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  2. The Project and the Team THE PREFERENCES OF THOSE WITH FOOD ALLERGIES AND/OR INTOLERANCES WHEN EATING OUT RESEARCH CONDUCTED FOR THE FOOD STANDARDS AGENCY MARCH 2014 – APRIL 2015 Prof Julie Barnett, Dr Debbie Roy & Dr Fiona Begen ( University of Bath ) Prof Jane Lucas ( University of Southampton ) Dr Audrey Dunn Galvin & Kathleen Ryan ( University College Cork ) Dr Anita Eves, Prof Monique Raats & Dr Bernadette Egan ( University of Surrey ) Ros Payne ( Creative Research ); Hazel Gowland ( Allergy Action )

  3. Eating out with an allergy Avoidance of the allergen is the key management strategy for people with a food allergy or food intolerance  20-30% accidental allergen ingestion occurs in restaurants  Another 13-23% occurs in other eating out establishments  Quality of life impacted by requirement for constant vigilance and risk management Leftwich, J., Barnett, J., Muncer, K., Shepherd, R., Raats, M., Gowland, H., & Lucas, J. (2011) The challenges for nut allergic consumers of eating out, Clinical and Experimental Allergy, 41, 243-249

  4. EU Food Information for Consumers Regulation From December 2014….  New requirements to provide allergy information around what is deliberately added as an ingredient or processing aid  For prepacked foods there is a new requirement to emphasise allergens in the ingredients list  For loose (non prepacked foods) there is a new requirement to provide information about allergens  The presence of 14 allergens must be clearly declared  Information about allergens can be written or oral HOW DO CONSUMERS WANT TO RECEIVE INFORMATION ABOUT ALLERGENS?

  5. Our Research Two main research phases  In-depth qualitative exploration of the eating out preferences and practices of food allergic and intolerant individuals using 75 interviews + 19 diaries  Questionnaire survey to characterise the information preferences/practices of food allergic/ intolerant individuals and to derive baseline measurement of quality of life - completed by 874 people

  6. Who has taken part in this research? People with food allergy or intolerance…. BUT Confirmation of allergy in clinical setting  not possible  not desirable Self reported screening criteria  Must suffer problems after eating at least one of the 14 allergens – or have a child that does  Must avoid eating at least one of the 14 allergens because of this reaction  Should eat out sometimes

  7. Classification Symptom Severity 'Stinging nettle' rash, urticaria, hives MILD ALL LLERGY Itching or swelling of the lips, tongue or mouth Asthma, wheezing MODERATE Facial swelling (may also have mild symptoms) Breathing difficulties SEVERE Anaphylaxis, collapse (may also have mild and/or moderate symptoms) Vomiting Diarrhoea (NO ALLERGY SYMPTOMS +) Sneezing Catarrh Hyperactivity Tiredness INTOLERANCE INT Stomach cramps Other digestive problems (e.g. bloating, constipation) Eczema flare Migraines/headaches Aching joints/muscles Behavioural/mood changes

  8. Overview… Eating out is seen as increasing risk and is often a source of concern and anxiety Particular characteristics of information provision are likely to reduce concern and increase safe food choices The service encounter is basis for decision making  Ideally familiarity and trustworthiness are conveyed within the service encounter  People take notice of direct and indirect cues within the service encounter EXPERIENCES OF THE SERVICE ENCOUNTER ARE LINKED WITH SUBSEQUENT BEHAVIOURS: DISHES ARE ORDERED, CONSUMED OR AVOIDED. VENUES ARE VISITED, REVISITED OR SHUNNED

  9. Written information PRE REPLANNING AT T THE THE DOOR AT T TH THE E TABL ABLE  Decision points at which people use written information  Menu at the table was the primary and preferred written information reference point  Menu on website and outside venue inform assessment of how likely it is to be able to eat there safely  Clear allergen related information on menu was generally trusted & provided reassurance  In the face of unfamiliarity and reluctance to ask, written information provides a tangible anchor for food choice

  10. Additional written information Strong preference for information about ingredients – especially for those reacting to more than one allergen Participants valued  a supplementary list/menu of for example, gluten-free or milk- free options  an invitation to ask staff for more information about allergens/allergen-free options (on menu, on notices in the venue)  a reference source showing all ingredients/allergen content  signs next to e.g. gluten free products in a shop/café MANY FEEL THAT THINGS ARE IMPROVING … MORE OPTIONS, MORE INFORMATION

  11. Reservations about menu information Provide insufficient information  what do the dishes contain? how are they cooked? Use of symbols  restricted to a few allergens  applicability outside the UK unclear  presence or absence of allergen? Ambivalent about the role of detailed ingredients information on the menu  could it undermine the ‘ambience’ of the venue  would the menu be too unwieldy?

  12. 13 What is the role of oral information?  Strong preference for provision of written information - it provides sense of autonomy, control and of ‘being normal’  Unwillingness to speak to staff is common – embarrassment often cited as the reason  Good written information has a role in facilitating  Confidence to ask for information  Trust in oral information  Feeling known/understood by staff is highly valued

  13. Talking to staff Consumers highly attuned to cues from staff  How knowledgeable they are  How interested and engaged they are with customer needs Staff competence and care is read from demeanour and appearance While some felt that the new legislation would help ‘empower’ them to ask staff for more information, many objected to this being the principal means of accessing information

  14. You get some people that are quite perky and cheery and.. Also asking specifically as well. So I might accidentally say ‘no milk’ and they’d be like “do you also not want cheese?’ or ‘no prawns?’. And they are like, ‘Are you ok with…?’ this other thing. So you do get people that are quite on the ball in that sense Also [it is good ]if a waiter is really keen on ..listening and writing all the ingredients, just to make sure she speaks or he speaks to the chef. So yeah just basically communication and the way they treat those things I’ve had them just shrug their shoulders and say “I don’t know”.. “Well does the chef know?” “I don’t think he will”.. You know sort of thing and you’re thinking, you are joking…

  15. I think it’s very good. I think I would “I will be more confident choosing not still always ask, you know, even if only restaurants but even like different they said, if they’d shown that there places,… I will be more confident to was something with nuts, I would speak to staff members, will not feel always still ask, you know, about the I’m wasting their time, because individual dish that I was getting… sometimes that’s what I feel, and also, I’d ask to make sure that it would be will be more confident in large parties, because it will not cause that much made in a completely separate area trouble. or separate, you know, utensils and things like that. I think it would definitely make it easier, and, again, for somebody “ it would make you much more like me that feels self-conscious of confident going out. If I know that, you asking, I think it will make it a lot know people work as waiters, you can’t easier, and I won’t have to feel expect them to be up on allergies and that, you know, oh, self-conscious so on but if I’m confident that there is a that I’ve got an intolerance to list that I can see, just to double check something because then I can if there’s eggs in this, it’s not just their avoid it anyway, with them telling opinion or what they hope is in it. That me. would be much better, yeah .”

  16. Recommendations I  When considering their information provision practices food businesses should take account of the practices and preferences of food allergic consumers.  Written information provided by the venue is generally likely to be trusted – it is thus vital that it is trustworthy.  Consider how comprehensive allergen information can be balanced by simplicity and clarity in the basic menu and other detailed reference resources if required. The availability of the latter should be signalled in the basic menu.

  17. Recommendations II  When customers ask staff questions about allergens, they will take notice of more than the words that are given in reply. Staff training should take this into account.  Seek to identify ways in which the venue can actively and visibly signal that staff are attentive to the requirements of those that wish to avoid allergens


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