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Report: Restaurant staff not taking allergy requests seriously enough
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My Life With Food Allergy Report | seigefessoro.gq
Restaurant staff know surprisingly little about food allergies, and attitudes to customer health risks are often poor, according to a study of nearly employees in Germany. And less than half of employees — including waiters, chefs, managers and kitchen hands — answered all true-or-false questions correctly.
For instance, nearly one fifth of staff believed erroneously that customers with food allergies can safely consume a small amount of that food, that cooking can prevent food from causing allergies, and that removing an allergen from a meal already plated is safe. Recommended A cure for peanut allergy? The most common incorrect belief — held by more than a third of respondents — was that if a customer is having an allergic reaction they should be served cold water to dilute the allergen.
While many symptoms of food allergy are mild — albeit unpleasant — such as itchy skin rash, nausea and breathing difficulty, some kick in rapidly and can be life-threatening. The prevalence of food allergies has grown in the past 30 years. Data Availability: Data are available upon request due to the presence of potentially identifying information.
Competing interests: The authors have declared that no competing interests exist. Often symptoms e. A limited number of foods accounts for the majority of allergic reactions, these include peanuts, milk, eggs, fish, shellfish, wheat and soy [ 1 , 3 ]. Currently there is no cure for food allergies and thus successful food allergy management is dependent on the avoidance of allergen ingestion or swift treatment in case of exposure. In such circumstances allergen exposure is often caused by cross-contact during food preparation or the inclusion of ingredients that cannot be reasonably expected by consumers [ 4 ].
Even when consumers communicate their dietary needs to restaurant staff appropriately, the actual provision of suitable foods remains contingent upon the knowledge, attitudes and subsequent practices of the staff. Accordingly, food allergy knowledge and attitudes among restaurant staff have attracted increasing interest, particularly as prior research suggests profound knowledge gaps. An US study found that at least one quarter of staff hold important misconceptions, for instance, that it is safe for affected customers to consume small amounts of the allergen or that heating of foods destroys allergens [ 5 ].
These worrisome findings have been reproduced in various international studies [ 6 — 10 ]. The evidence about allergy-related attitudes is markedly sparse [ 11 — 14 ] but suggests some unfavorable and widely held attitudes. Such insights enable the identification of subpopulations with particularly poor knowledge or attitudes, who can then be targeted for interventions.
Prior research into determinants has been limited in terms of its i scope and ii methodological approach. Moreover, estimates were not mutually adjusted and it thus remains uncertain to what extent the identified correlates qualify as independent determinants. The only exception is a recent US study [ 11 ], which addressed most of the determinants mentioned above, but these did not generally emerge from multivariate regression models as significant determinants of knowledge or attitudes [ 11 ].
This highlights the importance of mutual adjustment for potential determinants or confounders. The US study further illustrated the relevance of examining restaurant-level factors as determinants of food allergy knowledge and attitudes e. Such determinants have been largely unaddressed in other studies.
We also aimed to further expand the current research focus to restaurant-level variables. Within each district, restaurants were randomly selected and there were no exclusion criteria with regard to restaurant characteristics e. We aimed to interview at least 20 adults per district and preferably one respondent per restaurant.
Data were collected during personal visits and by self-administered questionnaires or—in case of language problems—by personal interviews. The study coordinator ST was present while participants provided their data and collected restaurant-level information on site see below. When eligible individuals refused participation we gathered non-responder information.
Restaurant staff do not understand food allergy risks | Cosmos
Instruments or items applied in prior studies were used to collect data on food allergy knowledge [ 6 ] and attitudes [ 11 , 13 , 14 ]. We refined the devised instruments based on ten cognitive interviews with restaurant staff working in varying professional roles and different types of restaurants. During those interviews, we initially explored knowledge and attitudes by open-ended questions in order to test the completeness of our instruments.
Next, we explored how the items measuring knowledge and attitudes were understood and to what extent they were perceived to be relevant. Knowledge was assessed by two previously used tests. Correctness of responses was evaluated based on the specification of allergens in the EU food allergen labeling regulations [ 15 ]. One point was assigned for each correctly stated allergen and thus the potential total score ranged from 0 to 3.
The English-language instrument [ 6 ] was translated into German by the study team. Participants obtained one point for each correct answer and we calculated a total knowledge score across items. To devise a questionnaire capturing food allergy attitudes the study team first systematically searched and reviewed the instruments previously used [ 11 , 13 , 14 ]. We then selected items considered to measure different aspects of attitudes and translated those into German.
We further developed ten additional items. The cognitive interviews suggested that the translated general knowledge test was well understood and that there were no major misbeliefs that remained unassessed. Moreover, based on the cognitive interviews the pool of attitude items developed by the study team was reduced from ten to two items.
The cognitive interviews further confirmed that attitude items covered all relevant attitudinal elements, that the items were understood and that they were considered relevant by respondents.
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The final instrument measuring attitudes contained seven items see Table 2. Items were presented as statements and respondents were asked to indicate whether they agreed or disagreed. This binary response option was preferred by cognitive interview participants. Details on the measurement of those variables and how they were used in statistical analyses e. Our data included both individual-level data and restaurant-level data. Individual-level data comprised demographic information age, sex, and education , occupational data employment scheme, years of employment in the food industry, professional role, job satisfaction and two core components of burnout , and additional food allergy-related data the potential wish for further information on food allergies, the type of preferred format to receive such information, prior participation in food allergy training, and confidence in providing an allergy-friendly meal.
Restaurant level data included the number of staff members, the service type, the restaurant type, the number of tables, the most expensive main course, the price for a small glass of sparking water, and whether or not allergens were labeled in the menu. Among non-responders, we recorded their stated reason to decline participation, the observed gender, the type of service and restaurant see above.
We first compared characteristics of responders and non-responder using chi-squared tests. We then produced descriptive statistics for the study participants and restaurants, including the characterization of food allergy knowledge and attitudes. Next, we ran logistic regression models to examine associations between the above-mentioned potential determinants i.
General food allergy knowledge was dichotomized in a corresponding fashion i. The seven attitude items were analyzed individually. Items with such little variation are unlikely to provide meaningful insights in association analyses and therefore we decided to examine only the three remaining attitude items as outcomes in separate logistic regression analyses.
This process was repeated until no further variables could be excluded. All analyses were carried out using SAS. We approached a total of staff members in restaurants and Five participants had to be excluded as they reported in the questionnaire to be younger than 18 years. Language problems were a relatively infrequent reason for non-response In particular, working in an Asian restaurant was related to declining to participate Table 3 shows characteristics of the study participants from restaurants.
Educational levels were fairly high e. All professional roles were represented with the most frequent being waiters The majority of participants Job satisfaction was high We included participants from restaurants of differing sizes in terms of team size and the number of tables. Most restaurants provided full-service Food allergens were labeled in the menus of only A total of 54 participants One, two and three correct food allergens were reported by The most frequent misbelief entailed that customers should be served water in case of an allergic reaction correctly identified as false by The total knowledge score, based on five questions,was skewed towards an elevated number of correct responses but only Attitudes see Table 2 were favorable in terms of the norm that staff should be knowledgeable of food allergies.
Also, positive attitudes were expressed towards the need for cooperation and the shared responsibility of staff and customers to enable adequate dealing with food allergies. The results from the logistic regression models with backward selection are shown in Table 4.