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A message for parents of children with food allergies about epinephrine autoinjectors and back-to-school season from AllergyEats Founder & CEO Paul Antico:

PSA About Autoinjectors and Back to School - YouTube

The post PSA About Autoinjectors and Back-to-School Season appeared first on AllergyEats.

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Transparency is great. Transparency allow us, in the food allergy community, to make the most informed choices given our individual allergy sets and risk tolerance.  To that end, I am very happy that a Starbucks barista stepped forward with a concern she felt would create greater risk to Starbucks’ food-allergic customers, and I am also very happy that Starbucks corporate office was willing to take the time to address my concerns and clarify, openly and honestly, the risks to our community.

For those who do not know the genesis of this story, a Starbucks barista shared a concern that was widely spread across social media a few days ago.  It said, in part, “Starbucks made the decision to stop separating their milks into different steaming pitchers, blender pitchers, and shakers. We took off all the labels and now dairy, soy, coconut milk, almond milk, and other non-dairy liquids are no longer separated in different pitchers and while cross contamination was still an issue, it is now completely unavoidable.”

As this post spread, a few other baristas stepped up and to confirm.  In addition, other individuals asked their local Starbucks baristas, called customer service, and even called corporate, all claiming to receive the same information. We wanted to verify or clarify, so we called corporate ourselves and had an excellent, open and frank discussion with a senior rep.

The bottom line is this – the risk level for food-allergic customers at Starbucks has really not changed.  However, before anyone gets excited, the bad news is that the cross-contact risk was already significant and probably higher than people realized before.

For anyone who has stepped foot in a Starbucks (and who hasn’t), you know that it is often quite busy and employees have to move fast and keep moving.  So the truth of the matter is that, while baristas DID in fact have labels on pitchers detailing the milk that should be used in that pitcher, those labels weren’t always being strictly adhered to and the baristas were often just grabbing whichever was nearest.

So why take off labels? Starbucks says they made the change in the name of transparency.  In other words, they don’t want to give a false sense of security (and a false representation of risk) to their food-allergic customers.

Why do I believe them? The fact is that Starbucks is, and has been, very open about the fact that they use shared equipment and have a tremendous cross-contact risk.  So even before these labels came off – and even now if you request a “fresh pitcher” that is sanitized– the product is still being exposed to cross-contact risk with the other equipment used to make your drink.  That has not changed and will not change.  Starbucks cannot guarantee safety from cross-contact and I appreciate that they are willing to make that clear.  As a food-allergy advocate and father of kids with food allergies that would be at risk in this situation, am I happy about the level of risk at Starbucks?  No.  Do I wish they would do more to accommodate our community and make us feel more welcomed?  Yes. But do I appreciate the up-front honesty that lets me know this isn’t a risk I want to take?  Absolutely!

So, in summary:

  • Starbucks has and will continue to use shared equipment that poses a cross-contact risk – nothing has changed there
  • The removal of stickers on steaming and blending pitchers, etc. IS happening, but hasn’t changed the risk; if anything, doing so helps improve transparency about cross-contact risk
  • Individuals can still request a barista get a fresh pitcher (deemed sanitized), but the cross-contact risk from other equipment will still exist!
  • Starbucks pitchers on the customer side of the counter with regular milk, soy milk, etc. are also subject to the same cross-contact risk, even though the milk inside will be as advertised
  • Starbucks is very clear that customers with food allergies need to know that the company cannot guarantee their safety from cross-contact
  • Unfortunately, there are no initiatives in place at the moment to improve accommodations for food-allergic customers at Starbucks (however, they do read their customer feedback!)

I am very happy this issue came to light and thank those who brought it to our attention.  While we would obviously like to be reading about more positive initiatives at Starbucks, we always welcome and appreciate the opportunity to share the truth with all of you, positive or negative.

The post Recent Concerns About Food Allergy Risks at Starbucks Explained appeared first on AllergyEats.

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There has been a lot of disappointing chatter lately as dairy-allergic fans of Red Robin suddenly noticed that the allergy-friendly chain’s burger buns were showing up on the restaurant’s interactive allergen guide as unsafe for those with dairy allergies – a sudden and dramatic change from past practices.  We contacted top management at Red Robin and were told this was a temporary change and that the buns would likely be deemed safe again as of Monday.

Here’s a transcript from the company directly.

“The buns do not contain dairy/milk, however we are in the process of changing our cooking procedures/equipment for our buns and with this change our buns will no longer be toasted with an oil – they will be dry toasted.  Our current process is to “butter” our buns with a cottonseed oil (no [major] allergens) and the current bun cooking equipment does require an oil for toasting the buns.  In some markets, due to the transition of equipment, some areas have run low or out of stock on the cottonseed oil so we have approved the use of another butter oil used in our restaurants to make our buzz sauce.  This oil does contain butter.  This change is only a temporary change until all restaurants are fully transitioned to the new bun toaster.  To protect our Guest, we have added milk/dairy as an allergen to all of our buns (except for the gluten free bun) during this transition period.

Red Robin immediately followed up with this.

