Australia has one of the highest rates of food allergies in the world, and the incidence rate continues to grow. It's estimated that one in 10 babies born in Australia will develop a food allergy. With no known cure, allergy awareness and education is essential, as a severe allergic reaction or anaphylaxis can quickly become life-threatening to an individual.
Allergen awareness is especially important for food businesses and food service workers, who, once informed of an allergy, are legally responsible for preparing food that does not contain the allergen or for informing the customer that they cannot guarantee an allergen-free meal.
When training staff in allergen management, food business owners/managers and trainers need to ensure that staff:
- Know the most common food allergens (peanuts, tree nuts, milk, eggs, sesame seeds, fish, shellfish, soy, lupin, wheat)
- Are aware that any food can be an allergen
- Know what goes into the food being sold and meals being prepared, and which of these foods contain allergens
- Are careful to avoid cross-contamination by changing gloves and preparing foods hygienically
- Are comfortable reading ingredients and seeking clarification if needed
- Know who to ask when information is requested by a customer
- Communicate to all appropriate/involved staff when informed that a customer has an allergy
All employees should be trained to recognise the signs and symptoms of an allergic reaction, and at least one employee on the premises should be trained to act immediately if a customer has a serious allergic reaction.
What to do if a customer has an allergic reaction
A severe allergic reaction or anaphylaxis can be traumatic for the person it happens to, and frightening for witnesses who do not know what to do. It is important for the customer, the staff and the business to ensure that employees know their role in the event of an emergency.
Recognize the signs and symptoms of an allergic reaction
The signs and symptoms of a food allergy can vary from person to person. An allergic reaction can happen within seconds or minutes after eating, and can quickly become life-threatening.
An allergic reaction can involve any or all of the following symptoms:
- Hives, swelling, itching, warmth, redness or rash
- Coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, trouble swallowing, or hay fever-like symptoms (nasal congestion or itchy, runny nose, watery eyes, sneezing)
- Nausea, stomach cramps, vomiting or diarrhoea
- Changes in skin colour (pale/blue colour), weak pulse, dizziness, shock
- Anxiety, headache, uterine cramps or a metallic taste in the mouth
- Swelling of the tongue and/or airways causing difficulty breathing
- Drop in blood pressure (causing dizziness, light-headedness or passing out)
If a food worker notices that a customer is showing signs of an allergic reaction, they should remain calm and act quickly. Keep in mind that an allergic reaction can start with mild or moderate symptoms which can quickly become severe so the person should not be left alone. The food worker should stay with the customer and call for help.
Locate epinephrine auto-injector
At the first signs of an allergic reaction, locate the customer's epinephrine auto-injector (e.g. EpiPen, Anapen). Both the customer and the food service business/worker have a responsibility to prevent an allergic reaction, so the customer should have an epinephrine auto-injector with them. Instructions for use should be stored with the epinephrine auto-injector.
It is a good idea for food workers to get this information from the customer immediately after they have disclosed a food allergy, before an emergency can occur. Staff should ask the customer where they will find their epinephrine auto-injector in the event of an allergic reaction, and, if applicable, if anyone in their party has experience administering the shot. The more information obtained upfront, the better prepared staff will feel if quick action is required.
If the customer is having mild symptoms and can speak, discuss whether or not antihistamines can be taken to relieve their symptoms; however, staff should keep in mind that symptoms of an allergic reaction differ with each reaction and can become more severe over time.
If symptoms progress, epinephrine is the only suitable medication, so even if the customer believes that they are not in serious danger, staff should encourage the customer to self-administer a dose of epinephrine and continue to watch for any of the following signs of anaphylaxis:
- Difficult or noisy breathing
- Swelling of the tongue or throat
- Difficulty talking or a hoarse voice
- Wheezing or persistent coughing
- Loss of consciousness or collapse
- Paleness, weakness (especially in young children)
If the customer is under the age of majority or dining alone, staff should contact their parent/guardian or other emergency contact. If the customer's symptoms are worsening, action should be taken immediately.
If any one of the symptoms of anaphylaxis are observed, the following action should be taken (in order):
- Call an ambulance (000)
- Administer the epinephrine auto-injector
- Place the person in a position appropriate for the symptoms they are experiencing (lying down, on their side, or sitting up, depending on the circumstances — see below)
- Contact parent/guardian or other emergency contact
- Stay with the person until medical responders arrive
The individual should be placed on their back with their legs elevated, and should continue to lie down until emergency responders arrive or until they have fully recovered. If the person feels nauseated or is vomiting, they should be placed on their side to keep the airway clear and prevent choking on vomit. If they are having difficulty breathing, they should be kept sitting up, preferably on the ground with their legs outstretched.
It is important to remember that a person who is experiencing anaphylaxis may not be capable of self-administering an epinephrine auto-injector; they may be physically incapacitated or confused. They may also be anxious about using a needle, may downplay the seriousness of the reaction, or they may not want to draw attention to themselves. Assistance from others, especially in the case of young children or teenagers, is extremely important.
Don’t delay giving epinephrine. This is one of the most common mistakes people make during anaphylactic reactions. Epinephrine is safe and must be used promptly. It can save a life — don’t hesitate to use it.
Allergy & Anaphylaxis Australia encourages food business to have an emergency drill using an epinephrine auto-injector trainer device (with no needle or medication) every 3 – 4 months. A food business can purchase an auto-injector trainer device from Allergy & Anaphylaxis Australia.
After treatment, the customer should go to the nearest hospital, even if symptoms are mild or appear to have stopped, because the reaction could worsen or reoccur. Do not ask the customer to sit up or stand immediately following a reaction (even if treated), as this could cause a dangerous drop in blood pressure or other complications — including death.
As a food business owner or manager, prevention of allergy incidents should be your primary approach. Trained and certified Food Handlers help to minimise the risks involved when preparing, displaying and selling food products to customers and the Food Safety Supervisor will help to ensure safe food handling procedures are being followed. AIFS offers a variety of food safety training courses for different levels and needs. View our courses here, and be on the lookout for our new Allergen Management Course, coming soon.