The tingle comes first. A prickly feeling in the back of the throat, like cobwebs or tangled hair, impossible to swallow down or cough out. Then, lips, cheeks, and tongue bloat into edema. Skin flashes pale white or scarlet red. Blood pressure plummets. A forest of hives burst across the neck and hands.
If paralysing shock hasn’t already set in, then the throat begins to swell, throttling last gasps of air. This is the sudden horror of anaphylaxis, the most savage and severe kind of allergic reaction. It is a catastrophic overreaction, an unintentional self-destruct: the body’s immune system believes itself under attack from an outside agent, and releases floods of histamine.
At best, it means hospitalisation. At worst, death. It’s what killed 15-year-old Natasha Ednan-Laperouse, on a holiday flight to France in 2016, after she ate a baguette from Pret a Manger that contained sesame. It’s what killed Owen Carey as he was celebrating his 18th birthday, after a chicken burger marinated in buttermilk set off his dairy allergy.
For those who carry severe allergies with them for a lifetime, eating out has always been a calculated risk. Whether in a trendy new restaurant, a high-street sandwich shop, the local pub, or a corner takeaway, an immense degree of trust must be placed in the competency, attention, and knowledge of servers and cooks. Any false step – a tainted saucepan or cross-contaminated condiments – might mean the end.
Available data is thin, but a recent study of hospitality workers in Düsseldorf found that a third of those surveyed thought the best way to treat a customer’s allergic reaction was to give them water. So, is it better to die, or be a tad rude?
We allergics are familiar with the tact required in sending waiting staff back to the kitchen twice, even three times, to guarantee safety. We quickly acquire a sixth sense for blasé answers or dismissive guarantees. Since about the age of 16, I’ve rehearsed my (potentially life-saving) speech to countless waiters and roadside vendors. “I have a severe allergy to eggs and nuts. All nuts: peanuts, hazelnuts, almonds, you name it. And I mean severe, as in anaphylaxis. There’ll be an ambulance outside, and,” I say with the most encouraging smile possible, “it’ll be your fault.”
Cafés and diners that serve eggs dawn to dusk are a zone of Chernobyl-like contamination for me: a sliver of halloumi fried on the same surface that earlier scrambled an egg will invoke the familiar tingle. Entire categories of food have never passed my lips: cakes of any kind, pastries, proper handmade pasta. Even vegan fare is largely out of bounds, as an entire apothecary of nuts is often used to make up the protein deficit.
I don't dare touch a half-empty tub of butter in someone else’s house for fear of the deadly detritus left behind by a Nutella-coated knife. Often, on hearing about my allergies, friends will indignantly ask, “Well, do you carry an Epipen?” – a portable shot of adrenaline to combat an initial reaction. “No,” I reply sincerely. “I used them all for recreational purposes.”
The Epipen is only a stop-gap, not a cure or a fix-all. Owen Carey just so happened to leave his Epipen at home on the day he died, and even then it might not have saved him. Sixteen shots of adrenaline couldn’t halt the onslaught for nine-year-old tennis prodigy Sadie Bristow when she went into shock on a family picnic two years ago.
The ignorance amongst some members of the food industry can be put down to at least three factors. First: severe allergies are recent phenomena. In 2014 the European Academy of Allergy and Clinical Immunology described the rocketing global number of allergy sufferers over the last half-century as an “epidemic rise.” The Food Standards Agency estimates that at least two million people in the UK have serious allergies: one to two per cent of adults, and seven to eight per cent of children.
Secondly, picky eaters occasionally attempt to mask their fussiness with claims to an allergy that they do not have. Most chefs will have seen cases in which a particularly fastidious gourmand claims to have an allergy – dairy, for example – only to see them scoffing up a friend’s cheesecake for dessert. Waiters are perhaps a little justified, then, in their doubt. Nearly half (42 per cent) of the respondents to the Düsseldorf study said that when customers informed them of an allergy, they were inclined not to believe them, despite them describing the symptoms.
