Two decades ago and some change, Meg Ryan’s character, Sally Albright, in When Harry Met Sally gave the waitress of a Manhattan deli the order of a woman who knows exactly what she wants: “I’d like . . . the apple pie à la mode . . . but I’d like the pie heated, and I don’t want the ice-cream on top, I want it on the side, and I’d like strawberry instead of vanilla if you have it. If not, then no ice-cream, just whipped cream, but only if it’s real; if it’s out of a can, then nothing.”

Such a request today wouldn’t shock in its fussiness as much as it would in its old-fashioned calorie count. In modern-day Manhattan, a vegan Sally might substitute the ice-cream for non-dairy frozen dessert; or, a locavore Sally might switch out the pre-packaged apple pie for one purchased freshly baked from a regional apple orchard; or, a gluten-free Sally would skip the pie altogether for a bowl of apple and quinoa crumble.

Eating out has never been so complicated. While for a time the world was, if not happily, at least somewhat securely divided between vegetarians and meat lovers, these days the kitchen is crowded with other cooks: vegans, raw foodists, fruitavores, Atkins dieters, cavemen dieters, slow fooders, and a multitude of other ways of eating that would have never even occurred to our grandmothers. There are more tribes of eaters than ever before, all with conflicting preferences and restrictions and needs. What’s more, each of these burgeoning consumer groups expects to be served — and not only a meal, but something good at that: tasty, healthy, affordable, and convenient.

Along with this cacophony of divergent dietary trends, in the last half-decade food allergies have worked their way into mainstream consciousness. The number of diners adhering to strict allergen-free diets has increased dramatically. Although lactose intolerance and allergies to such foods as peanuts, milk, eggs, and shellfish have long had a reliable presence in Western countries, conditions like gluten intolerance and celiac disease are somewhat newer arrivals to the potluck. At this point it may be useful to point out the difference between a food allergy and intolerance. Dr. Asya Segalene, an allergist based in the greater Chicago area and who has been practicing in the United States for 12 years, notes that 5 percent of children and 3 percent of adults have true food allergies, where a reaction can be life-threatening. Food intolerance, on the other hand, is “disruptive, but not life-threatening.”

Dr. Segalene does say that she has noticed food allergies generally becoming more common. “I think we have to be aware that we are more attuned now, more able to recognize food allergies, than many years ago,” she states. “But it’s true, it is getting more common. I’m not sure about more serious. People are talking about it, it’s on the news.” According to her, the publicity is good because “when people know what they are facing they know how to react.” Dr. Segalene declined to comment on whether new ingredients in our diet or environment are potentially causing more allergies: “It’s very hard to say because we do not have 100 percent controlled studies…it’s my personal opinion that the more kinds of foods, food additives, processed foods we eat — that it’s possible that this changes our genetic predisposition to allergies.”

At least in the public eye, the most common condition to have increased in prominence in recent years is undoubtedly gluten intolerance, as diagnoses in the U.S. continue to multiply by skips and bounds. Still not precisely defined by medical experts, intolerance to gluten essentially involves a negative bodily reaction to ingesting this protein, which is found in wheat, barley, and rye. Celiac disease, an incurable autoimmune disease, prevents the body from properly absorbing nutrients. Those with gluten sensitivities and celiac disease face serious health problems, but these risks can be completely avoided by following a gluten-free diet. In the past, this was perhaps easier said than done — gluten is a primary component of the Western diet, found in beloved comfort and convenience foods like pizza, bagels, beer, muffins, pasta, and bread.

Now, however, gluten-free alternatives to these foods are becoming more widely available to meet the growing consumer demand. The organization “1 in 133” claims that one out of every 133 Americans suffer from celiac disease, and six more from gluten sensitivity. And in tune with Dr. Segalene’s observations, anaphylactic food allergies (especially among children) also seem to be getting more common compared with a few decades ago, as reported in a 2009 study published in Clinical Reviews of Allergy and Immunology.

The reasons behind all the hype around these food allergies — whether a result of increased diagnoses and awareness, the perceived connection between allergen-free diets and better health, or an actual increase in incidence due to dietary and environmental changes — is anybody’s guess. But hype there is, as celebrities jump on the bandwagon; Miley Cyrus, for one, touting the benefits of her gluten-free diet on Twitter.

A Few Crumbs

For restaurants, customers with severe reactions to miniscule amounts of allergens — such as those with celiac disease — pose a unique challenge. Although ingredients can be substituted or left out of a dish to accommodate most special diets, allergen-free food must be prepared with special attention from start to finish. The hazards of cross-contamination prevent restaurants from taking food allergies lightly. Last spring, Domino’s Pizza became the first pizza chain to offer gluten-free crust, only to let a large portion of the potential consumer group down by admitting that the pizza was not actually recommended for those with “celiac disease or non-celiac gluten sensitivity,” due to airborne flour at its facilities. A safely gluten-free menu item necessitates strict procedure and separate equipment in professional kitchens, including sterilization and use of dedicated cooking utensils, deep fryers, and frying oil. Restaurants that do make the change, however, have been rewarded with a faithful following of customers who are glad to have a place to eat out with no risk.

Maria Paola [who prefers to withhold her last name], an Italian researcher and blogger with celiac disease, explains how delicate cross-contamination can be to manage for those who are not familiar with her condition: “The tricky issue is the contamination. Even small amounts of gluten are dangerous for celiacs.” Citing a study from the National Center for Biotechnology Information, Maria Paola notes that even 50 milligrams of gluten per day can cause health problems for celiacs. “How much is it? A few bread crumbs?”she asks. “It is difficult to explain this to someone who has never heard of celiac [disease] before and might react like, ‘Come on! Do not exaggerate.’ Even more difficult if this is a waiter or the cook in a restaurant where you have never been before. However, we celiacs manage these situations every day. Sometimes I think we are just heroes.”

Three Menus and a Button

Native Foods Café, a California-based fast casual chain that specializes in chef-crafted vegan meals, has a practiced policy of accommodating food allergies with no questions asked. In addition to their regular menu, Native Foods provides three full separate menus for those allergic to soy, nuts, and wheat/gluten (as a 100 percent plant-based restaurant, it already avoids problems arising with dairy intolerance). On the cover of the allergy menus is a sprightly little squirrel, announcing, “We’re all kind of nutty here at Native Foods café…but for those of you who don’t eat nuts, soy, or wheat…here you go!” The cheerful, folksy chalkboard-drawing decor at Native Foods is clearly designed to make diners feel comfortable, safe, and welcome — not like they’re a burden; not like they’re different. I’ll always remember the quiet, frail first grade boy in my school that ate his sack lunch alone in a separate room away from the noisy tumult of the cafeteria; he was so severely allergic to eggs he couldn’t risk sharing the same air with other kids.

Aaron Buss, Chicago’s Native Foods Lakeview location restaurant manager, has witnessed changing attitudes toward food allergies in his 16 years in the restaurant business. When he first started working in the restaurant industry, Buss says, there was “almost no attention paid to allergies.” It was only about five years ago that he and other restaurant management started becoming more aware of customers with such needs.

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