Restaurant takeout practices of food-allergic individuals and associated allergic reactions in the COVID-19 era

In a US national registry study, 19% of food-associated fatalities occurred in restaurants.1,2 Although restaurant staff may feel comfortable providing allergen-safe meals, deficits exist in staff training and knowledge of food allergies.3,4 A recent analysis of national survey data showed that the home accounts for 51% of food-allergic reactions in children.5 Some of these reactions could result from restaurant takeout, but takeout was not specifically assessed. [...]certain precautionary strategies may have different levels of effectiveness compared with others. Restaurant staff lack of knowledge is also likely.3 A high percentage of restaurants had no menu allergen labeling (35.8%), and there was a borderline difference in this category between those who did and did not react (P = .06), which suggests that this could be a focus area and may reflect increased allergen awareness and protocols in those establishments (ie, better communication and knowledge). Allergists should carefully discuss risks with patients, promoting clear communication and asking and educating about cross-contact and hidden ingredients.7,8 Mandating the declaration of allergenic ingredients on menus, encouraging free text options for food allergies to be declared by individuals ordering takeout, and regular and effective restaurant staff training may be helpful in reducing risk.8 Prior studies from the hospitality industry also indicate interest from restaurants in obtaining additional food allergy training.9 Together, these efforts may improve takeout experiences among food-allergic individuals, so that food can be enjoyed safely.Online Repository Takeout characteristics Reacted, n (%) (n = 28) No reaction, n (%) (n = 144) P† Ordered takeout 27 (96.4) 131 (91.0) .47 Takeout precautions Write child's food allergy in online order 11 (39.3) 66 (45.8) .52 Call restaurant to discuss allergy 23 (82.1) 94 (65.3) .08 Visually inspect dish 12 (42.9) 49 (34.0) .37 Other 3 (10.7) 20 (13.9) 1.00 None 1 (3.6) 7 (4.9) 1.00 Takeout mode Online application 7 (25.0) 59 (41.0) .11 Restaurant website 7 (25.0) 56 (38.9) .16 Telephone order 24 (85.7) 105 (72.9) .15 Menu allergies declared∗ .06 Yes, all of the time 1 (3.7) 15 (11.5) Yes, most of the time 3 (11.1) 18 (13.7) Yes, half of the time 1 (3.7) 5 (3.8) Yes, some of the time 7 (25.9) 51 (38.9) No 15 (55.6) 42 (32.1) Restaurants for orders American 17 (60.7) 82 (56.9) .7119 Bakery 1 (3.7) 10 (6.9) 1.0000 Deli 8 (28.6) 31 (21.5) .42 Chinese 15 (53