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When eating out, people with food allergies often have to trust their servers for information on what is safe to eat. But most restaurant staff have limited knowledge about allergies, according to new research.

An international research team tested the food allergy knowledge of 295 restaurant staff members in 15 randomly selected districts of Düsseldorf, Germany.

They found that 30% of workers could correctly name three food allergens such as milk, eggs or fish. Fewer than half of participants got a perfect score on a general food allergy knowledge test, according to the study, published Wednesday in the journal PLOS One.

“We looked at knowledge and attitudes, and the key finding would be that the knowledge levels are not as good as we would expect in restaurant staff, because these are people that are handling food in a daily basis,” said Adrian Loerbroks, a senior researcher at the University of Düsseldorf.

Food allergies are a result of the body’s immune system mistakenly treating the proteins found in food as a threat. A small number of foods, such as peanuts, milk, eggs or shellfish, are responsible for most allergies.

The researchers conducted face-to-face interviews with 295 restaurant staff between August and October 2017. About 48% of them were servers, and nearly half – 46% – had undergone food allergy training. The majority of them – 89% – expressed confidence in providing information on allergy-friendly meals.

However, the team found that this confidence was misplaced, with only 41% of participants able to answer all questions correctly on a five-question true or false quiz on general food allergy knowledge.

Loerbroks called the findings “quite concerning.”

Although he wouldn’t expect the general public to be that knowledgeable, he said, he “actually expected higher knowledge levels” for people who handle food as part of their daily jobs.

More than 10% of American adults – about 26 million people – have at least one food allergy, according to research. In Europe, such allergies affect about 10% of the population, a 2018 paper said.

“Food allergy affects millions of people worldwide and, for some the consequences of an allergic reaction can be fatal,” said Bridget Benelam, nutrition communications manager at the British Nutrition Foundation, a UK charity.

Benelam, who was not involved in the new study, wrote in an email that it’s “vital” that staffers are “equipped with the right knowledge to ensure people with food allergies can eat out safely.”

The researchers found that managers and other staff at larger restaurants and servers who completed high school had better knowledge of allergies.

Many staff members had negative attitudes toward customers with food allergies, with 42% not believing customers who declared food allergies. However, staff expressed positive attitudes about the need to help customers with food allergies.

Some staffers also believed misconceptions, the most prominent being that water should be given in case of an allergic reaction, something that does not work “at all,” according to Loerbroks. About 65% of the study participants identified this misconception as false.

One notable finding for Loerbroks’ team was that female restaurant staff were more likely to believe customers who said they had allergies. It is not clear why, but Loerbroks thinks those servers might have had better dietary knowledge or were better able to tell the difference between food allergies and lifestyle choices.

The study also found that 19% of restaurant staff said they would prefer to not serve customers with food allergies. “Not feeling confident to provide a safe meal was linked to this preference not to serve customers with allergies,” Loerbroks said.

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The researchers said it was was “particularly striking” that there was no link between food allergy knowledge and completion of food allergy training. In Germany, there is compulsory training for restaurant staff that deals with food hygiene but not allergies.

The findings were in line with other research suggesting that a quarter to half of restaurant staff were not able to identify three allergens, Loerbroks said. He cited research from Turkey and the United States showing 12% and 22% of participants, respectively, scoring 100% on general food allergy knowledge.

“All these studies highlight that this a problem. It is not a rate thing that a few staff members struggle with,” Loerbroks said.

Consumers need to be cautious when eating out, Loerbroks noted. It’s “unfair to fully assign responsibility to customers,” but diners can lower their risk by communicating with restaurant staff in detail about their allergies.