Eating out is often a scary experience for someone with food allergies. Instead of relaxing all evening, he needs to convince a strange waiter and a cook he'll never see to follow strict instructions.
But on Thursday, Massachusetts became the first state to officially put some of the responsibility on restaurants.
Under new regulations, some 24,000 restaurants statewide will have to educate their staffs on food allergies and require managers to get a certified through a food allergy training course.
Suzanne Condon, director environmental health assessment for the Department of Public Health, said she hopes walking into a restaurant and seeing the food allergy certification on the wall will put some customers at ease.
"The certification is the most significant, I think, in terms of food safety training," said Condon.
Restaurants also will have to post information and instructions about food allergies in a staff area, and are required to print the warning: "Before placing your order, please inform your server if a person in your party has a food allergy" on menus.
Dr. Clifford Bassett, an allergist with the New York University School of Medicine, applauded the effort.
"The responsibility is shared -- on the patron, on the restaurant, on the food allergist -- to make sure they have a food allergy action plan," said Bassett. "Most restaurants don't do it, because what if the chef changes the recipe, or what if the chef changes where he gets the ingredients."
Bassett encourages his patients to bring a laminated card with instructions about their food allergies when they go out. This way they can hand the card to the waiter and the message will not be lost or forgotten by the time it reaches the kitchen.
Tarlan Ellis, 29, sees Bassett regularly for her allergies, including an allergy to seaweed.
"I'm quite lucky," said Ellis. "I just have to make sure I don't eat it. I can eat stuff that's been in contact with it, but I can't seaweed itself."
Others with allergies can have an anaphylactic reaction merely by eating something that's touched a peanut, shellfish or milk.
What to Do When Dealing With Food Allergies
Ellis carries an EpiPen with her, just in case she goes into anaphylactic shock, and she also orders carefully. But she still believes some responsibility lies with the restaurant staff to protect patrons.
"I think both are responsible," she said.
However, even doctors who treat food allergies don't necessarily agree.
"I'm a person who believes that you teach patients how to take care of yourself, and not rely on other people to take care of you," said Dr. Richard Lockey, director of allergy and immunology at University of South Florida College of Medicine.
"I believe the responsibility should be the customer's," he said.
Lockey questioned the cost effectiveness of educating tens of thousands of employees, many of whom are only in the profession for a few years.
Food allergies occur in 6 to 8 percent of children under age 4 and in 3.7 percent of adults, according to the National Institute of Allergy and Infectious Diseases.
"To me, a patient information program would be much more cost effective than having people in restaurants trained," said Lockey, who also recommended a program to provide EpiPens for people with food allergies.
Who Pays for It, Should They Pay?
Condon said the state found food safety training programs that volunteered to run the food allergy education free of charge for the state.
"They may charge some nominal fee for the certificate and training process, but we don't ask," said Condon.
Once a restaurant's managers are certified, Condon expected that the certification and food allergy education will be checked several times a year by local health inspections.
Dr. Scott H. Sicherer, of the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York City, said studies have shown both patients and restaurant workers have a long way to go in learning how to deal with a food allergy.
Misconceptions About Food Allergy Safety
Sicherer completed a study of 100 employees in 100 New York restaurants in 2007 and found that most people had no food allergy training.
"Although over 70 percent expressed comfort in providing a safe meal, numerous misconceptions were found when we posed specific question about food allergy," said Sicherer.
For example, 24 percent of the restaurant employees thought a person could eat a small amount of the food to which they are allergic, 35 percent thought a fryer would destroy allergens, and a quarter of people thought it would be acceptable "to simply pick nuts from a finished meal to make it safe."
"None of these practices would be safe," said Sicherer. "Having training, raising awareness and increasing communication between the restaurant personnel and the person with food allergies will go a long way in making restaurant meals safer."
But Sicherer did a complementary study of restaurant patrons with food allergies, and found that often their communication of an allergy could be unclear.
"The problem we know is that sometimes the food allergy isn't communicated properly," said Sicherer. "If you say, 'I'm allergic to peanuts; even a small amount will make me sick,' that's different than saying, 'Hey, does that cake have peanuts in it?'"
Sicherer's research also has found that eating out is one of the major "quality of life" issues for people suffering from food allergies.
Chris Weiss, vice president of advocacy and government relations at the Food Allergy and Anaphylaxis Network (FAAN), said the legislation was a long ways coming.
"We track food allergy fatalities over the years," Weiss told MedPage Today. "We have looked at 63 deaths (in a 10 year period) and found almost half were caused by restaurants."
Weiss hoped that Massachusetts' regulation would catch on.
"We hope that other states will follow the lead," he said.
MedPage Today's Emily Walker contributed to this report