By Carolyn Crist

(Reuters Health) – If restaurants and other food establishments stocked epinephrine autoinjectors, the number of fatal allergic reactions, known as anaphylaxis, could decrease, a small study in Canada suggests.

After a two-year test of an epinephrine autoinjector stocking program in Hamilton, Ontario, diners with allergies as well as restaurant owners and staff said that having the devices onsite made them feel better about possible emergencies, researchers report in The Journal of Allergy and Clinical Immunology: In Practice.

The costs varied by how many staff needed to be trained to use the devices, but the expense was low compared with that of automated external defibrillator (AED) devices, the study authors note.

“Self-management of food allergy and anaphylaxis is sub-optimal, particularly among adolescents and young adults who most often engage in risk-taking behaviors such as neglecting to carry epinephrine autoinjectors or delaying its timely administration to treat reactions,” said lead author Dr. Susan Waserman, a professor of medicine at McMaster University in Hamilton and director of the Adverse Reactions Clinic at the Firestone Institute of Respiratory Health.

Between 1986 and 2011, about half of anaphylaxis deaths in Ontario were due to food allergies, and 14 percent occurred after eating at restaurants, fast food chains or shopping mall food courts.

In the U.S., more than half of anaphylaxis deaths occur at restaurants or other food establishments such as ice cream shops and food courts, the study team writes.

“Challenges also exist in food establishments, including the lack of knowledge and training of food service personnel about food allergies and the reluctance of food-allergic individuals to disclose their allergies to restaurant staff due to embarrassment,” Waserman told Reuters Health by email.

To test the feasibility of stocking epinephrine injectors in places where severe allergic reactions to food might occur, the researchers implemented a program at a Hamilton shopping mall between 2014 and 2016. Security guards had access to autoinjectors in first aid kits in the mall’s central administration office and received training on recognizing allergic reactions and how to use the injectors.

In two mall restaurants, staff were also given the three-hour training session and had access to injectors kept in a central area, such as behind the counter, as well as back-up doses kept in an office area. Each location also had a site leader and an anaphylaxis emergency response plan.

Only one critical incident occurred during the study period, so it is difficult to show the full benefits of the program, the study team writes.

However, since the pilot program, government-owned properties in Hamilton such as recreation centers, arenas, senior centers and community halls have installed autoinjectors. After finding that firefighters often arrive on the scene for anaphylaxis emergencies before ambulances, the Hamilton Fire Department also stocked its fire trucks with autoinjectors. The program is now in 50 restaurants across the city, with the goal of reaching all 2,000 restaurants in Hamilton.

The success of the epinephrine autoinjector stocking program depends on several factors, including local government support, effective staff training, low resource requirements and embedding the program into existing policies and procedures, Waserman’s team writes.

Costs in the pilot program ranged from C$715 ($543.93) for the sit-down restaurants to C$2,155 ($1,639.41) for the mall-wide program, they note.

“Whether you’re diagnosed with an allergen already or have your first allergic reaction at a restaurant, this could stop a potentially life-threatening moment,” said Dr. Scott Sicherer of the Icahn School of Medicine at Mount Sinai in New York City, who was not involved in the study.

“When you eat outside of your home, you depend on other people to make food for you,” he said in a phone interview. “This program is a good model that makes sense.”

Legislation and liability issues may pose more of a problem in the U.S., he added, since epinephrine autoinjectors are typically only available by prescription. Now that some schools are beginning to carry them, however, that could open the door for other public places.

“At a restaurant, you can say you have an allergy and you can carry a card with instructions,” Sicherer said. “A chef or server may guarantee they can provide a safe meal, but when that means just scraping nuts off the top of a salad, that doesn’t work, and you may not realize.”

SOURCE: https://bit.ly/2nEwQIW The Journal of Allergy and Clinical Immunology: In Practice, online August 2, 2018.