LEGISLATION AND GREAT RESOURCES | Dimitrios Journeys (buhalis.blogspot.com)

https://owens-law.co.uk/

https://www.narf.org.uk/natashaslaw

References

Baseggio Conrado, A., Ierodiakonou, D., Gowland, M.H., Boyle, R.J. and Turner, P.J. (2021) ‘Food anaphylaxis in the United Kingdom: analysis of national data’, 1998-2018. BMJ, p.n251. DOI: https://doi.org/10.1136/bmj.n251.

Food Standards Agency 2024 - Feinmann, J. (2024) ‘Up to 6% of UK adults might have a food allergy, says report’, BMJ, pp.q1122–q1122. DOI: https://doi.org/10.1136/bmj.q1122.

Credits

This article is one component of the research project endorsed by the Royal Society for Public Health UK and the Food Standards Agency UK.