Food Protection Trends - September/October 2016 - 377

(b) maintaining clear and open communication betweem customers and restaurant staff; (c) asking a lot of questions; (d) listening for cue words that may imply food allergies; and (e) being willing to listen. Few training guidelines focusing on food allergy risk management for restaurateurs are available (25). Our findings were consistent with results of previous research, as very few restaurant managers had provided training focusing on proper communication between the front-of-house and back-of-house staff, or restaurant staff and customers with food allergies (22). For those managers who included topics related to communication (n = 3) in employee training, most taught their servers to pass allergen-free requests to managers rather than empowering their servers to make proactive decisions. This is concerning, because improper communication between and among restaurant staff and customers with food allergies is recognized as one of the major causes of food allergy reactions in restaurants (16, 20, 23). Merely handing over responsibility to the manager may not properly prepare employees to handle these situations. In addition, most restaurants trained employees about food allergies on a "one-time basis" (e.g., initial orientation) or "every once in a while." Frequent training may be needed, considering the increasing number of customers with food allergies, the variety of food allergens, and high employee turnover in the restaurant industry. Even though food allergy risks cannot be completely eliminated (18), reducing them may be attainable through training that focuses on risk management. Identifying the current status of food allergy risk perception and communication behaviors of restaurant staff may be an important first step in establishing training protocols. Food allergy risk perceptions Most participants (n = 10) were aware of the prevalence of food allergies in the U.S., and one participant indicated that "it seems like every day, more and more people are telling us that they have an allergy when they come in to the restaurant." Some managers (n = 5) were confident of preventing food allergy reactions in their operations because of "the procedures that we have in place" and the fact that food is prepared in a "from-scratch kitchen." Participants presented different opinions about whether serving customers with food allergies was a significant concern in their operations. About half (n = 7) of participants viewed them as a significant concern, particularly because of the severity of allergic reactions. Participants recognized that it is their responsibility to serve food that is safe for customers with food allergies. One participant stated that it was the "establishment's liability to ensure that the need is met," and another stated that "It's our responsibility to not only feed people but feed them a dish that is safe." Even though it was difficult for participants to guarantee allergen-free service because of potential cross-contacts, one participant stated that "[we] would do our best to accommodate their needs." These findings were consistent with previous research findings on restaurateurs' perceptions regarding risks of facilitating and accommodating customers with food allergies (1). Participants also expressed their perceptions regarding specific food allergy risks in their restaurants (Table 4). Previous research has indicated that customers with food allergies perceived the potential for cross-contact in food preparation areas as one of the major causes of food allergy reactions in restaurants (20). Further, about 22% of reported peanut and/or tree nut allergen exposures in commercial foodservice operations were due to crosscontacts from shared cooking equipment or service supplies (16). A majority of participants (n = 9) indicated that potential cross-contact was a significant risk when preparing allergen-free orders. In the kitchen cross-contacts can happen easily, "from something as simple as a cook grilling a piece of fish on a grill and then going to cook a steak for a guest with a fish allergy on the same grill." Participants also identified human errors as one of the contributing factors in potential food allergy reactions. One manager stated, "there is always a risk because a simple mistake can turn into a serious problem" but "we are all humans, we all make mistakes, but it can be life threatening to a person and even severe neglect can cause legal action." Human errors identified by our participants were improper washing of utensils (e.g., "a knife accidentally touches something and there is the assumption that it was washed properly") and cross-contacts from allergenic food (e.g., "there is always a risk of some kind of food cross-contamination [cross-contact] that happens in the back that no one has ever seen before or wasn't aware of." Risk communication scholars admit that zero risk is not realistic or attainable when managing food allergy risks in foodservice establishments (18, 24). Some participants (n = 4) recognized the fact that human errors could lead to serious accidents, and therefore, food allergy risk communication training in restaurants may be needed to minimize these possibilities while serving customers with food allergies. Even though hidden ingredients constitute a relatively well-acknowledged food allergy risk, only one participant recognized them as a risk factor. If service staff is not aware of hidden ingredients, they may give a false sense of security to customers with food allergies. Nearly 50% of reported peanut and tree nut food allergy reactions in the U.S. were caused by hidden food allergens in sauces, dressings, and complex food items such as egg rolls (16). Food allergy risk communication Customers with food allergies perceived miscommunication as one of the major causes of food allergy reactions in September/October Food Protection Trends 377

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