I just received an update from our supply chain team and the installation of the new bun toasters in all restaurant will be complete by the end of the week [this weekend].  To provide a bit of a buffer, I will have the milk allergen removed from buns next Monday.

I have to admit that I wish management had given the community (or even just us, to pass on to you) advanced notice of this issue so as not to disappoint any diners.  Regardless, I appreciate – once again – management’s concern for the food allergy community and their willingness and desire to take as much extra precaution as possible on our behalf.

So dairy-allergic diners (including my son, if you’re reading), fret not.  It’s almost time to enjoy those juicy burgers again!

The post Red Robin Buns Soon-to-Be Safe for Dairy Allergies Again appeared first on AllergyEats.

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A few things happened today that shed more light on the shortage of EpiPens in the U.S. market since I last shared my point of view (though, again, Mylan and Pfizer – who manufactures the product – continue to point out that the FDA is NOT calling this a shortage, but rather, an “intermittent supply”).

First, the FDA DID today add Mylan’s branded and generic versions of the regular and junior EpiPens to their drug shortage list. The stated reason is “manufacturing delays.”  The following is under “relation information.”

There are intermittent supply constraints due to manufacturing delays from the manufacturing partner, Meridian Medical Technologies, a Pfizer company. Mylan is receiving continual supply from MMT and expediting shipment to wholesalers upon receipt. Supply levels may vary across wholesalers and pharmacies. Patients who are experiencing difficulty accessing product should contact Mylan Customer Relations at 800-796-9526 for assistance in locating alternative pharmacies.

So here we see those same words both Mylan and Pfizer are using – “intermittent supply.”  What does that mean?  Means you may not be able to find these products easily.  Why does that occur?  It occurs because there’s a shortage.  That’s how I translate legal language to common sense language.  It doesn’t mean they’re in such short supply that we need to storm the pharmacies before they’re all gone, but they’re still not satisfying the market’s need.

The second occurrence today was the release of Mylan’s 1stquarter financial results and association investor conference call.  First off, Mylan’s revenues from EpiPens declined significantly once again.  My best estimate parsing their words was that EpiPen revenues were down roughly $50-100M in the quarter alone!  Now, during the investor day they held last month – in which they only mentioned EpiPen once in a 108-slide presentation – they said that “competitive market dynamics” were causing a decline in EpiPen sales.  (This follows a year in which EpiPen revenues were down dramatically – by $655 million!!!)  While a large part of this is likely related to the shift in sales from the $600 branded EpiPen to the $300 generic, and an unknown amount must have been lost from the manufacturing problems causing Canadian, and now U.S., shortages, we know Mylan is losing share as well.  But how much? How much share is AUVI-Q stealing? How much is CVS getting with their generic?

Related to the shortage, Mylan confirmed “supply disruption” and “intermittent supply,” noting Pfizer’s “manufacturing setbacks.” They say that Pfizer’s supply is increasing each month, but did not specify how substantially.  Notably absent was any confidence that this issue would be resolved soon.  Remember that when we reported on the Canadian supply shortage, the company was confident about when the shortage would end.  They turned out to be very wrong, but still thought they had an answer. So is Mylan just being cautious now after the Canadian experience or do they lack enough visibility to give a time frame?

Judging by our research and contacts with the companies, as well as those by others, I’d say no one knows when the shortage will be resolved.

And yes, I still call it a shortage.

What are your thoughts?  Where have you experienced a lack of supply?  Has it been related to branded EpiPens, the generics, or both?  Are you switching your epinephrine autoinjector supplier (and, if so, to who)?  Share, share, share!  We need your feedback!

The post Mylan confirms EpiPen “supply disruption” (i.e. shortage) and more appeared first on AllergyEats.

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Rumors started swirling last week as I received messages and read online banter about individuals not being able to procure EpiPens at their local drug stores.  There didn’t seem to be a pattern – various drug stores, various states, both branded and generic EpiPens – but it was soon clear that these weren’t isolated incidents.  Patients were legitimately having problems acquiring the most widely-used epinephrine auto-injector in the US – and they were concerned.

Other leading voices in our community, most notably Allergic Living and Snack Safely, were receiving the same news and published articles about it.  (Darn that family vacation for allowing me to get scooped!)  Calls and emails to Mylan and the manufacturer of EpiPens (Meridian Medical Technologies, a subsidiary of Pfizer) have led all of us to the same “official” canned response from Pfizer:

“We are currently shipping product; however, supplies may vary from pharmacy to pharmacy. The FDA has not announced a shortage in the U.S. 

 We understand how important this potentially life-saving product is to patients, and we are working closely with Mylan to monitor supply levels so patients have access to epinephrine auto injector products.”

Hearing It For Ourselves

Enough of these corporate responses; it was time to call customer service as an average everyday customer.  The response I got was interesting.  There were “intermittent supply constraints.”  The company “can’t fulfill all demand.”  This is “not specific to any region or state” and it “depends on the supplying wholesaler.” Lastly, the simple fact was that they “can’t keep up with demand; it is not a quality issue.”

