Background
Methods
Overview
Online survey
Recruitment and study population
Online survey
Classification | Symptoms | Severity |
---|---|---|
ALLERGY: Symptoms associated with IgE-mediated reactions | ‘Stinging nettle’ rash, urticaria, hives, Itching or swelling of the lips, tongue or mouth, asthma, wheezing, facial swelling (does not experience ‘severe’ symptoms) | MILD/MODERATE
(Does not include ‘severe’ symptoms)
|
Breathing difficulties, anaphylaxis, collapse
(May additionally include symptoms associated with non-IgE-mediated reactions)
| SEVERE
(May additionally include ‘mild/moderate’ symptoms)
| |
INTOLERANCE: Symptoms associated with non-IgE-mediated reactions | Vomiting, Diarrhoea, Sneezing, Catarrh, Hyperactivity, Tiredness, Stomach cramps, Other digestive problems (e.g. bloating, constipation), Eczema flare, Migraines/headaches, Aching joints/muscles, Behavioural/mood changes
(Does not include symptoms associated with IgE-mediated reactions)
|
Survey content
Survey subscale | Survey itema (R) = Reverse scored | Response scale | Cronbach’s alpha |
---|---|---|---|
Reliance on speaking to staff | - I am happy to ask serving staff about allergens in the food they are serving - I ask to speak to the manager if I want more information about allergens in the dishes - I ask to speak to the chef if I want more information about the meal being cooked for me - I don’t like asking staff questions about allergens (R) - I feel awkward and embarrassed to ask staff questions about the food they are serving (R) | 0 ➔ 6 Never ➔ Always | .685 |
Satisfaction with written information | - Menu information online (R) - The menu displayed outside the place (R) - The menu displayed at the counter (R) - The menu at the Table (R) - Phone apps (R) - Information folder about ingredients of foods being served (R) | 1 ➔ 5 Very satisfied ➔ Very dissatisfied | .827 |
Staff as an additional information source | - Even if there was information about allergens on the menu I would like to ask a member of staff about the dish (R) - No matter how good the written information is I would prefer to talk to staff (R) | 1 ➔ 5 Strongly agree ➔ Strongly disagree | .834 |
Preference for a separate allergen menu | - I would like to see separate menus for people with particular food intolerance or allergies. (R) - I want to know from the menu how the food is cooked not just what is in it (R) - It is reasonable to expect that there are separate menus to help people avoid particular allergens (R) | 1 ➔ 5 Strongly agree ➔ Strongly disagree | .730 |
Menu invites you to ask staff about allergens | - I like it when it says in the menu that they welcome customers with allergies and intolerances asking about dishes (R) | 1 ➔ 5 Strongly agree ➔ Strongly disagree | Single item |
Sign invites you to ask staff about allergens | - I like it when there is a sign up that says that they welcome customers with allergies and intolerances asking about dishes (R) | 1 ➔ 5 Strongly agree ➔ Strongly disagree | Single item |
Procedure
Data analyses
In-depth interviews
Recruitment and population
Procedure
Analyses
Results
Online survey
Variable | Gluten (n = 66) n (%) or M (SD) | Nuts (n = 94) n (%) or M (SD) | Milk (n = 72) n (%) or M (SD) |
---|---|---|---|
Adult | 56 (84.8) | 40 (42.6) | 39 (54.2) |
Parent | 10 (15.2) | 54 (57.4) | 33 (45.8) |
Gender | |||
Adult/Parent | |||
Male | 13 (19.7) | 12 (12.8) | 9 (12.5) |
Female | 53 (80.3) | 81 (86.2) | 61 (84.7) |
