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Why food allergy fakers need to stop

From gluten to garlic, diets and dislikes are being passed off as medical conditions. Chefs and real sufferers have had enough.

BEFORE WE GET INTO IT, let me make one thing clear. This intervention is not aimed at those with life-threatening food allergies or similarly grave medical conditions. I would never question people whose faces will balloon if they ingest trace amounts of shellfish. Or people who risk going into anaphylactic shock with a whiff of peanut dust. Or people whose ingestion of a smidge of gluten will send their bodies on an autoimmune witch hunt that over time will eat away at the lining of their small intestines and potentially lead to everything from infertility to cancer. Those problems are very real, and everyone who is afflicted with one or more of them has my sympathy.

I’m talking about the rest of you. Those of you who don’t eat garlic because you detest its smell or avoid cauliflower because it makes you fart or have gone gluten-free because you heard it worked wonders for Jennifer Aniston or Lady Gaga or Dave, your toned instructor from spin class.

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When you settle into your seat at a restaurant, don’t be shy about telling your server your food preferences. By all means, ask if your dish can be prepared garlic-free or cauliflower-free or gluten-free. You’re paying good money, so you should get the meal that you want, not one that leaves you riding home in a foul mood and a plume of fetid air. The days of the imperious no-substitutions chef, telling you to take it or leave it, now seem as dated as a rerun of that SeinfeldSoup Nazi” episode from 20 years ago.

But for the love of Julia Child and the sake of every other soul in the restaurant, particularly the underpaid line cooks sweating their way through another Saturday night shift, please, please stop describing your food preferences as an allergy. That is a very specific medical term, and invoking it triggers an elaborate, time-consuming protocol in any self-respecting kitchen. It shouldn’t be tossed around as liberally as the sea salt on the house-made (gluten-free) breadsticks.

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I know you want your dietary preferences to be taken seriously, and you think invoking the A-word is a harmless little white lie. But you have no idea how much trouble you’re causing and how much you’re helping to erode hard-won progress for people with genuine allergies and disorders.

In a stunningly short slice of history, we’ve gone from food allergies being met with ignorance or indifference in the restaurant world to their domination of the discussion between server and diner, starting with the greeting and continuing all the way to dessert. The seriousness with which most chefs now take allergies has opened up the restaurant experience to a whole group of people who previously couldn’t risk dining out. That progress should be celebrated.

But it shouldn’t be taken for granted. And we’ve come to a tipping point, thanks to the explosion of faddists and bandwagon-jumpers and attention-seekers who wrap their food dislikes in the packaging of allergy and disease. After witnessing enough diners who make a big fuss about how their bodies can’t tolerate gluten and then proceed to order a beer or dig into their date’s brownie dessert, fatigued chefs and managers are beginning to adopt a less accommodating approach. But the people who may ultimately pay the price for this pushback won’t be the “free-from” fabulists. They’ll be those with serious conditions.

Roots of gluten

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This isn’t just my opinion. The physician-researcher who put gluten on the map in America and the parent-activist who led the crusade that transformed how seriously this country takes food allergies both admitted to me that they can’t believe how much things have gotten out of hand.

When Dr. Alessio Fasano came to the United States from his native Italy in the 1990s, the prevailing view in medicine was that celiac disease — the autoimmune disorder triggered by eating the gluten protein composite in wheat, barley, and rye — effectively didn’t exist here. It was a problem only for European kids. Through a meticulous years-long study, Fasano demonstrated that, in fact, 1 percent of Americans have the disease, cutting across all ages and races.

Suzanne Kreiter/Globe staff

Dr. Alessio Fasano, who put celiac disease on the map in the United States, is troubled that so many people are diagnosing themselves with gluten intolerance.

Yet Fasano, who founded the Center for Celiac Research now at Massachusetts General Hospital, never could have predicted the market-fueled tsunami of me-too-ism that his findings would release. “We were so good,” he says, “that we lost control.”