Seeking to confirm, a colleague called a little later in the day with interesting results.  Call #1: After asking when she could get EpiPens in her market, she was put on hold for 8-9 min and then disconnected without a response.  Call #2: Immediately disconnected upon asking (different customer service rep from call #1).  A little later, call #3: Immediately to voicemail!

All of this alone is enough to be concerning.  However, a deeper look makes it even more so.

Reading Between the Lines

First, though, kudos to our friend Dave Bloom at Snack Safely, who pointed out something I didn’t know when he said “we are avoiding using the term ‘shortage’ because it is an official designation that the US Food and Drug Administration (FDA) uses.”  And as we know from the official Pfizer statement, there is no declared shortage (yet?) from the FDA.  Interestingly, our friends at Allergic Living pointed out that the FDA told them that “its supply information is coming from [Pfizer].”  Anyone else see the paradox?

So let’s parse a few things out:

As I often do, I’m going to jump back into my old job as financial analyst.  I interviewed tens of thousands of senior company executives over 17 years and was, amongst other things, trained in perceiving “deceptive or misleading statements.”

Using those skills, the official Pfizer statement is telling.  Here is the first part of their statement again: “We are currently shipping product; however, supplies may vary from pharmacy to pharmacy. The FDA has not announced a shortage in the U.S.”  Note the change from “We” to “The FDA.”  Now, if you were at Pfizer and there wasn’t a shortage, would you say it this way?  Of course not.  You would say “We do not anticipate a shortage” or “We have not announced a shortage.”  Putting it off on the FDA is one way of avoiding answering the question.  The second interesting piece to me: the FDA “has not announced a shortage.”  Read this closely.  It very deliberately doesn’t say there isn’t a shortage, as one would say if they were certain there wasn’t; it says no one has “announced” a shortage.  That’s a big difference.

Am I reading too much into a brief statement?  Absolutely not.  Corporations are very careful about how they write these statements.  What this one is telling me is that Pfizer is concerned that there may in fact be an upcoming shortage, but they haven’t reached whatever threshold triggers that designation yet.

So let’s consider my call.  Simply put, they “can’t fulfill all demand” and “can’t keep up with demand.”  (My friends… that’s a shortage, despite official FDA designations.)  That second phrase, in particular, surprised me because I am unaware of a sudden surge in demand for EpiPens.  That doesn’t mean there isn’t one.  Is there a summer surge?  If so, that would seem to be an annual issue that the company would be prepared for.  So why would there be trouble keeping up with demand… especially given that market share has been taken by AUVI-Q and generic suppliers over the past 15 months?  It was interesting that the customer service rep said that there was “not a quality issue.”  I never asked.

Possible Causes of the Shortage?

That, then, reminded me of the FDA “warning letter” that was given late last year to Meridian Medical Technologies regarding faults in some EpiPen units and the company’s failure to properly investigate hundreds of complaints.  The FDA inspection that triggered the letter, according to the St. Louis Post-Dispatch (Meridian’s manufacturing facilities are located in the St. Louis area), detected that “a critical component” of the auto-injector product failed last year.  Meridian did, earlier in 2017, recall tens of thousands of devices after complaints that some failed to activate.  Could manufacturing problems be causing these current issues?  This is just stream of consciousness.  I have no evidence to make this claim.  But without transparency from the manufacturers, one is left to guess.

Lastly, as we reported a few months ago, EpiPens DID experience and ARE still experiencing supply problems in Canada, and very recently, the same was reported in the UK.  Could some US supply be being diverted to these markets?  Even if not, what is causing those shortages?  And doesn’t it stand to reason that there is a global issue affecting production?  The Canadian shortage has been going on for over 3 months now despite Pfizer’s claim at the time that “EpiPens would be unavailable in Canada for two weeks and then in limited supply thereafter.”  It was subsequently communicated that “thereafter” referred to February.  But late April?

Stay Tuned for More

So, at the end of the day, what do I make of all this?  I say that there is much more going on behind the scenes than we are being told and I would not at all be surprised to hear an announcement in the near-term about an “official” supply issue (i.e. shortage) in the US.

I requested a call with a Pfizer rep (after I was sent the generic company statement) in order to more clearly and transparently address this incredibly important issue.  My request was denied.

Ensuring Your Access to Epinephrine

So what can you do?  If you are a staunch EpiPen user, I suggest you speak to multiple pharmacies in your area. As mentioned earlier, supplies are not specific to a region or supplier.  Second, if you are not married to the EpiPen, you can certainly pursue an alternative.  Remember that AUVI-Q devices are available to almost everyone at no cost (see details in the link). [Full disclosure: kaleo, maker of AUVI-Q, is an AllergyEats sponsor.] Lastly, you can pursue other generics.

I’m positive this story isn’t over.  I look forward to updating everyone with more details as they become available. Meanwhile, please share your experiences in the comments section below.

And once you’ve done that, please go to our home page where you can rate any restaurant you’ve dined at recently – or search for a new place to dine, thanks to the help of other food-allergic diners.  Each new rating you submit makes AllergyEats a more valuable resource for our entire food allergy community.

The post EpiPen US supply sporadic, but not a formal shortage… yet? appeared first on AllergyEats.

