Food Allergy Knowledge and Attitudes of Restaurant Managers and Staff: An EHS-Net Study

Radke, Taylor; Brown, Laura G.; Hoover, E. Rickamer; Faw, Brenda; Reimann, David; Wong, Melissa R.; Nicholas, David; Barkley, Jonathan; Ripley, Danny

doi:10.4315/0362-028x.jfp-16-085

Cited by 59 publications

(75 citation statements)

References 9 publications

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“…These data can contribute to generating hypotheses about the context in which outbreaks occur. For example, the proportion of establishments with outbreaks engaging in complex food preparation processes (87%) is high compared with the proportion of establishments without outbreaks engaging in these processes (approximately 50%) found in other studies (EHS-Net restaurant cooling practices study, unpublished data, CDC, 2009) ( 20 ). This difference suggests that outbreaks might occur more often in establishments where complex food preparation occurs.…”

Section: Discussionmentioning

confidence: 77%

Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Lipcsei

Brown

Coleman

et al. 2019

MMWR Surveill. Summ.

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Problem/Condition State and local public health departments report hundreds of foodborne illness outbreaks each year to CDC and are primarily responsible for investigations of these outbreaks. Typically, investigations involve epidemiology, laboratory, and environmental health components. Health departments voluntarily report epidemiologic and laboratory data from their foodborne illness outbreak investigations to CDC through the Foodborne Disease Outbreak Surveillance System (FDOSS); however, minimal environmental health data from outbreak investigations are reported to FDOSS. Period Covered 2014–2016. Description of System In 2014, CDC launched the National Environmental Assessment Reporting System (NEARS) to complement FDOSS surveillance and to use these data to enhance prevention efforts. State and local health departments voluntarily report data from their foodborne illness outbreak investigations of retail food establishments. These data include characteristics of foodborne illness outbreaks (e.g., agent), characteristics of establishments with outbreaks (e.g., number of meals served daily), food safety policies and practices of these establishments (e.g., glove use policies), and characteristics of outbreak investigations (e.g., timeliness of investigation activities). NEARS is the only available data source that includes characteristics of retail establishments with foodborne illness outbreaks. Results During 2014–2016, a total of 16 state and local public health departments reported data to NEARS on 404 foodborne illness outbreaks at retail establishments. The majority of outbreaks with a suspected or confirmed agent were caused by norovirus (61.1%). The majority of outbreaks with identified contributing factors had at least one factor associated with food contamination by a worker who was ill or infectious (58.6%). Almost half (47.4%) of establishments with outbreaks had a written policy excluding ill workers from handling food or working. Approximately one third (27.7%) had a written disposable glove use policy. Paid sick leave was available for at least one worker in 38.3% of establishments. For most establishments with outbreaks (68.7%), environmental health investigators initiated their component of the investigation soon after learning about the outbreak (i.e., the same day) and completed their component in one or two visits to the establishment (75.0%). However, in certain instances, contacting the establishment and completing the environmental health component of the investigation occurred much later (>8 days). Interpretation Most outbreaks reported to NEARS were caused by norovirus, and contamination of food by workers who were ill or infectious contributed to more than half of outbreaks with contributing factors; these findings are consistent with findings from other national outbreak data sets and highlight the role of workers in foodborne illness outbreaks. The ...

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Section: Discussionmentioning

confidence: 77%

Foodborne Illness Outbreaks at Retail Establishments — National Environmental Assessment Reporting System, 16 State and Local Health Departments, 2014–2016

Lipcsei

Brown

Coleman

et al. 2019

MMWR Surveill. Summ.

Self Cite

View full text Add to dashboard Cite

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“…Overall the managers, food workers, and servers were knowledgeable about food allergens and had positive attitudes about accommodating those with food allergies; however, it was noted that 10% of workers thought a person with a food allergy could safely consume a small amount of the allergen. The study also showed that allergy training improved attitudes towards the patients with food allergies but not the knowledge [50]. For patient safety, discussing eating out as well as tactics on how to do it successfully are essential.…”

Section: Eating Outmentioning

confidence: 90%

IgE-Mediated Food Allergy

Anvari

Miller

Yeh

et al. 2018

Clinic Rev Allerg Immunol

270

197

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Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. IgE-mediated food-allergic disease differs from non-IgE-mediated disease because the pathophysiology results from activation of the immune system, causing a T helper 2 response which results in IgE binding to F c ε receptors on effector cells like mast cells and basophils. The activation of these cells causes release of histamine and other preformed mediators, and rapid symptom onset, in contrast with non-IgE-mediated food allergy which is more delayed in onset. The diagnosis of IgE-mediated food allergy requires a history of classic clinical symptoms and evidence of food-specific IgE by either skin-prick or serum-specific IgE testing. Symptoms of IgE-mediated food allergies range from mild to severe. The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. Diagnosis is excluded when a patient can ingest the suspected food without clinical symptoms and may require an in-office oral food challenge if testing for food-specific IgE by serum or skin testing is negative or low. Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. Management of food allergies requires strict avoidance measures, counseling of the family about constant vigilance, and prompt treatment of allergic reactions with emergency medications. Guidelines have changed recently to include early introduction of peanuts at 4-6 months of life. Early introduction is recommended to prevent the development of peanut allergy. Future treatments for IgE-mediated food allergy evaluated in clinical trials include epicutaneous, sublingual, and oral immunotherapy.

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“…Among the 1,307 restaurants contacted for participation in the study, 852 met the study eligibility criteria, and 278 (32.6%) of those agreed to participate; 58 restaurants were excluded because they did not have an English-speaking manager, and another 177 were excluded because they did not meet the restaurant definition for EHS-Net inclusion. Data on restaurant, manager, food worker, and server characteristics have been published previously ( 4 ). Among 277 managers, 123 (44.4%) reported that they had received training on food allergies while working at their respective restaurants ( Table 1 ).…”

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confidence: 99%