That’s why I’ve called you here today. So grab a dairy-free, soy-free, gluten-free snack and sit back to learn how we got so off-track and what we need to do to regain control.

ONE WINTER NIGHT IN 1986, a Brown University freshman joined her friends for dinner at Montana, a popular restaurant at the edge of campus. The Tex-Mex BBQ place was so well known for its beef ribs that the word was marbled into its phone number (273-RIBS). Its other signature menu item was chili — good enough to have won a best-in-Providence contest.

As a nationally ranked squash player, Kate Brodsky had won her share of contests as well. She also had a very serious peanut allergy, so she had learned to ask before ordering any dish that was likely to contain nuts. But that didn’t seem necessary with the chili.

After taking her second bite around 7:30 p.m., the 18-year-old felt ill. Rather than go to the hospital, she asked to be taken back to her dorm room. She didn’t get to the hospital until 9:30 p.m. By 10:55 p.m., the Ivy League student with the limitless future was dead. The agent was Montana’s prizewinning chili, which, it turned out, contained peanut butter as a thickener.

This death-by-chili tragedy, which attracted coverage in The New York Times and the wire services, ricocheted around the country. Even if there had been earlier deaths, the shocking circumstances turned Brodsky into a sort of Patient Zero of restaurant food-allergy victims, a chilling reminder of how easily the neighborhood bistro could become a deathtrap. Nonetheless, the story soon faded, and it would be a couple of years before these kinds of fatalities were examined in the medical literature.

Carol Rosenblatt, who owned Montana with her husband, tells me that as much as she believes Brodsky would still be alive if the young woman had gone immediately to the hospital, she continues to feel awful about what happened. “Just thinking about what the family was going through, losing a child,” Rosenblatt says, “you can’t help but identify.”

Around the same time as Brodsky’s death, a Virginia mother of two and former researcher for Time-Life Books was figuring out how to protect her 2-year-old daughter from a similar fate. Anne Munoz-Furlong’s younger daughter, Mariel, had been diagnosed at age 9 months with a serious allergy to eggs and milk. For nearly two years after that diagnosis, Munoz-Furlong learned the hard way just how often these ingredients were hiding in unlikely foods. It was trial by projectile vomit.

Graham Smith

Food Allergy Network founder Anne Munoz-Furlong, who led one of the most effective citizen crusades in recent memory, fears that fakers may jeopardize allergy progress in restaurants.

When her family traveled, they would reduce the odds of accidental exposure by eating in the hotel restaurant every night, ordering plain white rice for Mariel. The cautious approach didn’t always work. On the third night eating at one hotel restaurant, after her daughter had suffered repeated bad reactions, she called over the chef to try to figure out what could possibly be happening with the white rice. “I felt sorry that the food was so bland,” the chef confessed, “so I added a pat of butter to give it some flavor.” That, Munoz-Furlong says, “is when I realized how eating out in a restaurant is such a leap of faith.”

By 1991, she had founded the Food Allergy Network, an advocacy group arming parents with information to keep their afflicted children safe and lobbying food manufacturers to disclose all of their ingredients.

She began FAN with a focus on the food served in schools, then moved on to the packaged food industry. Only later did she turn her attention to the dining-out scene, figuring “You can live without going to restaurants.” Along the way, she withstood ferocious criticism. Peanut farmers accused her of killing their livelihoods. PB&J-loving parents accused her of being a worrywart whose campaign was leading to the peanut bans that would become standard in schools around the country.

With assists from “Dear Abby” and others, Munoz-Furlong led what became one of the most effective citizen crusades since Ralph Nader shamed Detroit into taking safety seriously. Despite the accusations by peanut farmers, Munoz-Furlong had never been a radical. She didn’t pressure restaurants to stop serving certain foods, only to be transparent about ingredients and vigilant about cross contamination. And she urged allergic people to be reasonable. If they had a shellfish allergy, she advised them to avoid seafood restaurants altogether, rather than ordering chicken at one of them.