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Today’s blog was written by AllergyEats’ team member, Adrienne Walkowiak, who recently experienced life at sea with a food allergy.

Dairy-free diner, Adrienne, and her family aboard Royal Caribbean’s Allure of the Seas.

Royal Caribbean’s Allure of the Seas was so amazing at accommodating my food allergies that, upon my return from the cruise, I needed to wear baggy pants!

I have a dairy allergy and I only eat at restaurants that can accommodate this dietary requirement. Until my recent February vacation, I had never been on a cruise before. Prior to our departure, I worried that I’d be out to sea with nothing I could eat. My travel agent assured me that the cruise ship’s staff could accommodate me, and she notified them in advance of my allergy. I received a “form letter” via email telling me that they knew about my allergy and that I’d be all set, but I still didn’t know what to expect.

On the first day, at the first meal, I informed my server about my dairy allergy. He immediately got the head waiter, Jerome, who quickly became my new best friend. Jerome asked me what I wanted to eat for dinner, and I asked him what I could have. Typically, when I dine out – even at allergy-friendly restaurants – I have limited choices around what I can order. At dinner that first night, Jerome told me I could have whatever I wanted – that they’d make it special for me. And make it special they did!

At every meal, they treated me like a VIP. Each night, I’d place my order for the next day’s meals and Jerome (who took care of me every day) would personally bring out my allergy-friendly meal, confirming as he served it that it was dairy-free. I imagined that I’d be “stuck” eating simple foods – turkey sandwiches are my typical go-to at restaurants – but the meals they prepared were sensational, going way beyond a simple sandwich.

I had delicious prime rib for dinner one night, and lobster tails the next. They made me a grilled shrimp dish on a separate surface, away from where they prepared other guests’ buttery shrimp dinners.

When I asked them to “surprise me” one day, they brought out four (FOUR!) plates of dairy-free food, so I was sure to have something I’d like.

(And there was not a single turkey sandwich as an option!)

At breakfast and lunch, they offered enormous buffets, but I was afraid to eat from them in case of cross-contamination. I’d go to the restaurant with my friends and family and while they helped themselves to the buffet offerings, the chefs made my meals separately to minimize the cross-contamination risk. Keep in mind that the dining rooms were huge and crowded, but the staff never once made me feel like I was being an imposition. Amid all the chaos of busy shifts, they happily made my special meals and had the head waiter deliver it personally every time.

Over the course of my week-long cruise, I ate short ribs, steak, swordfish, shrimp cocktail, Pad Thai, a ham omelet, pasta primavera, pork tacos, and so much more. Everything was delicious and I didn’t have a single reaction to any of the food.

As someone with a dairy allergy, I’m rarely able to eat dessert when I dine out. Some restaurants have sorbet, but other than that, I’m usually out of luck. On the Royal Caribbean cruise, they served me desserts every day – and not once did they serve me sorbet. My favorite was a delicious dessert that tasted like a chocolate cloud – I’ve never had anything like it. I also got amazing meringues topped with a sweet strawberry sauce, chocolate cake and more. I was able to join my dining companions for dessert each night, which is something I’ve never experienced before.

The Allure of the Seas staff was incredibly knowledgeable about food allergies, and were beyond delightful about making special accommodations for my dairy-free meals. I ate at the same restaurants for my meals all week, and was able to have the same servers throughout the week, so they knew me and understood what I could (and couldn’t) have. They treated me like royalty, knowing my name and my food allergies from day one. And when I commented that I especially enjoyed something (like that incredible chocolate cloud dessert, which changed my life for the better!), they’d serve it to me again later in the week. The servers were absolutely delightful – even hugging me when I entered and exited the dining room for each meal – and they made me feel like it was their privilege to accommodate me, rather than a tedious chore like I get at some restaurants.

I came home from the cruise completely satisfied – and needing to wear loose-fitting clothes. I would absolutely sail with Royal Caribbean again, and I’d enthusiastically recommend Allure of the Seas to the food-allergy community. And when you go, get that chocolate cloud dessert – you’ll be glad that you did!

A note from AllergyEats: While our app and website are focused on dining out at restaurants in the U.S., many of our users exchange information about cruises, hotels, stadiums, theme parks and other public venues in our Facebook group: Dining Out with Food Allergies. We encourage you to share all of your food allergy experiences with other food-allergic diners by rating restaurants on AllergyEats and by engaging in our social media forums. 

The post Royal Caribbean: Delicious Dairy-Free Meals appeared first on AllergyEats.

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We recently released AllergyEats’ 6th annual Top 10 Most Allergy-Friendly Chains in America List and thought we’d take the food allergy community “behind the scenes.” If you’ve ever wondered how or why a specific restaurant chain made (or didn’t make) the Top 10, then this is the blog for you!

1. How does AllergyEats determine which chains make the Top 10 Most Allergy-Friendly Chains in America list each year?

Actually, AllergyEats doesn’t determine which chains make this coveted list – our users do! This list is objectively created each year based on the ratings of individual restaurants around the country by our food-allergy community. At the end of the year, those chains that have earned the best overall ratings – accumulated from the ratings of all their individual restaurants – make our list. We include the Top 5 large chains, defined as those with over 50 restaurants, and the Top 5 small chains, those with fewer than 50 units.

