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.
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.
Condon said the state found food safety training programs that volunteered to run the food allergy education free of charge for the state.