The word “allergy” has been around only since 1906, when Austrian pediatrician Clemens von Pirquet coined it to describe altered biological reactivity. It didn’t gain traction until the mid-1920s, when it took on a big-tent definition describing reactions to everything from food and insect stings to mold and hay fever, says medical historian Matthew Smith, author of the new book Another Person’s Poison: A History of Food Allergy. For most of the 20th century, research-focused “orthodox” allergists, who insisted on a definition requiring a measurable immune reaction, battled with more flexible food allergists, whose main focus was bringing relief to their patients’ hypersensitivities.

The peanut wars of the 1990s brought heightened visibility to the battle. In 2009, Massachusetts led the nation as the first state to require restaurants to undergo allergy training, followed by Rhode Island.

A year later, Paul Antico, a former Fidelity portfolio manager from Cohasset, started AllergyEats, a Yelp-type website, and now also an app, where customers rate restaurants based on how seriously they take allergies. As the father of five, three with food allergies, Antico wanted to give families the freedom to eat out without paralyzing fear. The site now has tens of thousands of user reviews of restaurants from around the country.

Allergy advocacy culminated with the 2013 law signed by President Obama — whose older daughter has a peanut allergy — pushing schools to stockpile anaphylaxis-combating auto-injecting epinephrine EpiPens.

Today, an estimated 4 percent of American adults — or around 10 million — are believed to have food allergies. The percentage is higher for children, 5 percent or more, although many kids will outgrow allergies to milk, egg, wheat, and soy. The other four biggies — peanuts, tree nuts, fish, and shellfish — are more likely to endure. Catering just to the gluten-free subset (technically, celiac and gluten sensitivity aren’t allergies) represents an estimated $23 billion-a-year market.

In his presentation to restaurateurs, Antico argues that appealing to the allergy crowd can pay off in dollars and cents. The market, he says, is much bigger than just people with diagnosed allergies. He cites a Journal of Allergy and Clinical Immunology study that found a whopping 30 percent of Americans believe they have a food allergy.

Still, even he acknowledges the excesses. “There are people who fake allergies, and that stinks,” he says. “We, as the food allergy community, have to be respectful of what the restaurant goes through and be thankful that they’re willing to slow down the entire machine on a busy Saturday night to address our needs.”

Munoz-Furlong stresses that consumers need to know the harm they’re causing when they phrase their food preferences in the form of an allergy. Not long ago, she laid into an acquaintance who had told their waiter, “I am allergic to peppers,” then confided to Munoz-Furlong, “I just hate peppers.”

“People have to understand why it took us so long to get restaurants up to speed,” she says. “It was like getting an ocean liner to change course. We don’t want to go backward because the restaurant industry can’t trust that people are really being honest.”

Dina Rudick/Globe Staff

Chef Michael Leviton at Lumiere in Newton says if diners are honest about what’s a food preference and what’s an allergy, everyone will be better off.

IT’S 5:15 ON A RECENT FRIDAY evening at Lumiere, the upscale restaurant in West Newton run by noted chef Michael Leviton. Right now, just one of the burgundy-and-cream banquettes is occupied, though soon all 88 seats will be filled. The tiny kitchen is already humming. It takes hours of prep work for a restaurant with an ambitious menu to run smoothly on a busy night.

The little black ticket machine in the kitchen spits out a takeout order for a chicken dish. In red block lettering, the ticket reads GLUTEN ALLERG. As special requests go, this one is easy. The machine will occasionally produce a ticket with so many allergy notations in red that it stretches as long as a supermarket receipt from a stock-up-and-save sale.

Every time the cooks see the word “allergy,” they have to assume the customer’s condition is life-threatening. The big danger is cross contamination, where an allergen is inadvertently transferred from one dish to another, often through a shared cutting board or utensil, or through the oil in the fryer or even food dust in the air.

