Charting a research agenda for understanding the epidemiology of food allergy in adults in Europe

Knowledge, attitude, and practices of restaurant and foodservice personnel in food allergy. A systematic review and meta-analysis

Background

Currently, there may be 240-250 million people worldwide affected by food allergies. Dining out can be challenging for individuals with food allergies who rely on restaurant and food service staff to properly prepare allergen-free meals. For this reason, the personnel working in restaurants and other food services play a significant role in managing the risks faced by customers with food allergies.

Objectives

A systematic review and meta-analysis was conducted to assess the existing evidence concerning the knowledge, attitudes, and practices related to food allergies among restaurant and foodservice personnel.

Methods

To identify, characterize, and synthesize published research on the prevalence of positive responses regarding knowledge, attitudes, and practices related to food allergies among restaurant and food service personnel, international recommendations for systematic reviews and PRISMA guidelines were followed. The search was conducted between January 2012 and January 2022, utilizing the electronic databases PubMed, Web of Science, Scopus, and the Cochrane Library. Selection and data extraction were carried out following predefined protocols, and constructs based on reported outcomes were generated and subsequently analyzed in the meta-analysis. Trials were evaluated using the Cochrane tool for risk of bias. The results are presented using summary tables, forest plots, and box plots, showcasing the combined proportion of constructs obtained from independent surveys conducted without control groups. These constructs were then grouped into categories as an organizational framework and analyzed to determine their distribution among quintiles, aiming to provide a detailed overview of data variability. This strategy allowed us to demonstrate how results from the analyzed categories were distributed.

Results

The algorithm identified 23 relevant studies, primarily originating from the United States and Europe. The main observed variability was related to the evaluated populations and the instruments used. A total of 28 constructs were identified, with 10 related to knowledge, 9 to attitudes, and 9 to practices. A proportion meta-analysis was conducted to determine the prevalence of positive responses within these three study categories. The results obtained reveal that, in the knowledge category, quintiles 4 and 5 exhibit strong knowledge on the subject (over 84 %). In contrast, starting from quintile 2, the majority of participants shows a positive attitude toward catering to consumers with food allergies (over 85 %). However, after examining the practices category, responses belonging to quintile 5 reflect a low level of risk, while in the other quintiles, behaviors with a higher potential risk for consumers with food allergies are identified.

Conclusions

The knowledge, attitudes, and practices of personnel in the food service sector are crucial due to the increasing prevalence of food allergies today, as well as the growing frequency of eating out. Knowledge is the most extensively studied category, showing generally acceptable but still insufficient levels in some areas. Positive attitudes are expressed towards individuals disclosing allergic conditions, yet they do not necessarily correlate with high levels of knowledge. The identified practices do not ensure the safety of the dish served to the customer. There is limited awareness regarding the importance of preventing acute allergic reactions at the time of food consumption. Restaurants and food services should train all staff involved in customer service, implement protocols aimed at preventing allergic reactions during food service, and establish guidelines for handling a customer experiencing an acute reaction.The limitations of this research are related to the heterogeneity present in the synthesized results, urging caution when interpreting the overall estimate of the combined effect, as the findings may not be applicable to all populations or study settings. Indeed, more studies are needed to enhance result precision and provide more specific recommendations for catering to allergic customers in restaurants and food services.

Experiences and perceptions of people with celiac disease, food allergies and food intolerance when dining out

Introduction

Eating out is a common practice in modern society. Celiac disease (CeD) and food allergy (FA) are among the most common conditions responsible for adverse reactions to food. Despite their different origins, both require treatment with restrictive diets (avoidance of gluten and/or specific allergens) and this results posing similar challenges when eating out. Our objective was to learn about the experiences/perceptions of consumers with CeD and FA when dining out, as well as the challenges they face in food service environments.

Methods

An ad hoc questionnaire was used to record consumer perceptions, food service characteristics and resulting adverse reactions.

Results

377 individuals living in Santiago, Chile, provided complete information and were analyzed (160 CeD, 105 FA). 301 participants (79.8%) declared eating out, 33.6% reported experiencing an adverse reaction at least once while eating out. 94.4% of the 377 participants believed that the serving staff had little or no knowledge about his/her condition. Consumers reporting symptoms as severe adverse reactions were more common among celiac than allergic patients (p < 0.001).

Discussion

The study showed no significant differences based on consumer-related characteristics (p:NS). The consequences of eating out did not vary based on individual's data, including diagnosis, age, frequency of eating out, adverse reactions experienced, or intensity. These findings suggest that the most important determinants of risk associated with eating out are characteristics of the food service, like availability of information, staff training, and establishment's facilities like equipment available, exclusive utensils for customers with special dietary needs and kitchen and bathrooms organization.

Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice

BACKGROUND

Shared learnings from the early use of novel therapies can aid in their optimization. The recent introduction of peanut oral immunotherapy (peanut OIT; Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp]) for peanut allergy addresses a significant unmet need but also highlights the requirement for consideration of several factors by both prescribers and patients.

OBJECTIVE

To provide guidance for prescribers of licenced peanut OIT to facilitate treatment delivery and improve outcomes.

METHODS

Clinicians with experience of licenced peanut OIT (United States n = 6, United Kingdom n = 1) participated in a series of interviews and group discussions designed to elicit tips for successful implementation.

RESULTS

Clinicians identified 8 tips that were considered the most relevant, practical, and impactful for prescribers of Peanut (Arachis hypogaea) Allergen Powder-dnfp: (1) preparing to provide treatment, (2) assessing the medical indication for treatment and (3) shared decision making, (4) staff education, (5) establishing office processes, (6) managing patient expectations and using anticipatory guidance, (7) optimising adherence and (8) maintaining flexibility throughout the treatment process. In addition, a range of supporting materials (e.g., checklists and action plans) are provided.

CONCLUSION

The introduction of a novel therapy often requires healthcare providers to modify or adopt practices to effectively employ the treatment. The provision of guidance based upon early real-world experiences of licenced peanut OIT may help inform clinical practice and improve treatment outcomes.

Food allergy knowledge, attitudes and their determinants among restaurant staff: A cross-sectional study

Background

There is wide international variation regarding food allergy knowledge among restaurant staff. Further, attitudes towards food allergy remain under-researched. Insights into the independent determinants of knowledge and attitudes are limited due to lacking mutual statistical adjustment for determinants/confounders in the vast majority of prior studies. In this study we aimed to contribute novel data on the food allergy knowledge and attitudes among restaurant staff in Germany whilst also examining potential determinants of both outcomes using multivariable approaches.

Methods

We collected data face-to-face from 295 staff members in restaurants in Düsseldorf, Germany. Knowledge was assessed by asking participants to name three common food allergens and to answer five true/false-statements. Seven items assessed attitudes. A total of 16 potential determinants were examined using logistic regression models with backward selection.

Results

Only 30% (n = 89) of the respondents correctly named three food allergens and 41% (n = 120) attained a perfect score on the true/false statements. The vast majority expressed positive attitudes toward the need for cooperation and shared responsibilities for food-allergic customers. However, the expressed attitudes towards serving customers with food allergies and validity of customer-reported food allergies were unfavorable. Determinants of food allergy knowledge (e.g. the type of restaurant, professional roles, or levels of school education) and of unfavorable attitudes (e.g. gender) were identified.

Conclusions

Food allergy knowledge was suboptimal among restaurant staff and attitudes towards customers were rather poor. While we identified some determinants, additional studies are needed to systematically examine potential determinants for targetting educational interventions in the future.