Abstract
BackgroundUp to 3–5% of adults may be affected by food allergies, while approximately 1% are affected by Celiac disease (CD). Food allergy reactions can be severe and potentially fatal, while CD can result in various symptoms. Restaurant and food service establishment staff have an important role in helping to prevent food allergy and CD risks among affected customers.ObjectivesA systematic review was undertaken to identify, characterize, and synthesize published research on the prevalence of food allergy and CD knowledge, practices, and training among restaurant and food service personnel. The population of interest included any personnel in these settings who prepare, handle, or serve food. Outcomes included the prevalence of food allergy and CD knowledge, practices, and training.MethodsThe review was conducted using standardized methods, including: a comprehensive search strategy; relevance screening of abstracts; characterization of relevant articles; data extraction; and risk of bias assessment. Outcomes were stratified into comparable subgroups and descriptively analyzed to examine prevalence trends across studies. Meta-regression was conducted on selected outcomes to identify possible sources of variability in prevalence estimates across studies.ResultsThirty-eight relevant studies were identified; most were conducted in the United States (50%) and focused on food allergies (90%). Significant variability was identified across studies for most outcomes. Participants generally had a higher knowledge, self-efficacy, and use of practices related to preparing and serving allergen-free meals compared to food allergy emergency response. Participants’ reported use of various risk prevention and response practices was generally low. Most participants across studies had not received prior food allergy training (median prevalence of 65% across 12 studies).ImplicationsKey knowledge and practice gaps were identified that could be targeted by future training programs. Research gaps were also identified, including a need for more experimental studies to evaluate food allergy and CD training interventions.
Highlights
Food allergies refer to an adverse immune reaction to foods
Up to 3–5% of adults may be affected by food allergies, while approximately 1% are affected by Celiac disease (CD)
Thirty-eight relevant studies were identified; most were conducted in the United States (50%) and focused on food allergies (90%)
Summary
Food allergies refer to an adverse immune reaction to foods. While it is challenging to determine reliable population-based estimates of the prevalence of food allergies due to the limitations of self-reporting and other methodological issues, previous studies suggest that up to 3–5% of the adult population in North America may be affected by them [1,2,3]. Food allergy reactions can range from mild and limited symptoms in the oral cavity to anaphylaxis, which can be fatal if not immediately treated with epinephrine [4,5]. In the United States (US), 63 deaths were identified from 1994–2006 in a voluntary registry of food-induced anaphylaxis fatalities [4,6], and nearly half of these deaths (46%) were caused by food exposure at a restaurant or other food service establishment [7]. A study of the Coroner’s database in Ontario, Canada, found that 40 of the 92 identified anaphylaxis deaths from 1986– 2011 were food-induced [5], with most cases (24/40) occurring due to exposure outside of the home (e.g. at restaurants, schools and camps) [5]. Restaurant and food service establishment staff have an important role in helping to prevent food allergy and CD risks among affected customers
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