That means with every allergy, the action must stop in this kitchen jammed with cooks and dishwashers. The cooks consult a printed breakdown of ingredients in each dish to make sure the allergen isn’t hiding out in a component. They either grab new cutting boards, knives, and tongs or put theirs through the sanitizing dishwasher. And when the plate is done, they use disposable wipes to hold it by the edge.

Imagine doing that repeatedly across a breathless night, disrupting the choreography of the kitchen each time. I asked numerous chefs how many tables have a diner asking for these special accommodations on a typical night, and I heard estimates ranging from 10 percent to a jaw-dropping 60 percent.

Now imagine that a diner whose “serious dairy allergy” required you to take all those time-consuming steps decides to finish her meal by ordering ice cream, telling her server that it’s OK if she “cheats a little.” This, Leviton says, happens all the time.

He has no problem if a customer says, “I’m not eating gluten” or “I’m avoiding dairy.” The kitchen will make sure those ingredients aren’t in the dish. But they won’t be wasting time taking unnecessary steps. “We’re jumping through a different level of hoop,” he says.

Still, he stresses that people must have realistic expectations. If they come in with no early notice, proffering a card listing “15 different things they’re allergic to,” he says, “there’s not an awful lot we can do on a Saturday night at 7:30.”

Moreover, Leviton emphasizes that, as much as they work with extreme caution, they don’t cook in a vacuum. “We make bread in the same tiny kitchen we make everything else in,” he says, noting that it’s not as if the kitchen is being steam-cleaned to remove all flour dust. Most people who are “super-hyper-allergic,” he says, would stay away from restaurants because they know that just one tiny mistake could prove fatal.

That fear of a customer being carried out on a stretcher forces chefs to be vigilant. But the growing worry is that, as they run around addressing the needs of exaggerators and outright fakers, they might slip up on a customer with a genuinely deadly allergy.

Is it any surprise that more and more chefs are hitting their boiling points?

Kenny Shopsin, the cantankerous owner of the famed New York diner bearing his name, has bragged that when customers tell him they’re deathly allergic to something, he kicks them out, only to hear many confess that they’re not “that allergic.”

This frustration with fakers has occasionally led to recklessness. Recall what a former cook at the Tavern on the Green in New York’s Central Park copped to a few years back. Alleging that customers’ gluten problems were all in their “disturbed little heads,” Damian Cardone boasted he had made a habit of secretly giving anyone ordering gluten-free pasta the normal stuff with gluten and that they were no worse for it. (He seemed clueless that the most serious damage that celiac patients suffer takes place over time, not immediately.)

Then there was the waitress who posted an anonymous screed on Reddit that went viral. It began: “A server will never say this to your face but we all know your gluten allergy is fake. . . . You are just on a gluten-free diet and want attention.” When I track down the author, Chelsea Welch, she admits she had written the post in frustration, after witnessing too much nonsense as a waitress in an Italian restaurant in St. Louis.

The 21-year-old former waitress, who was once fired from Applebee’s for exposing a pastor as a tip cheapskate and who now goes by the name Ferris McEvoy, describes being a server as “a balancing act between pleasing the customer and not pissing off the kitchen.” Because servers are so dependent on tips, customers who make unreasonable requests “are dangling the server’s pay in front of them.”

Lately, the allergy pushback has been coming from more prominent quarters.

At the end of last year, as the European Union prepared to enact a law requiring restaurants to disclose every possible ingredient used in their meals, 100 of Europe’s top chefs joined forces in protest. “It’s a total fiasco,” former BBC MasterChef winner Thomasina Miers told the Telegraph, noting that she herself suffered from a serious allergy. “It’s the responsibility of the allergee to ask, not the restaurateurs to list.”

10/7/2015 - Burlington, MA - Burton's Grill - Burton's Grill locations offer gluten sensitive customers a specialized menu. Topic: 101815allergies. Story by Neil Swidey/Globe Staff. Dina Rudick/Globe Staff.

