Allergies 101: Taking steps toward a safer dining experience

By Joni Huang
November 24, 2015

Anaphylaxis, the most serious type of allergic reaction, is a growing public health concern. With an estimated two per cent of Canadians – approximately 700,000 people – at risk of anaphylaxis from food and insect stings1, the restaurant industry faces an increasing number of requests to accommodate food-allergic diners. You can help prepare your staff for these requests by informing them about the basics of food allergies and anaphylaxis.

In Canada, the most common food allergens that cause anaphylaxis are peanuts, tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, walnuts), milk, egg, mustard, sesame, soy, wheat, seafood (including fish such as trout and salmon) and shellfish (crustaceans such as lobster and shrimp, as well as molluscs such as scallops and clams).

Safety basics

For people with food allergies, avoiding the allergen(s) is the only way to prevent an anaphylactic reaction1. When dining out, these individuals should inform the hostess and server of their allergies and ask the manager or chef about ingredients and food preparation practices. While much of the responsibility rests with the food-allergic diner, there are steps your staff can take to create a safer and more pleasant dining experience. It is important that staff:

Understand the seriousness of food allergies

  • Very small amounts of a food allergen can trigger an allergic reaction when eaten
  • Allergic reactions can happen quickly and become life-threatening

Be familiar with the restaurant’s allergy policy and procedures and know their respective roles

  • Ingredient information – Are lists detailed, up-to-date and accessible?
  • Cross-contamination – Do staff understand what it is and how the transfer of food allergens can happen (some examples: hand-to-food, food-to-food, utensil-to-food, surface-to-food in food storage, preparation, cooking or serving)?
  • Communication – What is the process for managing food allergens and how is information shared with others? How is information collected from, and provided to, food-allergic diners?
By answering these questions, you and your staff can minimize the risk of accidental exposure, provide information to help food-allergic diners make informed menu choices and lessen the possibility of an allergy-related incident in your establishment.

Recognizing the symptoms

Despite your best efforts, anaphylactic reactions do sometimes occur and it’s best for staff to be able to identify and respond to an emergency.

Symptoms of anaphylaxis generally include two or more of these body systems: skin, the respiratory system and the gastrointestinal and/or cardiovascular systems. To remember the potential symptoms of an anaphylactic reaction, it can help to “Think F.A.S.T.”2:

Face – customers may experience hives, itching, redness, or swelling of the face, lips or tongue

Airway – customers may have trouble breathing, swallowing or speaking, or may experience nasal congestion or sneezing

Stomach – customers whose gastrointestinal systems are affected may experience stomach pain, vomiting or diarrhea

Total Body – customers having a “total body” reaction may experience hives, itching, swelling, weakness, dizziness, a sense of doom or even loss of consciousness

Symptoms can appear within minutes of exposure to an allergen or may take longer to develop in some cases. Additionally, symptoms can vary from one person to the next, and even from one reaction to another in the same person1. Because anaphylaxis is unpredictable, it should always be treated as an emergency situation.


The first-line medication used to treat anaphylactic reactions is epinephrine. In Canada, the EpiPen® brand of epinephrine auto-injectors is available. These devices contain a needle and a pre-measured dose of epinephrine, with the dosage based on a person’s weight. It is recommended that individuals with potentially life-threatening allergies carry epinephrine with them at all times.

Dealing with an emergency

According to the consensus guidelines contained in Anaphylaxis in Schools & Other Settings, allergic individuals should follow these five steps in the event of a life-threatening allergic reaction:

  1. Give epinephrine at the first sign of a reaction
  2. Call 9-1-1 or local emergency medical services
  3. Give a second dose of epinephrine as early as five minutes after the first dose if there is no improvement in symptoms
  4. Go to the nearest hospital right away (ideally by ambulance) and stay for possible treatment and observation
  5. Call an emergency contact person

Someone experiencing anaphylaxis may not be able to self-administer epinephrine. If this is the case, a family member or friend who is with them may be asked to help. If the person is alone, a manager may be asked to help3.

Stock epinephrine

An undesignated or “stock” epinephrine auto-injector refers to a device which is not prescribed for a specific person. This medication may be used in an emergency to help someone who is experiencing an anaphylactic reaction but does not have his/her own epinephrine available, is experiencing a first-time reaction or needs a second dose. In Canada, epinephrine auto-injectors can be purchased without a prescription.

Some restaurants have taken a proactive approach by having epinephrine (e.g. EpiPen®) on hand in their establishments. Chris Christidis, owner of Ice ‘n Cake, decided to purchase two EpiPen® auto-injectors for his Toronto restaurant. He explained: “I thought it was important to take every precaution for my customers. The cost of these devices is a small price to pay for someone’s safety.” Similar initiative has been shown by La Cage aux Sports, the first restaurant chain in Quebec to have EpiPen® auto-injectors in each of its 51 locations.

Other resources: 

By being aware and better prepared, your staff can create a safer and more enjoyable dining experience for people with food allergies. The efforts taken to accommodate the needs of the food-allergic diner will not go unnoticed!

EpiPen®, EpiPen® Jr are registered trademarks of Mylan, Inc. licensed exclusively to its wholly owned affiliate, Mylan Specialty, L.P.; sub-licensee, Pfizer Canada Inc. This article is supported by Pfizer Canada Inc.

  1. Anaphylaxis in Schools & Other Settings, 3rd Edition.
  2. Think F.A.S.T. concept developed by Anaphylaxis Canada.
  3. Allergen Training Basics for the Foodservice and Food Retail Industry.

Editor’s Note: A previous version of this article referenced Allerject brand epinephrine, which was voluntarily recalled across Canada and the United States. This article has been edited to reflect the recall. Please visit for more information.
See also:

About the author:

Joni Huang has been involved with the development of anaphylaxis-related educational resources for nine years and has worked with different national organizations, including Anaphylaxis Canada and the Canadian Society of Allergy and Clinical Immunology.

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