Thirdly, allergies are still a largely Western health crisis. One 2014 study showed that migrants to new countries developed allergies at a higher rate than those in their country of origin. Huddled around a grill in a friend’s backyard in the mountains of Tsakhkadzor, Armenia, the response to my anxious questions were met with laughter. “We don’t have allergies here,” one woman scoffed, sipping homemade pomegranate wine. My fears were eased with a hunk of heavily-salted pork rib wrapped in a warm lavash flatbread – one of the most gorgeous things I’ve ever tasted.
In the last year, however, I’ve noticed a change. Since the Government announced new rules for allergen labelling on food packaging in mid-2019 (dubbed Natasha’s Law, to honour Ednan-Laperouse), and the high profile coroner’s inquest into Carey’s death late last year, there seems to have been a radical shift across the entire food industry.
Most restaurants, food trucks and market stalls will now have a small plaque in front of the till: “Speak to staff if you have any allergies.” Menus now come littered with footnotes and legends: little depictions of nuts or eggs or fish, noting potential allergens in each dish. Waiters on the whole are far more concerned and attentive than shrugging and flippant.
As one of the most ubiquitous chains in the country – and the outlet at the centre of an allergy scandal – Pret a Manger overhauled its policies in the wake of Ednan-Laperouse’s death. Between November 2018 and September 2019, the company introduced individual product labelling and retrained 9000 staff members. At the popular noodle-house chain Wagamama it is now a regulation that any meal flagged for allergies is prepared in a separate area of the kitchen by the managing chef. Every Nando’s restaurant in the UK has, on request, an enormous allergen guide roughly the size and weight of the Catholic Catechism.
But while large chains can more easily absorb the costs of rigorous label changes and training, smaller independent restaurants might seem more vulnerable to change. Is it harder for such businesses to cater to patrons with allergies? “l don’t think so,” says Karan Gokani, director of the popular Sri Lankan-inspired restaurant Hoppers in Soho, London. “The approach we take is to prepare dishes that inherently avoid allergens.”
“We work hard to create well-balanced menus to cater to needs of different guests rather than having to alter dishes on the fly. We don’t see it as a reaction to fads or industry expectations, but more just doing what we have always done.” A chef who oversees just a dozen tables each night arguably has a closer relationship with their ingredients – and with patrons.
“No restaurant wants to be responsible for an incident resulting in a death,” says Leigh George, Head of Endorsements for the advocacy group Allergy UK. “We do feel that over the last year there has been a shift in attitudes toward allergies and a greater awareness and willingness to make the changes needed to help keep the allergic community safe. The advances in food labelling and packaging are a clear example of where this progress is being made.”
But the critical work of bringing restaurateurs, chefs, owners, and staff up to scratch on regulations has taken a while longer than these visible changes indicate. “The shift has taken time,” George notes. “Implementing new procedures into daily practice is a huge undertaking… especially to ensure that all members of staff understand the seriousness of adhering to allergen management procedures. [Although] necessary, it can seem like a daunting task when it is a subject you’ve little understanding about.”
During that time, however, the popularity of new diets has ballooned, veganism being the most visible. There are wider cultural shifts already at work in the industry. Restaurants, caterers, and suppliers may find it easier to overhaul menus with dietary preferences in mind, rather than allergies specifically. This is certainly the case with airlines. Less than a decade ago, most carriers would cater to flyers with allergies. Now, major airlines like Singapore and Emirates offer (what seems like) several dozen dietary options – vegan, kosher, halal, low-carb, no-sugar, etc – without giving detailed ingredients lists.
On a recent long-haul flight from New Zealand to London I spent 18 hours eating nothing but raw fruit. “Lifestyle choices such as a vegan regime can complicate the allergy issue,” says George, “as people wrongly believe that a vegan option is suitable for people affected by allergy simply because it does not contain dairy. This is a dangerous assumption as there may have been cross contamination which could cause an anaphylactic reaction.”
According to the latest NHS figures for 2018/19, the number of people admitted to hospital for food allergy reactions has been rising year-on-year. We will have to wait for coming data to judge whether this new change in attitude across the food industry will have a profound effect on the number of trips to the emergency room.
What remains important is the reduction in risk. The fear that someone, somewhere, might get something wrong will never pass. But if the level of knowledge is increased, then having a delicious night out may no longer be a game of Russian roulette.