Dina Rudick/Globe Staff

At Burtons Grill, the philosophy rests on always saying “yes” to the customer.

Closer to home, some restaurants have begun using surcharges to call the bluff of fakers.

Paul Overgaag, chef-owner of back-to-back Harvard Square restaurants The Red House and Charlie’s Kitchen, has found the upcharge can be an effective deterrent. If a customer says he’s got a dairy allergy and the accompanying starch has dairy in it, he will be offered a substitution such as a salad, for a couple of bucks extra.

“If you’ve got a serious allergy, of course you’d be willing to pay,” Overgaag says. “But at least two to three times a night, the word comes back from the customer: ‘I’ll just have the starch with the dairy in it.’ They don’t want to pay for it.”

Leviton, whose success at Lumiere has long rested on the combination of high-quality food and service, hit his breaking point a few months ago. He told his staff that while they should continue to meet reasonable requests, they would begin saying no to customers more often.

For example, to cope with the spike in diners claiming garlic allergies, he had been holding off on adding the garlic until the very end, so it could be easily eliminated. But because a dish will be more flavorful when garlic is added early on, he concluded he was penalizing the many to please the few.

“We had crossed over and were making too many accommodations, and it was adversely affecting the majority of the customers,” he says.

These days, diners who report a garlic allergy will learn that the garlic cannot be omitted and will be encouraged to select another dish.

Leviton says this “recalibrated” policy hasn’t produced many complaints. “If we’re offending someone by not being as accommodating as they would like,” he says, “we just might not be the right place for them.”

IN THE ’90S, fat-free diets were all the rage. But people didn’t go into restaurants announcing that they were “allergic to fat.” So what has caused this tremendous spike in allergy claims?

It starts with a bunch of self-promoting, self-appointed “experts” dishing out lousy advice.

Consider Dr. Andrew Ordon, one of the stars of that inane The Doctors syndicated TV show, who offered viewers this kernel of wisdom when they dine out: “Probably the only guaranteed way to avoid that butter is to say, ‘Garcon, I have a bad butter allergy.’ ” How did the other talking heads on the panel react to this serving of nonsense? With approving nods and exclamations of “I like that!”

Then there’s blogger Vani Hari, who calls herself the “Food Babe.” Her dubious advice includes this gem: “Go so far as telling your server you’re allergic to butter and dairy, soy and corn.”

Dr. John McDougall, who peddles his low-fat, high-starch McDougall Program diet as a way to prevent degenerative disease, kicks it up a few notches, urging his flock to paint a picture for their servers. “Tell them you’re allergic to oil. [Say] ‘If I eat oil, I’ll have an anaphylactic reaction. I’ll have a seizure. You’ll have to call the ambulance. It will just be a whole big bad scene here in the restaurant. . . .’ ”

Graham Smith

Medical historian Matthew Smith says the word “allergy” didn’t gain traction until the mid- 1920s, when it took on a bigtent definition describing reactions to everything from food and insect stings to mold and hay fever.

Medical historian Matthew Smith says that on top of all that bad advice, there’s this reality: We’ve stomped out most major infectious diseases, leaving us with hard-to-treat chronic illnesses. Because diet is the one variable people feel they can control, they tinker with it. Some of them end up medicalizing benign conditions through self-diagnosis, swapping tips and drawing affirmation from online communities. That helps explain why so many Americans believe they have a food allergy and act on it without ever going to the doctor to confirm the hunch. (It might also help explain the excesses of the current landscape, where a Massachusetts prep school recently found itself sued by a couple who accused officials of ignoring their complaints about their son’s allergy to the school’s Wi-Fi signal.)

And then there are the diners who simply thrive on attention. They’ll announce that they don’t see anything they like on an extensive menu and ask the chef to make them something special. There’s no more surefire way to ensure your dietary desires are met these days than to invoke an allergy.

