Families of children with food allergies get particularly nervous about dining out. For certain people, unsanitary or disorderly kitchens may be not just be cringe-worthy, but downright dangerous.
Earlier this summer, Sharon Brigner's son Brandon was one of many children who had an extremely close call. On June 11 at a Chuck E. Cheese restaurant in northern Virginia, Brigner told ABCNews.com that her son had a severe allergic reaction to egg after eating several mozzarella sticks that unknowingly contained the food he was allergic to.
Brigner said this week that the reaction happened despite her son's nanny asking the manager of the kid-friendly restaurant twice whether the food contained egg, and being reassured by the manager that it did not.
The allergic reaction immediately closed Brandon's throat and sent him to the hospital where he received a maximum dose of epinephrine to recover. Brigner said the doctor told her that if a reaction so severe happens again, it could result in death.
"He said, 'I've used my arsenal of medicines. I don't know what else to do,'" Brigner recalled. "Those are scary words for me to hear as an ER nurse and a mom."
Brandon has made a strong physical recovery but remains so upset by his close call that he anxiously watches his mom prepare food.
Brigner is now certain her family's scare is among many that highlights the need to step up restaurant safety. The plea comes at the same time that a report details unsanitary and unsafe conditions, such as contaminated kitchen countertops, in restaurants nationwide.
To make sure people stay well while dining out -- whether they are getting sick from dirty conditions or put in danger due to allergies from unannounced ingredients -- calls for restaurant safety are rising. To prevent severe allergic reactions, many people say those efforts need to begin with close communication between customers, servers, managers and chefs, and perhaps also include public signs and posters detailing the ingredients that meals contain.
"We encourage staff to know what the most common allergens are," Sheila Weiss, registered dietitian and director of nutrition policy for the National Restaurant Association, told ABCNews.com. "We encourage them how to avoid cross contact -- that if a mistake is made, to take the food back and remake it, not just scrape the cheese off, for example."
"Our incident could have been prevented," said Brigner, a registered nurse and deputy vice president for affordability and access at the Pharmaceutical Research and Manufacturers of America. "It is like handing a child a loaded gun. This is a food that can and will kill him if not receiving the proper care."
The Emotional Impact of Food Allergies
According to the Centers for Disease Control and Prevention, food allergies plague between 4 and 8 percent of children nationwide. The CDC said it is still trying to understand why, but it appears that food allergies are on the rise.
Food allergies are responsible for up to 200 deaths and 30,000 emergency room visits every year, according to the Food Allergy and Anaphylaxis Network, a nonprofit group dedicated to raising awareness about food allergies.
"We use food to show affection, to show comraderie. It's all about sharing food," reflected Anne Munoz-Furlong, founder and CEO at the Food Allergy and Anaphylaxis Network. Munoz-Furlong, who started the group 17 years ago when her daughter was diagnosed with milk and egg allergies, called restaurants "the group that serves the most people and where the risks are the highest."
"From the allergic person's perspective, it's a leap of faith that you're going to get accurate information about the ingredients," she said.
In northern Virginia, Dr. Richard C. Loria, an allergist who works with both children and adults, said traumatic allergic reactions can sometimes take an emotional toll. Some children may need help from psychologists and psychiatrists to confront their food fears, he said.
"There's a term I like to use, which is we have the occasional dietary allergic cripple," Loria said. "There are people that are so impaired by fear of their allergy or of using their epipen that they don't function well."
An epipen is a portable injection that looks like a pen, which allows people with allergies to administer ephinephrine in case of emergency.
Loria said most children do outgrow their food allergies, but severe allergic reactions can set them back in that effort. For those that do not outgrow them, he cautioned that it's unrealistic to think they would go from kindergarten through high school without having an allergic reaction that calls for them to use their epipens.
Loria said medical professionals need to have a very low threshold for giving a child an epipen.
"Most of the times if you think the word epipen, it means you should use it," he said.
Today, Brandon Brigner is set to start a new preschool in a few weeks. Brigner said she is worried but is taking the opportunity to educate his new community about the dangers that come with eating away from home for students like her son.
"I am extremely nervous," she said. "He needs socialization. I know I can't make him a bubble boy even though I want to sometimes."
A Plan for Restaurants
As to whether restaurants should have epipens at their disposal to use in case of emergency, Loria said it's "a very difficult question," especially considering how that practice would be reinforced and how restaurants would know whether or not the epipens are expired.
Meantime, with more than 12 million Americans living with food allergies, what is certain on restaurants' end, Weiss said, is that there should be no secret ingredients.
"When you're cooking, it's a great secret that makes it taste better or makes it thicker, but those pieces of information should be fully disclosed to the customer," she said.
In addition to open communication, Weiss advises diners to keep it simple and avoid things like soups, souffles and stews that may have many ingredients to minimize concerns.
To prevent allergic reactions, the Food Allergy and Anaphylaxis Network works with the National Restaurant Association and has already developed a training program for restaurants. At the National Restaurant Association, Weiss said they will also work to train managers and employees next month as part of a September education campaign.
"Restaurants are certainly more aware of food allergies than before and we are working more to educate our restaurant and members on food allergies," Weiss said.
To be sure, many restaurants are trying to improve their practices. The Chuck E. Cheese Web site, for instance, has a section with answers to questions about food allergies. It says the restaurants do not serve foods containing peanuts and also lists which foods contain gluten. Brigner said she is hopeful the restaurant will do even more to promote food allergy information by listing the allergens and foods regularly served at their locations.
Loria also said listing ingredients in restaurants is imperative, adding, "The least you can do is try to let the consumer make a decision."
Loria advises customers to talk with managers and to make sure someone goes to the kitchen to speak directly with the person preparing the food.
"If they're not willing to speak to you, go to a different restaurant," Loria said.