Childa | |||
Male | 4 (40.0) | 32 (59.3) | 19 (57.6) |
Female | 6 (60.0) | 21 (38.9) | 14 (42.4) |
Age (yrs) | |||
Adult/Parent | 41.2 (11.9) | 39.6 (9.7) | 37.6 (10.5) |
Child | 8.5 (3.8) | 10.6 (4.2) | 5.1 (3.8) |
Food allergic | 8 (12.1) | 86 (91.5) | 27 (37.5) |
Food intolerant | 58 (87.9) | 8 (8.5) | 45 (62.5) |
Diagnosis | |||
Clinical diagnosis (by GP; Dietician or Allergy specialist at hospital) | 47 (71.2) | 84 (89.4) | 44 (61.1) |
Self diagnosis | 19 (28.8) | 10 (10.6) | 28 (38.9) |
Severity of reaction (FA only)b | |||
Mild/Moderate | 5 (62.5) | 28 (32.6) | 23 (85.2) |
Severe | 3 (37.5) | 58 (67.4) | 4 (14.8) |
Time since diagnosis (yrs) | |||
< 2 | 12 (18.2) | 3 (3.2) | 14 (19.2) |
2–4 | 20 (30.3) | 23 (24.5) | 24 (33.3) |
5–9 | 18 (27.3) | 24 (25.5) | 22 (30.6) |
≥ 10 | 16 (24.2) | 43 (45.7) | 11 (15.3) |
Treatment | |||
Avoidance | 66 (100) | 94 (100) | 72 (100) |
Antihistamines | 4 (6.4) | 67 (71.3) | 15 (20.8) |
Injectable adrenaline | 1 (1.5) | 66 (70.2) | 2 (2.8) |
Inhaler | 1 (1.5) | 33 (35.1) | 10 (13.9) |
Special diet | 32 (48.5) | 9 (9.6) | 25 (34.7) |
Support group membership | 27 (40.9) | 36 (38.3) | 7 (9.7) |
Survey subscale | Gluten | Nuts | Milk | ||||
---|---|---|---|---|---|---|---|
Mean (SD) | df | F | ηp2 | p | |||
Reliance on speaking to staff | 3.26 (1.25) | 3.79 (1.27) | 3.15 (1.22) | 2, 220 | 4.20 | .037 | .016 |
Satisfaction with written information | 3.30 (0.91) | 3.59 (0.73) | 3.41 (0.73) | 2, 220 | 3.13 | .028 | .046 |
Staff as an additional information source | 3.48 (1.29) | 4.00 (1.02) | 3.10 (1.23) | 2, 220 | 4.13 | .036 | .017 |
Preference for separate allergen menu | 4.11 (0.87) | 3.93 (0.97) | 3.49 (0.99) | 2, 219 | 5.15 | .045 | .007 |
Menu invites you to ask staff about allergens | 4.55 (0.79) | 4.67 (0.67) | 4.33 (0.87) | 2, 218 | 3.53 | .031 | .031 |
Sign invites you to ask staff about allergens | 4.59 (0.78) | 4.60 (0.81) | 4.29 (0.94) | 2, 217 | 3.83 | .034 | .023 |
Reliance on speaking to staff
Satisfaction with written information
Staff as an additional information source
Preference for separate allergen menu
Menu invites you to ask staff
Sign invites you to ask staff
In-depth interviews
Variable | Gluten (n = 13) n (%) or M (SD) | Nuts (n = 14) n (%) or M (SD) | Milk (n = 13) n (%) or M (SD) | Multiplea (n = 9) n (%) or M (SD) |
---|---|---|---|---|
Adult | 12 (92.3) | 11 (78.6) | 8 (61.5) | 9 (100) |
Parent | 1 (7.7) | 3 (21.4) | 5 (38.5) | 0 |
Gender | ||||
Adult/Parent | ||||
Male | 1 (7.7) | 5 (34.7) | 4 (30.8) | 1 (11.1) |
Female | 12 (92.3) | 9 (64.3) | 9 (69.2) | 8 (88.9) |
Childa | ||||
Male | 0 | 2 (66.7) | 2 (40.0) | 0 |
Female | 1 (100) | 1 (33.3) | 3 (60.0) | 0 |
Age (yrs) | ||||
Adult/Parent | 37.5 (18.0) | 38.9 (15.2) | 43.1 (10.8) | 39.78 (13.3) |
Childb < 10 | 0 | 0 | 1 (20.0) | 0 |
10–14 | 0 | 2 (66.7) | 0 | 0 |
> 14 | 1 (100) | 1 (33.3) | 4 (80.0) | 0 |
Food allergic | 1 (7.7) | 14 (100) | 2 (15.4) | 5 (55.6) |
Food intolerant | 12 (92.3) | 0 | 11 (84.6) | 4 (44.4) |
Diagnosis | ||||
Clinical diagnosis
(by GP; Dietician or Allergy specialist at hospital)
| 10 (76.9) | 13 (92.9) | 7 (53.8) | 3 |
Self diagnosis | 3 (23.1) | 1 (7.1) | 6 (46.2) | 2 |
Severity of reaction (FA only)c | ||||
Mild/Moderate | 1 (100) | 7 (50.0) | 2 (100) | 3 (60.0) |
Severe | 0 | 7 (50.0) | 0 | 2 (40.0) |
Time since diagnosis (yrs) | ||||
< 3 | 0 | 1 (7.1) | 0 | 0 |
3–7 | 8 (61.5) | 3 (21.4) | 5 (38.5) | 4 (44.4) |
≥ 7 | 5 (38.5) | 10 (71.4) | 8 (61.5) | 1 (11.1) |