But restaurants are not blameless in this dance of deception. Culinary Institute of America professor and author Ezra Eichelberger is a leading voice on all things front-of-the-house. For too long, he says, too many restaurants tried to talk diners out of their preferences (“You’ve never had garlic the way our chef uses it”) or outright lied to them. They might, for instance, fail to disclose to vegetarians ordering the French onion soup that it was made with beef stock or neglect to wave pescatarians off the clam chowder because it has a little pork hidden in it.

This behavior is irresponsible. Tragically, people still do die from allergic reactions at restaurants, though with heightened awareness and plentiful EpiPens, less frequently than in the past. A 2011 review found all food allergy incidents to be responsible for about 200,000 emergency room visits a year, though a study tracking anaphylaxis deaths over the last decade found that less than 7 percent involved reactions to food. (Most were caused by reactions to medication.)

Eichelberger recognizes how out of whack things have become. When big bus-tour groups come in for a meal at the CIA and people start rattling off allergies that they failed to mention in advance, the staff will make accommodations — for a $10-a-plate surcharge.

Nothing, he says, has fueled the recent explosion of allergy complaints like gluten. At a National Restaurant Association trade show not long ago, Eichelberger quipped: “I didn’t realize that celiac disease was contagious. It seems like everybody is getting it.”

WE WERE NEVER meant to eat gluten.

That’s the favorite refrain of gluten-free warriors.

It’s true, says celiac expert Alessio Fasano, that in the 2.5 million years since our ancestors took their first bites, we’ve been eating gluten for only about 10,000 years. However, he stresses that for thousands of years, most people have been eating it with no problem. And gluten-dense wheat made possible our transition from hunter-gatherer life, where we spent almost all our energy on food procurement, to agriculture, which enabled creative work, like building the Colosseum or inventing the computer.

In his book Gluten Freedom, Fasano notes that the first hint of celiac disease in the medical literature came nearly 2,000 years ago. A Greek physician named Aretaeus described a condition that involved “suffering in the bowels.” There was silence in the literature for the next 1,800 years, before British physician Samuel Gee in 1887 correctly diagnosed this malady of chronic indigestion as malabsorption caused by some unnamed foodstuff. Gee’s solution for his patients was less spot-on: He advised them to make sure the bread they ate was thinly sliced and toasted.

Fasano trained at the University of Naples, a hotbed of research on celiac disease, at the time associated almost exclusively with European children suffering chronic diarrhea and other gastrointestinal problems. He tells me he came to the United States partly “to get away from celiac.” Yet when he arrived at the University of Maryland in 1993, he couldn’t accept the prevailing medical view that celiac basically didn’t exist in this country.

Proving his intuition would consume a decade of his life. (Diagnosing the disease is cumbersome, requiring both blood tests and intestinal biopsies.) By 2003, he showed that 1 out of every 133 Americans — about 1 percent of the population — had celiac. It had been hiding because many Americans didn’t have the classic GI symptoms, but rather problems like anemia, joint pain, and chronic headaches.

Imagine the exhilaration felt by these long-suffering patients who finally had an answer for their debilitating pain. Imagine their outrage at learning they had been hastening their deaths by unwittingly feeding themselves something that had been turning their bodies against them.

They became powerful evangelists about the perils of gluten.

But it didn’t take long for health-food hobbyists and diet-peddling hucksters to overrun the relatively small pool of celiac sufferers. And the “We were never meant to eat this” historical argument made their pitches all the more persuasive. That’s particularly true in the current climate, where we have become so estranged from our food and suspicious of the agribusiness behemoths supplying it. (While Fasano says pesticides may be a factor in rising rates of gluten intolerance, he sees no evidence for the popular claim that our wheat is substantially different from what it’s been for the last couple of centuries.)

That’s the backdrop to a recent study that found 11 percent of American households are following a gluten-free diet, even though only a quarter of them said they were doing it because of celiac or gluten intolerance.