2. Are there any newcomers to this year’s Top 10 list?

Yes! We are always excited to see restaurant chains get rewarded for their efforts and make our list for the first time. This year, we enthusiastically welcome four new members. On the Large Chain list, Bertucci’s Italian Restaurant (4.43 overall rating) and Longhorn Steakhouse (4.28 overall rating) are our new additions. (Actually, both were previous members from when we actually had a Top 15 list – Bertucci’s in 2013 & 2014 and Longhorn in 2013.) On the Small Chain list, the new names are Weber Grill (4.52 overall rating) and 110 Grill (4.43 overall rating). Weber Grill is our smallest chain to ever make the list, at only 5 units. Weber Grill is based in the Chicago and mid-west area, while 110 Grill has their units in Massachusetts and New Hampshire.

3. Many food-allergic diners will be surprised to see that their personal favorite chain is NOT on this Top 10 list, while at the same time, others will say that they have had negative experiences at a chain that DID make the list. Can you offer any insights on what may be seen as an oversight, one way or another?

Each year, we see many, many comments about chains that “should have” made the list as well as those that “don’t belong.” The simple answer, of course, is that AllergyEats ratings of individual restaurants, as well as chains, are determined by the entire community of food-allergic diners that use AllergyEats. Therefore, the determination of which chains belong on this list is based on the “wisdom of the crowd.” Certainly, there are other chains that do a great job day in and day out for most people; unfortunately, a Top 10 list can only include… well, 10! On the flip side, there is no chain in America – nor any restaurant, for that matter – that is perfect and will not disappoint customers from time to time, food allergies or not (which is why we don’t see chains with perfect 5.0 ratings). Thus, it should be no surprise that some people disagree with one or more of the chains being on this list. I might feel the same way if I had a negative experience at one of these chains. The bottom line is that experiences differ for different people at different times in different individual restaurants, and that the chains on this list have provided the most allergy-friendly service overall to customers in our community.

The most valuable way to influence the chains that make this list – which happens to be a great way to help our entire 15-million-plus food allergy community – is to download the AllergyEats app  (Google Play or App Store) or go to the website and rate all of your own dining out experiences! Each rating takes just a minute, but helps make AllergyEats a better resource for everyone.

4. How do a seafood chain and pizza/pasta-based chains earn a spot on the Top 10 list given the prevalence of fish, shellfish, wheat, and dairy allergies?

This is another great question and criticism we get each year… fortunately with an easy answer. That easy answer is this: the most allergy-friendly restaurants and chains, regardless of their specialty, have ways of accommodating individuals with almost any allergy – even those with an allergy that would seem to conflict with their concept. If they have the proper procedures and protocols in place, particularly a strong education on preventing cross contact, they should have the ability to accommodate people with peanut, dairy, shellfish, wheat, or almost any other allergy.

Take Legal Sea Foods as an example – a chain that has made our list for each of the 6 years we’ve published it. I personally recommended one of their restaurants to a friend with a fish-allergic daughter when they were visiting Boston. True, she thought I was crazy at first, but now that family has made Legals their go-to restaurant near their home! This is not to say that anyone should venture outside his or her personal comfort zone (which differs for everyone), but it does suggest that the way a restaurant is prepared to accommodate food-allergic guests is more important than the ingredients they have in the kitchen.

As final proof, I will share that Legal Sea Foods, which has a 4.52 overall rating since AllergyEats’ inception, has earned a 4.90 rating from diners with fish allergies and a 4.44 from those with shellfish allergies! Similarly, Maggiano’s and Mellow Mushroom have earned, respectively, a 4.75 and 4.36 rating from dairy-allergic diners and a 4.53 and 4.30 from those with wheat allergies! It can be done!

5. Do you find that the Top 10 recipients have anything in common that make them allergy-friendly?

Absolutely. The most important factor is that each of these chains has a strong commitment to food allergy-friendliness from the top of the organization. I firmly believe that without a commitment from senior management, a chain or individual restaurant will not be allergy-friendly. There needs to be commitment to drive the investment – financial and non-financial (mostly the latter) – that creates this allergy-friendly culture. From there, every chain may have different training processes, operations procedures, and communications protocols in place, but the bottom line is that each does have a well-defined, well-orchestrated system. You shouldn’t see “deer-in-the-headlights” looks on the faces of these employees. Key parts of that system will involve communications from the customer to the staff to the kitchen and back (whether a manager is always brought to the table and/or whether food allergy dishes come out on a different shaped plate or other visible indicator), processes for preventing cross contact (which could include changing gloves, using a separate cooking station, frying in a pan instead of a shared fryer), training (whether in-house or with an outside service), a knowledge of ingredients or the ability to readily produce them, and the ability and willingness to modify dishes, often with easy “substitution” ingredients (such as Daiya cheese for those with dairy allergies). Again, don’t expect any chain on the Top 10 list (or elsewhere) to exactly mimic the procedures of any other chain, but DO expect that they can confidently answer questions related to any of the above.

