It came as a shock when roommates found Sabrina Karim ’11 collapsed on her bed shortly after dinner last January. After seeing hives on Karim’s arms and head, her roommates immediately administered her EpiPen before calling for Yale’s minibus service to Yale University Health Services.
“The minibus driver thought I was drunk,” Karim said. “Only when I got to YUHS, they realized they couldn’t handle such a serious case.”
She was quickly transferred to Yale-New Haven Hospital, Karim recalled. Karim had suffered a potentially fatal allergic reaction.
The culprit? Karim said she believes it was a nut contaminant in the chocolate chip cookie dough ice cream she ate for dessert that evening.
Karim, who admitted that she was always a conscientious eater, is one of many students who have a food allergy on Yale’s campus. In an internal survey conducted by Yale Dining last fall, 188 students out of 1,801 meal plan holders responded that they have a food allergy — to peanuts, milk and eggs, among other foods. Yet according to Yale Dining, only 26 students have identified themselves to dining hall managers as allergic. Concerned with the lack of communication — and instances of emergency, such as in Karim’s case — administrators said they are looking for more opportunities to identify students with food allergies.
“A lot of the students unfortunately are reluctant to identify themselves as someone needing special attention,” said Karen Dougherty, Yale Dining’s director of nutrition and wellness. “We feel that most of the time we don’t know who the students are with allergies.”
With every dish that the dining hall offers, blue and orange cards reveal a list of ingredients — a list often scrutinized by Yalies with food allergies. Each dish containing an allergen from one of the eight main allergy groups has a specific warning near the top of its food label.
Dining hall staff are trained, Dougherty explained, to assist students with allergies by reviewing ingredients, providing alternative dishes and, in the case of an emergency, readily identifying any allergic reaction.
“Not very many people take advantage of that, and we’re not sure why,” Doughtery said.
One reason may be that allergic students are generally confident in their ability to self-monitor and make smart choices. The challenge, of course, is the variety of dishes for every meal, which can often make the choices more difficult.
Allergens are sometimes buried in the middle of the list of ingredients, Karim noted, especially when they are preservatives or additives rather than the main ingredient.
Skimming through the ingredients of the Thai vegetable wrap in the dining hall in September, Karim said, she missed a crucial detail in the middle of the paragraph.
“I felt something in the throat, ran back and read it again,” she said.
She did not miss the words a second time: peanut sauce.
Specialty items such as Chef’s choices can also cause problems because they are prepared shortly before the food is served, giving dining hall managers less time to provide adequate warning labels.
Niraj Patel ’11, who is allergic to dairy products, said he was surprised to have a reaction after eating a dish that was clearly marked as not containing any animal products: “Vegan Baked Ziti.” But despite this incident, he said, he feels comfortable eating in Yale dining halls.
“Aside from two incidents, I didn’t have a problem eating here,” said Patel, who has notified his dining hall manager in Timothy Dwight College of his allergic condition. “Figuring I eat three meals a day in Yale dining halls, that’s pretty impressive.”
Dougherty said Yale Dining takes “great pains” to avoid cross-contamination. Yale Dining provides employees with training that stress the severity of allergic reactions and the necessity for changing contaminated gloves and using designated serving utensils.
“There are people whose sensitivity is such that if a gloved hand picked up a peanut butter cookie and then picked up a sugar cookie, some people could still have a reaction,” Dougherty said.
But Karim’s experiences show that contamination can sometimes be inevitable.
Although her allergies are limited to nuts, she said, her doctor and the dining hall manager advised her against having any desserts from Yale dining halls due to the proximity between the food items. Ice cream scoops do not get completely cleaned out, and knives that dip into jelly have often already been dipped in peanut butter, she explained.
“They should try to get the dishes containing nuts separated from the rest of dishes,” Karim said. “When people scoop their food, some of it can get into the dish beside it.”
Other students are more troubled by the lack of options for their meals.
Julian Domo ’11, for one, is allergic to gluten, dairy and eggs. The Yale Dining Web site lists over 2,000 dishes offered across campus which contain at least one of these allergens, leaving students like Domo without many options.
“On sustainable pizza days, for example, it’s quite difficult to find anything substantial to eat,” Domo said, adding that during those days, Yale Dining concentrates on the specialty menu items.
Dougherty said maintaining a round diet is particularly difficult for students with gluten intolerance because Yale’s food vendor does not provide gluten-free products. But Saybrook-Branford Dining Hall manager Tom Helland said that he has enough students who have identified themselves as unable to eat gluten that he often shops for them in the gluten-free aisle while doing his own personal errands.
“I think one of the unique things about Yale is that it has the ability to be personal,” Helland said. “I’ve even been able to find gluten-free ice cream cones. Those are really popular.”
Fran Batesole, the chief resident nurse at YUHS’s Allergy Clinic, said she knows of at least two severe reactions this year at Yale Dining. Above all, she warned against taking a lax attitude toward food allergies.
“You are fallible. You can only walk across a street with a green light so many times before getting hit,” she said, referring to students she encounters who do not consistently carry their EpiPen, a device that can prevent anaphylactic shock when administered immediately after a reaction.
And eating off campus can be just as dangerous for allergic students.
Jose Calderon, YUHS’s head allergy physician, said the majority of students patients he has seen had an allergic reaction while eating in a local restaurant, rather than in a dining hall. Batesole added that the Allergy Clinic often warns students against eating out.
“Sometimes we even tell them to avoid those restaurants unless they actually know what they are eating, because chances are so high that they could have a reaction,” Batesole said.
Dougherty and Batesole both stressed the need for better communication between the administration and those with severe food allergies. They each proposed the creation of a support group for such students.
“We have peer educators for STDs and alcohol, but we don’t have one for allergies,” said Batesole. “Probably next year we’re going to try and work on that.”
Dougherty also noted that if all those with gluten intolerance were in contact, they could give each other advice when they discover dishes that caused problems.
“Once we figure out something for one, the others would benefit,” Dougherty said. “But we don’t know who they are to start getting out the message.”