The gluten-free spectrum is diverse. About 0.3 percent of Americans have a wheat allergy, meaning that ingesting even a trace amount could send them into anaphylactic shock. Then there is the 1 percent with celiac. Finally, there are people with gluten sensitivity, who suffer symptoms like diarrhea, bloating, or fatigue after eating gluten. Given the absence of diagnostic tools, the size of this last group is particularly fuzzy, though Fasano’s research suggests it’s in the 5 to 6 percent range.

Fasano is troubled that so many people are diagnosing themselves with gluten intolerance, changing their diet without ever going to the doctor. “You don’t say, ‘I’m drinking a lot and peeing a lot, so I must have diabetes,’ and then start injecting yourself with insulin.”

There is no cure for celiac or gluten sensitivity, and, unlike some allergies, people won’t outgrow the problem. So the only solution is to exclude gluten from the diet. That means going gluten-free is a therapeutic intervention, Fasano says. “It is not the South Beach diet.”

Many who go gluten-free find themselves feeling better and see that as proof that they have gluten intolerance. But a genuine gluten problem is only one of three possible explanations for their improved health, and statistically the least likely. Another reason could be the placebo effect. The most likely explanation is that paying closer attention to diet and avoiding fried and junk food — which tends to be loaded with gluten — is bound to make anyone feel better.

What’s the big deal if gluten-tolerant people go gluten-free, especially since they’ll be eating fewer Pop-Tarts?

The problem is the more these bandwagon-jumpers demand special attention, the more likely that restaurants and wider society will come to see all gluten-free people as phonies.

And by the time the fad-followers move on to another fad diet, they have cheapened the label for all those people who can’t move on.

The label is already becoming comic shorthand. Jimmy Kimmel and Seth Rogen have both mocked LA gluten-free proponents who actually have no idea what gluten is. (When pressed, Rogen’s character in This Is the End hilariously describes gluten as a “vague term” meaning “things that are bad,” like calories and fat.) The Onion offered up the headline: “14% of Americans Now Intolerant to Word ‘Gluten’. ”

With so many posers, people with celiac have to do a bit of acting themselves.

Dr. Sheila Crowe, a specialist at the University of California San Diego, has begun advising her celiac patients who eat out to spare no details in telling servers how dangerously ill they will become from gluten.

Fasano now gives his celiac patients permission to use the word “allergy” to describe their disease, since that will probably be taken more seriously.

He marvels at how quickly things went from no one believing gluten was a problem here to today’s gluten phobia. “To define gluten as this devil we have to fight,” he says, “is a real stretch.”

As he leans into his office chair, a gag box of Gluten Flakes cereal perched on the bookshelf above him, I ask Fasano, “Do you ever sit back and think, ‘What in the world did I unleash?’ ”

He smiles wearily. “Yes.”

Dina Rudick/Globe Staff

Celiac sufferer Kevin Harron, cofounder and CEO of Burtons Grill, has built a restaurant chain that caters to people with allergies.

WHEN KEVIN HARRON managed restaurants for Legal Sea Foods in the late 1980s and early 1990s, he says, “almost every year, we’d have somebody drop right at the table.” Typically, they’d be visitors from the Midwest or other landlocked regions. “They’d never eaten clams or lobster before, so they never knew they were allergic to it.”

These unlucky Midwesterners learned their diagnosis through anaphylactic shock. The staff would call 911 and hope the ambulance got the customer to the hospital in time.

Today, Harron is cofounder and CEO of Burtons Grill, a 10-year-old, 10-outlet chain of upscale casual restaurants. The Burtons philosophy rests on always saying “yes” to the customer. That’s particularly true if the request involves a food allergy.

Harron shows me around the open kitchen of the first Burtons, in Hingham. Pan handles, cutting boards, and tongs are color-coded, like a Boston subway map. Red for meat dishes, yellow for poultry, blue for seafood, and a purple cutting board for gluten-free meals. Final dishes prepared free of gluten or a particular allergen are served on a square plate rather than a round one. If they’re takeout meals, a big “allergy” sticker is affixed to the container.

