Although food allergen labeling is regulated, patients with food allergies may still have difficulty interpreting food labels due to cross-contact and other factors, with dining out posing additional considerations. Progress in improving food labeling standards has been gradual and requires cooperation among several groups. Providing patient education on existing food allergen labeling and how to communicate effectively when dining out can help patients and caregivers safely navigate food options.

In the United States, food allergen labeling is regulated by the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) and the Food Allergy Safety, Treatment, Education, and Research (FASTER) Act of 2021. These acts require food manufacturers to list any of the 9 major food allergens on food labels if they are in the product.

However, companies often list their products as containing these allergens if the product is made in the same factory as other allergen-containing foods to protect themselves from liability from cross-contact (also called cross-contamination), and this can be confusing to consumers. In addition, some of the listed food allergens on labels are present only in trace amounts, so patients with allergies likely may not react. As general education, I advise patients to avoid the food if an allergen is listed as an ingredient on the label and to be less concerned if it is discussed in other areas of the label but not as an included ingredient.

Cross-contact can occur, which can be a concern when patients with allergies are dining out. For example, this may happen at a bakery, where butter may be on a pan used to make a “milk-free” product; in high-risk situations such as a buffet, where people are self-serving different foods with the same utensil; or at an ice cream parlor, where the same spoon is used to serve different flavors of ice cream. So, patient-specific education should be a nuanced conversation between providers, dietitians, and families based on a patient’s specific allergies and their degree of sensitivity.

Progress in improving food labeling standards has been slow because it requires cooperation among food experts (who determine the quantity or concentration of allergen thresholds that would need to be listed), the US Food and Drug Administration (FDA), and food manufacturers, all of whom must agree on the labeling. Often, there is a lack of data to determine the real window for threshold reaction rates, in part because we do not aggressively challenge many of the super sensitive patients to identify this allergen threshold.

Identifying allergens in food when dining out requires asking about specific allergens in particular foods. For example, I educate patients with milk allergies about the importance of not ordering a cream sauce when dining out; if they have multiple food allergies, I advise them that it may be best to order something like baked chicken. Some of this is obvious, but we need to make sure that people with food allergies are able to find ways to dine out safely.

However, certain places, such as buffets, are more high risk for patients with food allergies. Most municipalities do not have mandatory regulations regarding labeling for allergens in restaurants, in part because these establishments may not know the specific allergen content in food ingredients from their suppliers. Implementing such regulations would require working backward to the supplier. Restaurants do not have this obligation, and, although some (such as farm-to-table restaurants) may do it voluntarily, it is highly variable.

Some college cafeterias have menu apps that allow diners to enter their food allergens into the app to see what can be eaten. Restaurants could do the same thing. The technology and knowledge base exist. So, hopefully over time, additional cafeterias and restaurants will incorporate this to allow patients with food allergies to more easily make informed dining choices.