6. If I go into one of these Top 10 chain restaurants, can I be assured a safe meal such that I don’t even need to bring an epinephrine auto-injector?

Absolutely not!!! No chain, no restaurant, and no individual is flawless. People make mistakes and we, with life and death potentially on the line, need to be prepared for mistakes. While the chains on this list are the best of the best, even they can have a breakdown in the process. Note that none of these chains have perfect ratings and, as mentioned earlier, some will be criticized by our readers given their individual negative experiences.

These chains have provided the most “comfortable” experiences for food-allergic diners over the past year, based on what you’ve told us on AllergyEats, but NO restaurant should ever by termed “allergy-safe.”

It’s not possible and it’s not prudent. (My family has even had multiple negative experiences at Disney World – the gold standard of food allergy dining!)

As I tell my kids, if you forget your epinephrine, you shouldn’t be eating. That applies anywhere.

7. How have the practices of Top honorees (and, in fact, the broader restaurant community) changed since the list began 6 years ago?

In general, with the passage of time and the acceptance that food allergies are real, widespread, and increasing, we’ve seen a general trend of restaurants becoming more allergy-friendly. Certainly that’s not true for all restaurants, and we see less progress made at high-end restaurants where creating a meal is akin to creating art, as well as some large restaurant chains that rely on franchising rather than owning all of their restaurants (less incentive for the parent company), but I should be careful before generalizing. At the end of the day, restaurants – and colleges, and sports venues, and vacation “destination locations” – are becoming more aware of the writing on the wall saying, “Ignore this large customer base at your own peril.” Our community is large and our sphere of influence is larger (we are the “veto vote” regarding where our party dines out or goes on vacation), so there is a lot of money to be lost for an organization that doesn’t make their foodservice business more allergy-friendly – not to mention that the risk of an accident, and associated liability, is higher.

8. Since these are chains with many individual restaurants, how can we rely on a chain-level rating to cover every individual restaurant in the chain?

It comes down to what I said earlier about commitment from the top. In general, chains with strong allergy-friendliness ratings have the commitment, and thus the procedures and protocols in place, such that their individual restaurants should be more allergy-friendly. The reverse is true too. That said, it is impossible to expect every unit in a 50-unit chain, let alone a 500-unit chain, to show consistent commitment. That’s why AllergyEats highlights the user ratings of each individual restaurant on its app and website, showing chain-level ratings less prominently. In actuality, I see much more variability of practice in non-allergy-friendly chains where some of their restaurants may be run by managers who deal with food allergies more personally and thus “get it,” even if the corporate level management doesn’t display strong commitment.

9. In general, which are more allergy-friendly – large chains or small chains?

A glance at the Top 10 list would suggest to some that smaller chains are more allergy-friendly, though that could be deceptive given the much larger number of small chains from which to choose the top five. While I do in fact believe that the average small chain is more allergy-friendly than the average large chain, I would strongly remind everyone that large chains can absolutely be as good, if not better than, most small chains. Again, I refer you to the Top 10 list. Maggiano’s – a large chain – has a higher rating than every small chain in this country except 2. Chipotle, all except 4. Bertucci’s, the same. So while I find smaller chains that understand food allergies to be more aggressive in making allergy-friendly changes and more nimble in their ability to do so, thus giving them an inherent advantage, there is no reason a large chain can’t be just as allergy-friendly. Your best bet is to just check AllergyEats.

10. Some people insist that chains are more allergy-friendly than independent restaurants while others say the opposite. Which is true?

Ahhh… the eternal debate in the food allergy dining community. Yes, some insist that chains have the financial strength to invest in equipment and strict chain-wide processes and procedures to ensure better accommodations for food allergy diners. Others are equally adamant that independent restaurants have greater flexibility in taking appropriate steps to more safely take care of their food-allergic guests. So what do I say? I say that both sides have hit on the positives, but at the end of the day the answer to the question of which are more allergy-friendly, chains or independents, is neither! Again, chains or independents, it all comes down to commitment. The fact that a chain like Burtons can hit a 4.83 chain-wide rating, and a larger chain like Maggiano’s can hit a 4.76, says a lot. At the same time, there are independents all around the US, led by restaurants like One Dish Cuisine in Ellicott City, MD, who can maintain ratings this high and higher. Similarly, there are many chains dragging along the bottom with ratings in the low 3’s and below, as well as many independents that just don’t know how to – or don’t care to – cater to our community. Some will outright state that they don’t want our business. So, in the end, there are many great chains and many great independents… and many poor chains and many poor independents.

Please be sure to review your latest restaurant experiences – chains or independents – on AllergyEats today. Remember – we can’t do this without you. We’re all in this together! 

The post The Making of AllergyEats’ Top 10 Chains List appeared first on AllergyEats.

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AllergyEats Releases 2018 List of Top 10 Most Allergy-Friendly Restaurant Chains in America

New List Offers a Variety of Dining Options: Italian, Mexican, Steaks, Seafood & More

BOSTON, MA (March 7, 2018) – AllergyEats, the leading guide to allergy-friendly restaurants in the United States, has just released its 2018 list of the Top 10 Most Allergy-Friendly Restaurant Chains in America. The chains on this highly-anticipated annual list have earned top ratings on the AllergyEats app and website, per feedback from the food allergy community. These chains are rated solely on how well they have accommodated food-allergic diners over the past year.

