What to do if a Customer has an Allergic Reaction

Food allergies are one of the leading causes of anaphylaxis — the most serious and potentially life-threatening allergic reaction — and an important public health concern in Canada. Over 2.6 million Canadians, including 500,000 children, live with food allergies that must be managed on a daily basis.

Business owners, managers and workers in food businesses are all responsible for providing safe, allergen-free meals once they have been informed of a food allergy by customers. If a food business cannot guarantee an allergen-free meal, the customer must be notified as such. Failure to properly communicate this information to customers could result in serious injury and even death.

The first step in managing allergic reactions in a food business is, of course, to prevent them. An allergen management plan, detailing the training, processes and procedures in place for allergenic foods and ingredients. Training is especially important to ensure all staff are aware of their obligations and are capable of fulfilling them. 

When training staff in allergen management, food business owners/managers need to ensure that they:

• Know the most common food allergens 
• Are aware that any food can be an allergen
• Know what goes into the food being sold or meals being prepared, and which items contain allergens
• Are careful to avoid cross-contamination by changing gloves and preparing foods hygienically
• Are comfortable reading ingredients or seeking clarification
• Know who to ask when information is requested by a customer
• Communicate to all appropriate staff when informed that a customer has an allergy

All employees should be trained to recognize the signs and symptoms of an allergic reaction, and at least one employee on the premises should be trained to act immediately if a customer has a serious allergic reaction.

What to do if a customer has an allergic reaction

An allergic reaction can happen within seconds of being exposed to an allergen. A severe allergic reaction or anaphylaxis can be traumatic for the person experiencing it, and frightening for witnesses who do not know what to do. It is beneficial for your customers, your staff and your business to make sure that employees know their role in the event of an emergency.

RECOGNIZE THE SIGNS AND SYMPTOMS OF AN ALLERGIC REACTION

The signs and symptoms of an allergic reaction can vary from person to person, and can quickly become life-threatening. 

Symptoms can involve any or all of the following:

• Hives, swelling, itching, skin warmth, redness or rash
• Coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, trouble swallowing, or hay fever-like symptoms (nasal congestion or itchy, runny nose, watery eyes, sneezing)
• Nausea, stomach cramps, vomiting or diarrhea
• Changes in skin colour (pale/blue colour), weak pulse, dizziness, shock
• Feelings of anxiety, headache, uterine cramps or a metallic taste in the mouth
• Swelling of the tongue and/or airways causing difficulty breathing
• Drop in blood pressure (causing dizziness, lightheadedness or passing out)

If a food worker notices that a customer is showing signs of an allergic reaction, it is important to remain calm and act quickly. Staff should stay with the individual having the reaction and call for help — never leave the person alone. 

LOCATE EPINEPHRINE AUTO-INJECTOR

At the first signs of an allergic reaction, locate the customer's epinephrine auto-injector (e.g. EpiPen®, AUVI-Q®). Both the customer and the food business have a responsibility to prevent an allergic reaction, so the customer should have an epinephrine auto-injector with them. Instructions for use should be stored with the epinephrine auto-injector.

It is recommended to get this information from the customer immediately after they have disclosed a food allergy, before an emergency can occur. Staff should ask the customer where they will find their epinephrine auto-injector in the event of an allergic reaction, and, if applicable, ask if anyone in their party has experience administering the shot. The more information obtained upfront, the better prepared staff will feel if they need to act quickly.

If the customer is having mild symptoms and can speak, discuss whether or not antihistamines can be taken to relieve their symptoms; however, keep in mind that symptoms of an allergic reaction differ with each reaction and can become more severe over time.

If symptoms progress, epinephrine is the only suitable medication. Even if the customer believes that they are not in serious danger, staff should encourage them to self-administer a dose of epinephrine and continue to watch for any of the following signs of anaphylaxis:

• Difficult or noisy breathing
• Swelling of the tongue or throat
• Loss of consciousness or collapse
• Difficulty talking or a hoarse voice
• Wheezing or persistent cough
• Paleness or weakness (especially in young children)

If the customer is under the age of majority or dining alone, contact their parent/guardian or other emergency contact. If the customer's symptoms are worsening, take action immediately.

TAKE ACTION

If you see any one of the symptoms of anaphylaxis, you should do the following (in order):

• Call an ambulance (911)
• Administer the epinephrine auto-injector
• Place the person in a position appropriate for the symptoms they are experiencing
• Contact parent/guardian or other emergency contact
• Stay with the person until medical responders arrive

The person should be placed on their back with their legs elevated and should continue to lie down until emergency responders arrive or until they have fully recovered. If the person feels nauseated or is vomiting, they should be placed on their side to keep the airway clear and prevent choking on vomit. If they are having difficulty breathing, they should be kept sitting up, preferably on the ground with their legs outstretched.

It is important to remember that a person who is experiencing anaphylaxis may not be capable of self-administering an epinephrine auto-injector as they may be physically incapacitated or confused. They may also be anxious about using a needle, may downplay the seriousness of the reaction, or they may not want to draw attention to themselves. Assistance from others, especially in the case of young children or teenagers, is extremely important.

Don’t delay giving epinephrine! This is one of the most common mistakes people make during anaphylactic reactions. Epinephrine is safe and rarely causes harm, even if given when not needed. It can save a life, but it must be used promptly – don’t hesitate to do so.

After treatment, the person should go to the nearest hospital, even if symptoms are mild or appear to have stopped, because the reaction could get worse or reoccur. Do not ask the person to sit up or stand immediately following a reaction (even if treated), as this could cause a dangerous drop in blood pressure or other complications — including death.

The importance of prevention

Unfortunately, most fatalities related to a food allergy occur when eating outside the home, which indicates that some food businesses:

• Do not have an effective process for preparing foods for customers with food allergies
• Are not training staff about how to communicate with customers about food allergens, including what information they need to provide and how to ask customers about food allergies
• Are not training staff on food safety best practices to prevent cross-contamination
• Are not effectively communicating allergy requests
• Are not adequately prepared to handle emergency situations

As a food business owner or manager, prevention of allergy incidents should be your primary approach. Trained and Certified Food Handlers help to minimize the risks involved when preparing, displaying and selling food products to customers. In addition to Food Handler Certification Training, which provides Canadian food workers with the information and skills they need to handle food safely and prevent cross-contamination, CIFS Food Allergen Training provides an even more focused look at everything staff should know about allergen management. 

It's a good idea to incorporate an allergic reaction emergency drill into regular staff training sessions, using an epinephrine auto-injector trainer device, which contains no needle or drug. Free training devices can be ordered from epipen.ca.

For more information about Food Allergen Training, visit our course page by clicking the link above or contact us today.