Treatment | ||||
Avoidance | 13 (100) | 14 (100) | 13 (100) | 9 (100) |
Antihistamines | 2 (15.4) | 7 (50.0) | 3 (23.1) | 3 (33.3) |
Injectable adrenaline | 1 (7.7) | 7 (50.0) | 0 | 1 (11.1) |
Inhaler | 0 | 4 (28.6) | 0 | 0 |
Special diet | 8 (61.5) | 2 (14.3) | 5 (38.5) | 1 (11.1) |
Support group membership | 2 (15.4) | 3 (21.4) | 0 | 2 (22.2) |
Disparities in allergen information provision
1) | ‘I’ve definitely seen it [allergen information] a lot more about. It’s kinda really visible in a lot of places which is alright… I think it is just a few of them [allergens]… Just nuts and gluten.’ (A32, FI: Gluten) |
2) | ‘… they have an entirely separate menu so I feel very comfortable going there… my preference is a separate gluten free menu but I realise it’s probably unrealistic to expect everywhere to do that so I guess, if I’m going into a place I know doesn’t have a gluten free menu it just makes things 10 times easier if they’ve got a little symbol… the little symbols and then a key under every dish. Just printed those symbols and then it’s done, easy.’ (A13, FI: Gluten) |
3) | ‘… going out it normally says on the menu now. It will have a little ‘N’ next to it or something... Is that a new thing? It’s getting better since I last saw you. Most places do it now and they do it for gluten free and things… It will say if it’s got nuts in. It makes it easier for them because they’re not having to answer your questions all the time. You can read the menu and say “that has got nuts in”.’ (A58, FA: Peanuts & tree nuts) |
4) | ‘In my experience it’s [the legislation] been ineffective for his condition and I have actually been in a restaurant with a friend that was presented with a gluten free menu for breakfast and I was so impressed that they could do that with the gluten free but [it] wasn’t available for dairy- and in fact the same restaurant was able to present a different menu for [healthy weight loss] diets which I thought was amazing- that they could go to that effort but yet it wasn’t available for something that seems to effect a lot of people.’ (P7, FI: Milk) |
5) | ‘… mainly vegetarian and vegan, yep, and gluten free and they were the main ones. But not dairy? Not dairy, nothing. I haven’t come across a single place that talks about dairy free. But I think it’s because it’s not very well understood.’ (A51, FI: Milk) |
6) | ‘On the menu where you see the ‘V’ or the ‘G’ and all that business, to have a ‘D’ for dairy so that covers any type of dairy then at least you could say, actually for me, I would rule it all out…’ (A44, FI: Milk) |
Understanding the needs of customers avoiding different allergens
1) | ‘… there’s so many different things it [milk] could be in so that’s why I think people who work in restaurants and cafes they just sort of panic and don’t fully understand… they just assume dairy for me is cheese or butter or it’s got cream on it. Well no, it’s not the cream I’m talking about, I’m talking about the content in the scone for example or in the cake.’ (A44, FA: Milk) |
2) | ‘I just feel that actually some people don’t feel like it’s actually worthy of a restaurant going out of your way for it. I still don’t feel comfortable, I still don’t think [milk allergy/intolerance is] an acceptable thing to legitimately have. You think there’s a stigma attached? Yeah, I still think people have.’ (A51, FI: Milk) |