“For the over 15 million Americans with food allergies, it’s incredibly important to know which restaurants are the best at creating allergy-friendly experiences so these individuals can more comfortably dine out,” said Paul Antico, Founder and CEO of AllergyEats. “The restaurant chains on our 2018 list have differentiated themselves with exceptional food allergy protocols, education, and training, according to peer reviews from AllergyEats users. Even better, this year’s list includes chains that offer diverse types of cuisine – from Italian and Mexican to steaks, seafood, and more.”

AllergyEats’ Top 10 Most Allergy-Friendly Restaurant Chains are grouped into two categories – large (50 or more restaurants) and small (under 50 restaurants). The list was created per crowdsourced feedback from the AllergyEats app and website through December 31, 2017. Ratings are based on a 1 through 5 scale, with 5 being the most allergy-friendly.

Most allergy-friendly large chains:

Most allergy-friendly small chains:

** Denotes restaurant chains that are new to the list this year.

“We are excited to announce that four restaurant chains are new to the list this year, earning top honors for their exceptional food allergy accommodations, as determined by AllergyEats users. These new additions to the 2018 Top 10 list – Bertucci’s Italian Restaurant, Longhorn Steakhouse, Weber Grill, and 110 Grill – have shown the same outstanding commitment towards accommodating food-allergic guests as those chains that consistently make this list, such as Maggiano’s Little Italy, Chipotle Mexican Grill, Burtons Grill, and Legal Sea Foods,” Antico added.

“On behalf of all of us at Bertucci’s, we are honored that AllergyEats users have recognized our brand and the efforts of our local teams to individualize guest special requests,” said Brian Wright, CEO, Bertucci’s. “We take pride in our scratch kitchens, fresh ingredients and passionate culinary staff and we are ever-grateful for a legion of amazing guests who’ve supported us since 1981.  Thank you, AllergyEats, for providing your service and giving voice to this distinctive guest recognition.”

The AllergyEats Top 10 Most Allergy-Friendly Restaurant Chains list – and the growing number of AllergyEats ratings of all restaurants around the country – helps the food allergy community make more informed decisions about which restaurants to visit and which to avoid, based on how well or poorly they’ve accommodated other diners’ food allergies.

AllergyEats is a crowdsourced restaurant guide for the food allergy community, available as a free app on both iTunes and Google Play, as well as on www.allergyeats.com. Restaurants are easily searchable by geographic location, so people can find allergy-friendly establishments anywhere in the country.

The Top 10 Allergy-Friendly Chains list was created by the food allergy community, for the food allergy community. Please share your own dining experiences at these restaurant chains (and any independent restaurants, too!) by rating them on our app or website

The post 2018 Top 10 Most Allergy-Friendly Restaurant Chains appeared first on AllergyEats.

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It seems that most food allergy research these days, including the pioneering LEAP study published late last year, is focused on young children or babies. However, a recent study out of Melbourne, Australia – the School Nuts study – was instead focused on adolescents with food allergies. After reading this article reviewing the research, I thought it raised many points worth discussing. It indicated that:

  1. 44% of 10-14 year-old children had experienced a food-allergic reaction in the past year
  2. Just shy of 10% of these children experienced a potentially life-threatening anaphylactic reaction
  3. Reactions most commonly occurred at home versus restaurants, schools, or other venues
  4. Teens and young adults are most at risk of dying from anaphylaxis (thought little research has been done on them)
  5. There are many questions lingering regarding why these children are having such frequent reactions
  6. Precautionary food labeling may actually be more problematic rather than helpful

The first two points are pretty straight-forward, albeit concerning, facts from the study. I’d like to comment on the last four.

Reactions most commonly occurred at home

I think most parents hit a “new level” of concern about their food-allergic children when these kids reach the age where they are going out with their friends alone, often to foodservice facilities (e.g. Starbucks, Chipotle, etc.). Parents also, of course, have a very difficult time sending their kids off to school for the first time (when they’re much younger, of course). That’s part of what makes this observation so shocking.

As parents, we think that if we can only keep our kids at home, they’ll be safe. This study says otherwise.

The article doesn’t say whether the at-home reactions occur more often when parents are present or not, but perhaps the knowledge and preparation sweeping schools and restaurants around the world are paying dividends. Or perhaps the explanation is simple – that kids are home more often than they are out. Either way, the bottom line is that parents need to teach kids about always being vigilant everywhere – even in their own house. I confess to not only having made one or two mistakes in my own home with my kids, but also being caught (thankfully) by my young daughter just prior to making one or two others. I am in my 40’s. She was 6 or 7 at the time.

Teens and young adults are most at risk of dying from anaphylaxis

I think this has always been the common assumption and won’t surprise that many people. As kids gain more freedom, they don’t have their parents – who have been taking precautions on their kids’ behalf for 10+ years – to watch over them and provide a strong layer of protection.

