Seafood Allergic Reactions in Restaurants

Abstract

RATIONALE: Seafood allergy is estimated to affect 2.3% of the US population; restaurant reactions are common, but little is known about the circumstances. METHODS: A structured questionnaire was administered to a random sample selected from 415 registrants reporting restaurant reactions in the National Seafood Allergy Registry (n=1000). RESULTS: Participants (125 registrants describing 182 reactions [42% first lifetime reactions]) included 58% allergic adults and 42% surrogates for children. Allergies included: shellfish (60%), fish (17%), or both (22%). The most frequent restaurant types were seafood (23%) and Asian (18%). Reactions were attributed to oral ingestion (90%), skin contact (4%) or inhalation (6%). Symptom distribution was: gastrointestinal (67%), cutaneous (61%), respiratory (47%), and cardiovascular (9.4%). Treatment was given for 70% of reactions (epinephrine-17%, antihistamines-81%). Only 21% with a known allergy disclosed their allergy to the restaurant. Mistakes were attributed to cross-contact (same oil, grill or pan) in 34% of reactions. It was common (61%) for persons with a prior reaction to re-order seafood. A subsample who did so indicated their reasons: allergy not clearly diagnosed (64%), attributed to a different category of seafood (23%), or curiosity about persistence (13%). Restaurants were rarely (19%) notified about reactions. Participants did not reduce their frequency of restaurant dining, but 95% indicate they ask more questions or avoid particular types of foods/restaurants. CONCLUSIONS: Seafood restaurant reactions can be attributed to poor communication, misunderstanding of the allergy by those affected, and cross-contact in preparation. These problems could be rectified through education of patients and the restaurant industry.