3) | ‘When I used to say coeliac or gluten free they would look at you a bit… now I think staff are more totally up on it. So I think in the majority of places they are told about it, I mean obviously there is nut allergies and things, but nut allergy is quite obvious, it’s nuts. When you say gluten they think “well” you know “what’s that in?”… unless you’ve come across it, I would have been the same. But I have found it much better.’ (A57, FI: Gluten) |
4) | ‘… things have changed and got better yet I’ve still had reactions- and of course with the growing increase of “fad diets” there is always the risk that you’re not taken seriously and you know, yeah great, “gluten free” is getting awareness these days but it’s about whether it’s the “right type”, or whether people just think it’s… you have to be taken quite seriously as a coeliac sufferer and I don’t think we are anymore. So it’s kind of swings and roundabouts.’ (A13, FI: Gluten) |
5) | ‘I think what the problem is particularly with the nuts is that there are so many things made without nuts and get cross contaminated, so they tend to see it as not as problematic as someone who is coeliac. I think they look at it as “oh you’ve got a nut allergy”, yes. I think there are places that don’t tend to think it’s serious.’ (P2, FA: Peanuts, Tree nuts) |
Customer demand for information about specific allergens
1) | ‘… out of interest what are the sort of allergies and intolerances that you hear more of, most of? Gluten, nuts and seafood. Okay right and very often? No, not often at all actually. Like a lot, gluten more than anything... Nuts maybe four or five times in a year, yeah not often at all. I don’t know whether it’s not that common, or people just don’t mention it and seafood maybe once or twice a year to be fair, not often at all.’ (A59, FA: Peanuts, Tree nuts) |
2) | ‘… I think there aren’t enough people who are lactose intolerant for companies to see it as viable. Or enough people to make a fuss. So I’m part of the problem I think. There aren’t enough people making a fuss about it because of people not wanting to make it a big thing so companies don’t have to make a big deal about it, but if everyone who had slight lactose intolerance… pushed in restaurants I think there would be a bigger appeal for it. We are part of the problem.’ (A51, FI: Milk) |
3) | ‘Well, if everywhere could do soya milk that would be excellent, or start having optional lactose or dairy free cheese as options rather than having to not have anything that’s a milk product but I don’t know if there’s an economic imperative for shops. If there’d be enough customers who would be interested in that, there might be. There might be plenty of people who are just avoiding these things who would buy them if they knew that they could have nachos with lactose free cheddar, then they would but I suppose until they try that they don’t know.’ (A10, FI: Milk) |
4) | ‘Nut allergies I think prevail a lot. I think they are aware of nut allergies… I don’t think they think anything else is… it’s a killer, do you know what I mean? But I’m not going to die eating a sandwich, but I can be in pain for hours and it can have a massive effect, because you can’t do anything.’ (A34, FI: Gluten, Milk) |
5) | ‘… it’s not life threatening like if I had nut [allergy] or anything like that. So, I just know that night I’m going to suffer… I think if I was nut intolerant I would be very… but because it’s not life threatening I think I tend to put up with it and think “I won’t have that again”.’ (A45, FA: Milk) |