For most people, a meal out is an experience to be savored, free from the worry and stress of food preparation and cleanup. But dining out is not completely worry-free, especially for people who have food allergies.
"I'm a foodie and I can't eat half the stuff," said Sloane Miller, president of the advocacy group Allergic Girl Resources Inc. in New York. Miller has severe nut and salmon allergies as well as allergies to some fruits and vegetables.
Given her restraints, Miller may be one of the smartest diners in New York.
"As an allergic diner, when I find a restaurant that is happy to accommodate my needs, I go back again and again," said Miller, who dines out five to 10 times a week.
And restaurants must be listening. Miller is just one among 12 million Americans who have food allergies, according to the Virginia-based Food Allergy and Anaphylaxis Network.
Though many of the larger, chain restaurants already offer allergy-friendly dining, the practice is gaining a steadier foothold in higher-tier restaurants, industry observers say. Places such as Blue Ginger in Boston and Bistro 110 in Chicago -- leaders in allergy-friendly dining -- are setting the bar for how independent restaurants feed their allergic clientele.
Often, the chefs at these restaurants begin by setting the bar at home. Ming Tsai, executive chef and owner of Blue Ginger -- an Asian restaurant outside Boston -- has a son who is allergic to seven out of eight top allergy triggers.
"It's amazing that people don't realize how a molecule can kill," Tsai said.
Tsai takes pains to make sure there are no wayward molecules in his kitchen. The crux of his modus operandi is his "bible," a notebook detailing the ingredients in each component of each dish on the menu. Allergens are noted prominently and many dishes are modifiable for specific allergens.
"With this system in place, the degree of negligence and human error is reduced," Tsai said.
Combined with a high level of communication between customers, wait staff, managers and the kitchen, Tsai estimated that he and his team may have made three mistakes in 10 years of operation -- and Blue Ginger serves about 15 allergic customers each night.
"It is your absolute right to be able to eat anywhere you want safely," said Tsai, who takes issue with restaurants that decline to serve customers because they are unsure of what ingredients are in the food. "I don't buy it. ... You can't be like that in retail. You can't say, 'I don't know.'"
But some would apparently rather say that they are not able to serve you a certain dish rather than risk a customer having an allergy attack. Sheila Weiss, director of nutrition policy in the health and safety regulatory affairs department of the National Restaurant Association in Washington, D.C., pointed out that there may be a situation in which, for example, an item comes from a supplier and it is unclear whether the food contains an allergen or was cross contaminated with a potential allergen during preparation or packaging.
"We have to let [restaurants] know that it is okay to tell somebody, 'No, this is not a safe food for you and I don't know all the ingredients in it,'" Weiss said.
As a diner with allergies, Miller agreed.
"I don't see it as an offense. It is honest communication," Miller said, adding that it is the patron's responsibility to be informed and vocal about their allergies and identify themselves to the restaurant staff. In turn, it is the restaurant's responsibility to say to what extent they can feed that person.
"Once you take your own needs seriously and respect them, other people respond to that," Miller said.
But this was not always the case. The restaurant industry has been slow to embrace food allergy, given how difficult it is to train staffs that have a high rate of turnover, said Anne Muñoz-Furlong, who's chief executive of the Food Allergy and Anaphylaxis Network. In addition, the process of calling food suppliers to learn what ingredients are in the foods restaurant kitchens buy can be difficult.
But Dominique Tougne, executive chef at Bistro 110 in Chicago, said he believes attitudes toward the process are changing.
"For most of the [chefs], it used to be the pain in the butt," Tougne said. "Things have changed. People really pay attention to those people."
Like chef Tsai, Tougne also has children with serious food allergies, and he pays close attention to diners with allergies at his restaurant.
Tougne launched a new series of allergen-free dinners this year targeting one category of food allergy at a time. Tougne wanted to show that classic French cuisine can be adapted and enjoyed by people who might not be able to eat unmodified French food.
"This can't be considered a trend," Tougne said. "The allergic reactions of the people are not going to go away in six months."
Dr. David Resnick, director of the Allergy and Immunology Division at New York Presbyterian Hospital, estimates that there are about 200 fatalities each year from food allergies, with the highest incidences of death among teenagers and patients of any age eating in restaurants.
And then there are the thousands of people who survive the often scary and dangerous reactions from food allergies every year.
"At the present time there is no treatment [for allergies]," Resnick said. "The only treatment is avoidance."
Many of the large, family-style chain restaurants get it. About 3 million children in the United States have food allergies, according to the allergy network.These children eat out with their families, and the restaurant industry reflects that demographic. Places like McDonald's, Outback Steakhouse, and P.F. Chang's China Bistro post their menus online, provide nutrition and allergen information, and sometimes offer limited allergen-free menus. These restaurants also may include sessions on allergies and safety in their staff training.
But as children with allergies get older, they will be going to a wider variety of restaurants. Being offered limited menu items or getting turned away because the kitchen is not careful about cross contamination with potential allergens will be unacceptable, industry observers say. These restaurants will need to have systems in place to handle food preparation for allergic customers, the allergy network's Muñoz-Furlong said.
And paying attention pays off.
"It makes good business sense," Muñoz-Furlong said. "They become your best customers because they're very loyal."
Chefs Tsai and Tongue believe their business increases as their reputation for being allergy-friendly grows.
But there is still more to do, they say. Tsai is working with the Massachusetts on a bill to help facilitate food allergy awareness in restaurants with a few simple measures such as posters and notices on menus to remind customers and servers to ask about allergies.
"As good as we are, we'll never be 100 percent safe," Tougne said. "We just have to be extremely vigilant and careful."
For Allergic Girl's Miller, the best taste scenario is one in which both she and key people at a restaurant are communicating clearly and often about her needs. On a recent night out, Miller arrived at a steak restaurant for dinner, having called beforehand and being told that they would be happy to accommodate her. That evening, the staff was ready and waiting for her.
"The chef came out and walked me through the menu, step by step, dish by dish," Miller said. "I ordered with ease, the food came out. ... The chef came by to see that everything was prepped to the specifications, and I called the next day to thank the general manager."
Miller said she enjoyed the meal all the more because she was relaxed and confident that her food was safe.
"It's a hospitality business," Miller said. "That's what they want for everyone."