That said, I would posit the theory that adults with food allergies may be an even greater at-risk group than teens or younger children. In fact, most food allergy fatalities in restaurants that I’ve heard of have been adults. Why? Complacency. “I’ll be alright.” No epinephrine. No disclosure to restaurant staff. No vigilance. It’s a recipe for disaster and often leads to it. I can’t tell you how many food-allergic adults I’ve spoken to just in the last few months who don’t carry epinephrine! (For those, by the way, I print out and give them the form for free Auvi-Q’s – this seems to be the least onerous way to get epinephrine into the hands of those who “don’t want to be bothered.”) This is another reason to train our kids well now, whether or not they are the most at-risk group. Teach them to be vigilant and share with them the stories of adults who take risks that they eventually pay for (when the kids are emotionally ready). Hopefully, this will educate them for a lifetime.

There are many questions regarding why adolescents are having so many reactions

The common refrain is that kids at this age are greater risk-takers and thus the increase in reactions. Probably much truth to this, but I would suggest that it might not be the entire story. As mentioned above, just the fact that parents are not around as often clearly increases risk. Also, however, the article suggests two other possibilities: are they less educated about how to avoid the foods they need to avoid, or is their food allergy itself changing in nature? My instinct says these are less likely, but I wouldn’t rule them out and believe more studies can definitely help us find ways to lessen the risk to our children.

Precautionary food labeling may be more risky than less

“The food industry’s self-regulated ‘precautionary labeling,’ where consumers were warned the food ‘may contain traces of nuts’ was widely over-used and could lead to complacency. It is actually unhelpful for consumers because there is no indication about what is safe to eat. We think the food industry wants to cover themselves and in fact that’s doing a disservice to the consumer because the consumer is taking all of the risk… in my view, it’s become almost useless.”

This is a tough one. Clearly, the optional labeling leaves a lot to be desired. Are the food companies just covering themselves legally? Should we be given these “kind-of warnings,” like we are now? Or would it be best to have a more clear ‘safe’ or ‘not safe’ designation. This is far from a black-or-white subject, in my opinion, and would require a long blog in and of itself. For now, I will just pose the question.

One point I didn’t mention above, but I’d love to learn if it is true or not is the assertion that “Melbourne is the food allergy capital of the world.” Just for interest sake. My Spidey-sense doubts it.

So what do YOU think of this article and the points raised in it? Are your kids in this age group? Where do you agree/disagree? And where do you think my commentary is off-base or spot-on? We love hearing your opinions, so please share them below!

I would also point out that AllergyEats has, on its website and app, a list of tips for parents of teens with food allergies, and even a list of questions to ask when dining out, both of which might be helpful during this phase. Teens can save the tips to their smartphones and, as fast as you can say “selfie,” use them as a reference point when talking with restaurant staff.

Lastly, of course, please take a moment right now to rate all your recent food allergy dining experiences on the AllergyEats website or app. Each rating only takes a minute, but helps an entire community! We’re all in this together!

The post Teens and Food Allergies: What Can We Learn From Australia’s Allergy Study? appeared first on AllergyEats.

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Last week, Pfizer, seller of EpiPens in Canada, published a disturbing press release saying that EpiPens would be unavailable in Canada for two weeks and then in limited supply thereafter (subsequently confirmed as through February).

Here is their release from January 11:

“As a result of a supply interruption, Pfizer is experiencing a supply shortage of EpiPen auto-injectors in the 0.3 mg format in January 2018.  EpiPen is a medically necessary product with currently no alternatives on the market in Canada.  At this time, there is limited supply of auto-injectors at wholesalers, distributors and at pharmacies.  While we are working closely with our distributors to avoid long-term supply shortage at the store level, we expect a period of between two and four weeks of no inventory.  Additional limited inventory will be supplied at the beginning of February 2018 which will be placed under allocation and we will continue to manage supply carefully.

Pfizer has advised and is working with Health Canada on this situation and we are exploring remediation plans to address this situation.

We understand and regret the challenges this shortage poses to patients.  Ensuring continuity of the supply of our medicines is paramount, and this temporary supply interruption does not indicate an impact on the quality, safety or efficacy of EpiPen auto-injectors currently available on the Canadian market.  Pfizer fully realizes the importance of this medicine to our customers and patients, and has taken action to minimize the duration of the supply interruption, including efforts to expedite delivery of available supply.”

Subsequently, we reached out to Mylan a few times to ask about any potential supply disruptions in the U.S. It took a week, but Mylan finally responded to us with a new statement put out today, calming any fears.

“Mylan is aware that Meridian Medical Technologies, a Pfizer company and Mylan’s manufacturing partner for EpiPen® Auto-Injector, has a temporary supply constraint for EpiPen® Auto-Injectors (0.3 mg) in Canada. Patients in the U.S. should not experience any difficulties in filling their prescription for a Mylan epinephrine auto-injector at this time.”

We hope this allays any concerns of patients in the U.S. who read the news out of Canada and we also hope those in Canada have enough epinephrine to carry them through this disruption or seek EpiPen alternatives elsewhere. “Don’t leave home without it.”

The post EpiPen shortages in Canada; U.S. unaffected appeared first on AllergyEats.

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