The Washington Post: When even one drink could kill you

By Sandra Beasley February 20

 Sandra Beasley is a poet and the author of “Don’t Kill the Birthday Girl: Tales From an Allergic Life.”

The recipe, scribbled above the bar at the Brooklyn club, looked delicious — mezcal muddled with basil and lime, and a dash of club soda. But the first sip raised a familiar itch in my throat. The bartender had not rinsed the milk, an ingredient in a previous order, from the shaker, which meant my lips would now be swollen for hours.

Given food allergies like mine, $8 wasted and a few hives is a lucky night; an unlucky one involves an ambulance. I’m at risk for anaphylactic shock, a rapid systemic shutdown that can affect blood pressure and breathing. Even with increased social awareness of allergies and ready administration of epinephrine (which I carry), the danger is real. The Food and Drug Administration estimates that food allergies cause an average of 30,000 emergency-room visits each year and 150 deaths.

Mostly, we think of this as a problem for children, who account for 40 percent of all allergy sufferers in the United States and experience anaphylaxis at higher rates than adults. In 2013, the Centers for Disease Control and Prevention reported a 50 percent increase in food allergies among children between 1997 and 2011. Up to 8 percent of all American children now have at least one significant food allergy, and almost 40 percent of food-allergic children have a history of severe reactions. Each year, families spend approximately $25 billion on accommodating these issues. Schools, stadiums and other public spaces have radically improved allergy precautions for children, some of whom will outgrow their sensitivities. 

But many food-allergic children will become food-allergic adults, who today make up 4 percent of the adult population. They reach the legal drinking age knowing exactly what foods to watch out for but not which cocktails could kill them: Reactions can occur after exposure to even trace amounts of any of the 160 or so known food allergens. Every foam, infusion, mixer and garnish in a drink is a potential source of proteins.

Just a few examples: Milk derivatives are used to bind margarita mix. A fancy Manhattan might use a black-walnut bitter. A popular Brazilian cocktail combines cachaça with cashew juice. A classic Tom Collins is made with cucumber. And every time I order sangria, I have to ask what fruits were added to the pitcher of wine.

This doesn’t even touch the murky topic of base alcohols. In 2004, the Food Allergen Labeling and Consumer Protection Act created standards for food products, but the Alcohol and Tobacco Tax and Trade Bureau is still catching up. Someone with a sulfite allergy knows to avoid wine, but someone allergic to apricots might not know to avoid Disaronno, an amaretto-flavored liqueur sometimes found in cocktails. In 2013, the Annals of Allergy, Asthma & Immunology reported the first documented case of anaphylaxis in reaction to tequila, the “gold” variety, because of the oak barrels it was aged in. Unable to guarantee that the ingredients don’t contain trace amounts of allergens, vodka-maker Absolut recommends that drinkers with allergies avoid flavored vodkas altogether.

We don’t yet have data on reactions specific to the bar, but members of the adult allergy community have their stories. On the Facebook page of the Food Allergy Research & Education advocacy group, the allergic swap cautionary tales — like a woman with a banana allergy who discovered that her frozen drink at the club was laced with banana liqueur. My friend Jenny broke out in hives at her cousin’s wedding after the catering staff served her a margarita with milk protein in the mix. 

Working as a barista and cocktail server made Amanda Orlando, 24, hyper-vigilant about her allergies, which include anaphylactic sensitivity to dairy, nuts and peanuts. Orlando has seen that allergy requests, once received by a waiter, are rarely passed on to the person working the bar. Her own requests as a patron can be stymied as well: While the first answer to “Does this drink contain dairy?” might be “No,” a follow-up question about a specific ingredient — “Are you sure the Godiva chocolate liqueur doesn’t contain dairy?” — would elicit a different answer. 

We take care to warn milk-allergic kids about whey as “hidden” dairy, but once they’re older we need to make sure they know that a “buttery nipple” shot contains real cream, a martini olive might be stuffed with blue cheese. This effort is trickier because ordinarily cautious young adults might obtain drinks in furtive circumstances or in an already intoxicated state. Frat-party concoctions will not be labeled.

Vigilance must last long past college, too. During a layover in Chicago a few years back, I sat down beside a businessman at a bar in O’Hare International Airport. We each ordered a bloody Mary; he got the signature, I got the regular. My eyes widened when his came out with a 10-element garnish. Fortunately, my cheaper version skipped the hunk of sausage, cube of cheese and whole shrimp. Any of which could have killed me.

The National Restaurant Association, whose membership represents nearly 500,000 ­food-service establishments, has an interest in responding to the concerns of the allergy community. After all, 15 million people with allergies (9 million of them adults) are potential customers. In partnership with FARE, the NRA debuted the interactive “ServSafe Allergens” digital training course in 2012. Certificate-level training is already legally mandated in Rhode Island and Massachusetts, and in theory, this course lays the groundwork for industry education in other states.

Curious about what the course contained, I enrolled. The interface escorted me to a virtual bar, and my hopes shot up. But this was simply a space for relaying information. The bottles on the shelves remained unlabeled and unacknowledged. Participants in the course are prompted to click, watch and respond, in areas called “Front of the House” and “Back of the House,” but the bar’s prep station is never mentioned. To avoid cross contact we are explicitly instructed to change out aprons, ladles, toasters, waffle irons — but never a shaker or strainer.

Trainees are warned about foods that contain the “big eight” allergens, which account for 90 percent of reactions in America — milk, eggs, soybeans, fish, tree nuts, peanuts, crustacean shellfish and wheat — but not white Russians (milk), Pisco sours (egg) or any other cocktail. The closest thing to a mention of alcohol is “penne alle vodka.” The course counsels against last-minute additions — in the kitchen. It does not mention the fact that, for someone with a severe citrus allergy, a swipe of lime on the rim of a glass is as dangerous as a squeeze of lemon over a salad.

As the customer, it is my responsibility to disclose my allergies, ask questions and articulate my needs. But once a restaurant has seated me and acknowledges those allergies, we have a contract. All I’m asking for is a consistent standard of service. When anaphylaxis-prone customers order entrees, they don’t have to specify, “Please use a clean cutting board.” So why should we have to hover by the bar to make sure a fresh knife is used on our garnish?

If businesses want to demonstrate consideration for those with food allergies, they need to frame bar menus with the same transparency and warning language used on kitchen menus. And waiters must stop rushing in drink orders, as a show of hospitality, before we’ve had a chance to properly engage and disclose dietary issues.

Here’s the thing: The tongue doesn’t care who is liable while it swells. The stomach doesn’t care as it heaves. The lungs don’t care as they struggle for breath. Usually, any advocacy piece in the food allergy community closes with a heartbreaking story of a life cut short by reaction. I don’t have one to offer you. I’m trying to avoid one.

sandrabeasley@earthlink.net

 

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