Harron, who is 61, was diagnosed 45 years ago with celiac, though back then it was known as “sprue” and an almost entirely overlooked condition.

He’s not particularly concerned about diners mislabeling their preferences as allergies, since his business is built to accommodate these requests. Still, he can understand why other restaurant owners have begun pushing back in frustration. “In this area, you’ve got to be either all in, or out,” Harron says. “There’s little margin of error.”

Faced with this choice, more restaurants are likely to opt out, unless they can do a better job of differentiating the serious from the frivolous requests. Follow-up questions from restaurant staff can help, though some allergy sufferers resent this tactic.

Graham Smith

AllergyEats founder Paul Antico argues that diners should not resent followup questions from servers. “There are people who fake allergies, and that stinks.”

But AllergyEats founder Paul Antico says the allergy community has to get less defensive. If restaurants can do a better job of distinguishing real from exaggerated, they’ll be more likely to continue making accommodations for the people who really need them.

And maybe if more people with preferences begin to appreciate the trouble they’re causing with their use of the A-word, they’ll correct their ways. That begins with awareness.

Carol Rosenblatt and her husband continued to operate their Tex-Mex BBQ restaurant in Providence for more than a decade after the death of the Brown student. Eventually, they closed the place and returned to their native New York. When I tell her how much things have changed since her day, how many times a night that kitchens now have to swap out their utensils to address the explosion of allergy requests, she is stunned. “Oh, my God,” she says. “I’m glad I’m out of the restaurant business.”

I ask her if there are any food allergies in her family. “My husband thinks he’s allergic to dairy and gluten and all that kind of stuff, but I think it’s more a sensitivity than an allergy.”

I wonder how he introduces the subject when he’s eating out.

She explains that “he asks the waiter, ‘Does it have this? Does it have that?’ ”

“Does he ever say he has an allergy?” I ask.

Rosenblatt pauses. “Oh, yeah. He sometimes does.”

Neil Swidey is a member of the Globe Magazine staff. E-mail him at swidey@globe.com or follow him on Twitter @neilswidey.

HOW A KITCHEN RESPONDS

Dina Rudick/Globe Staff

> Server has discussion with customer, trying to ascertain specifics of allergy. Often will get manager involved. Then server puts through order, noting allergy.

> Action in kitchen stops, and there is typically a discussion of everything that needs to change to avoid cross contamination.

> Cook clears an area and either grabs a new cutting board, tongs, saute pan, utensils, etc., or puts all of those through the high-temp sanitizing dishwasher.

> For fried food, cook must use different oil or a separate fryer.

> When final dish is ready, it is handled with extreme care. Kitchen staff may use a disposable wipe to grasp plate.

> In many restaurants, a specific person (such as a manager) is assigned to deliver dishes to any allergic diners.

GLOMMING ON TO GLUTEN-FREE

> $23 billion — Estimated size of US gluten-free market

> 1 percent — Percentage of Americans with celiac disease

> 11 percent — Percentage of American households following a gluten-free diet; only one-quarter of those are doing it because of a celiac or gluten sensitivity

Sources: Nielsen; MGH Center for Celiac Research; NPD Group

ALLERGY SHOTS

> 4 percent — Percentage of American adults with a food allergy (rate is 5 percent or higher in children)

> 90 percent — Percentage of food allergies represented by these 8 allergens: milk, egg, wheat, soy, peanuts, tree nuts, fish, and shellfish

> 200,000 — Number of annual visits to US emergency rooms because of food allergy reactions

> 7 percent — Percentage of anaphylaxis deaths in the US related to food allergies (more than 60 percent are related to medications)

Sources: Journal of Allergy and Clinical Immunology; Food Allergy Research & Education

Related:

When food allergies dine out

Chefs and dietitians join forces

Tastes good, no gluten

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