Jeff Williams just got his first EpiPen —- a small device that looks like a cigar case but contains a spring-loaded syringe filled with adrenaline.

After reading about the July 3 death of Rodney Hawkins, who died after mistakenly consuming seafood at a local Ruby Tuesday franchise, and following the heated back-and-forth discussion on a local blog, he figured "it was about time."

Williams also has a severe seafood allergy, and so far his symptoms from accidental ingestion in a restaurant —- swelled lips, labored breathing —- have been treatable with drugstore antihistamines.

But like many people with food allergies, he doesn't know whether the next episode will result in anaphylaxis, the acute reaction of blocked air passages and plummeting blood pressure that killed Hawkins. In that situation, Williams would have to remove the cap from the EpiPen, place it against his trousers and jam it into his thigh in order to live.

About 12 million Americans have food allergies. Even though an estimated 100 to 200 of them die each year from anaphylaxis, that doesn't stop them from eating out.

Yet waiters will surely get orders wrong. Cooks will flip their hamburgers with the same spatula used for a shrimp burger. The allergy sufferers themselves may be less than explicit when placing their orders. Even the best intentions can result in a possibly fatal mistake.

"We take it very seriously as soon as we find out a customer has a food allergy," says Zack French, a server at Aqua Blue in Roswell. "We tell the chef and the sous-chef as soon as we find out a customer has a food allergy, and they bring out a clean cutting board just to use for their food."

Communication is key

But customers don't always make their needs clear. French recalls one customer glancing at a dish of sea bass with clams and clam broth and simply asking for no clams. Only when the fish came out swimming in the shellfish broth did the customer think to mention he had a food allergy.

Russell Bell of Powder Springs makes sure nothing of that sort happens. Because his wife, Claudia, can't eat any member of the onion family, Bell brings printed adhesive labels to restaurants that read, "FOOD ALLERGY —- PLEASE NO ONION, GARLIC, SHALLOTS, CHIVES, or LEEKS" to attach the server's order.

"Just a little mailing label —- plain Times Roman, 12-point font," says Bell. "We really have to be careful, because everyone seems to think garlic is the magic bullet."

Ideally, the Bells wouldn't need to take such precautions. The National Restaurant Association publishes a food allergy training guide and encourages all members to follow it for service, food preparation and emergency procedures.

Among its recommendations: Servers should provide product labels when appropriate; chefs should refrain from "mystery ingredients" (the report cites a Rhode Island case where a guest died after eating chili seasoned with peanut butter); and staff should be trained to recognize signs of an allergic reaction.

For these reasons, some allergy sufferers consider multi-unit franchises a surer bet than independent operators, the recent episode at Ruby Tuesday notwithstanding.

"I tend not to go to the trendy places that use a lot of the fancy sauces and that kind of thing," says Lisa Stamitoles of Kennesaw, who has allergies to nuts, shellfish and sesame. Instead, she eats regularly at franchise operators such as Applebee's, Outback Steakhouse and Carrabba's Italian Grill.

"I know what to expect, I know what the food looks like and I know their training with their management and servers is really good."

Can't be too explicit

Jeff Williams takes that approach further, and usually sticks to hamburgers in franchise restaurants.

"Hamburgers are usually prepared on a separate grill," says Williams.

Even so, about three years ago his lips swelled after eating half a burger at a branch of a well-known chain, and he figured it was cross-contaminated with seafood. He and his wife were able to get to a pharmacy across the street for Benadryl before his breathing became labored.

Both Williams and Stamitoles might be wary of a small restaurant like the Globe in Midtown, where the grouper is sauced with coconut milk and papaya pickles, but they needn't be, says server Eddie Walker.

"We do a lot of training because we're a chef-driven restaurant with a lot of uncommon ingredients," Walker claims, adding, "Our menu would be a small book if we listed every single ingredient."

Yet the serving staff goes though regular training, not only in memorizing menu ingredients but also in learning how to make customers state as explicitly as possible what they can and cannot eat.

Dr. Scott Carroll, a senior partner in the Atlanta Allergy and Asthma Clinic, tells his patients that they can never be too explicit when they go to a restaurant.

"They should always tell the restaurant people what they're allergic to and how severely allergic to it they are."

ALLERGY FACTS

> More than 12 million Americans, or about 4 percent of the population, have food allergies. Six million are allergic to shellfish; 1.2 million are allergic to finned fish.

> Shellfish allergy is commonly an adult-onset condition.

> The incidence of food allergy is highest in young children —- one in 17 among children under age 3.

> In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting.

> 100 to 200 people die each year in the United States from anaphylaxis. Death sometimes occurs in a few minutes.

> Even trace amounts of a food allergen can cause a reaction.

> Early administration of epinephrine (adrenaline) is crucial to treating anaphylactic reactions. It is available by prescription in a self-injectable device (EpiPen or Twinject.)

Source: Food Allergy & Anaphylaxis Network