In addition, the campaign has produced the following notes.

Some key questions

Q	What is anaphylaxis?
A	Anaphylaxis is a severe allergic reaction - the extreme end of the allergic spectrum. The whole body is affected, usually within minutes of exposure to the allergen but sometimes after hours. Causes include food, insect stings and drugs
Q	What are the symptoms?
A	Any or all of the following symptoms may be present: swelling of throat and mouth difficulty in swallowing or speaking difficulty breathing - due to severe asthma or throat swelling hives anywhere on the body, especially large hives generalised flushing of the skin abdominal cramps, nausea and vomiting sudden feeling of weakness (drop in blood pressure) collapse and unconsciousness
Q	What foods trigger life-threatening allergic reactions?
A	The most common culprits are peanuts and tree nuts (such as walnuts, Brazils, almonds, hazelnuts). However, other foods may be implicated. Any customer who claims to suffer life-threatening allergic reactions to a food should be taken seriously. Foods which sometimes cause severe reactions include eggs, dairy products, sesame seeds and other seeds, shellfish, fish, soya, and pulses.
Q	What kind of quantities can trigger a severe allergic reaction?
A	For some people, tiny traces of a particular food can cause anaphylaxis.
Q	How common is anaphylaxis?
A	Statistics are hard to come by, but more than one child in 100 is believed to suffer severe allergic reactions to peanuts, tree nuts or both. A small but significant number are affected by other foods.
Q	How do these people protect themselves?
A	Many carry medication, to be taken if they inadvertently eat the food that affects them. But first and foremost, they must seek to avoid the offending food. They need accurate information about ingredients of foods they are about to eat.
Q	What can catering staff do?
A	Listen carefully and sympathetically to any customer who asks about ingredients. Take the enquiry seriously. Tell the truth about what's in a dish. If you don't know or aren't sure, never guess.
Q	What can catering managers do?
A	Managers can devise a system whereby there is always at least one staff member on duty who has access to accurate ingredient information. Staff with any queries about any dish on the menu can go to that person for help. Customers with allergies can be encouraged to question staff. Signs can be displayed stating: "Severe food allergies. We welcome enquiries from customers who wish to know whether any meals contain particular ingredients." Managers can minimise risks by seeking to avoid situations where cross-contamination can occur. The next page contains practical advice for managers and staff.

What can caterers do?

Guidance for managers and other senior staff

1. Ensure there is always a nominated person on duty who knows, or can find out, the ingredients of all dishes.
2. Encourage serving staff to make all enquiries to that staff member. Impress on them how important this is.
3. Ask suppliers to provide accurate written details about all ingredients, including any planned changes.
4. Try to avoid the indiscriminate use of nuts, eg chopped nuts as a garnish, unless this is an essential part of the recipe.
5. If a dish is meant to contain nuts, why not make sure this is reflected in the name: Eg nut and carrot salad. Apply this consistently.
6. If possible, keep certain preparation areas designated as nut free
7. Put up a prominent sign encouraging people with allergies to question staff.
8. Include a prominent statement on the menu encouraging customers with severe allergies to question staff. For example, this could state: "Some of our dishes contain nuts. If you are allergic to nuts, please ask the waiter to suggest a nut-free meal."
9. Try to ensure that where a dish contains potent allergens - particularly nuts - this is indicated in some way on the menu. Some restaurants adopt a circled N. Apply this rule consistently.
10. Organise for your staff a training session on allergies. Make sure that all new staff members (including part-time and casual staff) are aware of serious allergies and know how to handle a customer enquiry.

Guidance for serving staff

1. If a customer claims to have a life-threatening food allergy, take the customer seriously. Peanuts and tree nuts (such as almonds, Brazils, walnuts and hazelnuts) are the foods most commonly implicated. But other foods may be mentioned. These may include sesame seeds and other seeds, milk, eggs, soya, shellfish, fish, pulses (peas, beans, lentils etc) and fruit.
2. Find out which member of staff has access to accurate information about ingredients. Approach that person if you need information.
3. If there is any serious doubt about whether a food is free of a certain ingredient, such as nuts, admit to the customer that you are unsure.
4. If, on examining his meal, a customer realises it contains nuts and asks you to replace it, remember it is not enough simply to pick the nuts from the plate and return it to the customer. Tiny traces that remain may be enough to cause a severe allergic reaction.
5. If there is a gateau covered in nuts on the sweet trolley, ensure that no nuts could possibly be transferred to adjacent sweets.
   
   

Specific points for all staff

1. Remember that cooking in unrefined groundnut oil (peanut oil) may leave traces of nut protein in the food being cooked.
2. Any oil that has previously been used to cook products containing nuts may contain traces of nut proteins.
3. If you are preparing food for someone with a severe allergy, beware of transferring food from one dish to another.
4. Remember that salad dressing may be made from unrefined nut oil.
5. Hands, utensils, cutlery and work surfaces should be washed scrupulously after handling foods containing potent allergens.
   
   

What to do in an emergency

If an allergic customer becomes ill, it is likely that that person - or someone with them - will state that he/she is suffering from an allergic reaction. They may use the word anaphylaxis. This is the action plan to follow:

Immediately send someone to dial 999 and give the following information:

This is an emergency. A customer has collapsed and we believe they are suffering from anaphylaxis (pronounced ana-fill-axis).

Give the address and postcode of your establishment - clear enough so that the ambulance crew will know exactly where to come.

Someone should be sent to stand at the restaurant entrance to direct the ambulance crew to the patient.

Ask other customers if there is a doctor in the restaurant.

Staff trained in first aid should make a point of learning how to recognise allergic symptoms and what to do if someone suffers anaphylaxis.

If you would like to discuss any of these issues, please write to the Anaphylaxis Campaign, PO Box 275, Farnborough, Hants GU14 6SX. Tel: 01252 542029. Email: info@anaphylaxis.org.uk

For further information please visit our new website www.cateringforallergy.org

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