People with life-threatening food allergies, such as milk, nuts, citrus or shellfish, generally know what to look for when buying, making or ordering food, but may get caught in hidden ingredients in alcoholic cocktails. The danger is real. The Food and Drug Administration (FDA) estimates that an average of 30,000 emergency room visits and 150 deaths every year are caused by food allergies.

Four percent of the adult population has food allergies, and by the time they reach the age that they can legally drink alcohol they know exactly what foods to watch out for. However, they may not know what cocktails pose dangers. For some people, exposure to even trace amounts of any of the 160 or more known food allergens can cause a reaction.

For example, some people have severe milk allergies. But few would think to ask if the margarita they are ordering has milk in it, unaware that some margarita mixes use milk derivatives as a binder. Another method of exposure could be a hastily rinsed shaker used to blend a previous milk-based drink, still containing traces of the allergen. Something as innocent as an invisible swipe of lime on the rim of a glass could cause a severe reaction in someone with citrus allergies.

Cashews, walnuts, citrus fruits, and more can be present in drinks with the unwary imbiber never aware until problems begin. Someone allergic to apricots may not know to avoid the amaretto-flavored liqueur Disaronno. In 2013 there was the first documented case of anaphylaxis in response to tequila “gold,” due to the oak barrels it was aged in.

Amanda Orlanda is a 24-year-old cocktail server and barista who, because of her own severe allergies to dairy, peanuts and nuts, is particularly sensitive to customer allergy questions. She has seen that allergy requests and questions are rarely passed on from the waiter to the person at the bar. Back to the margarita example: asking the waitress if a drink contains milk may seem silly, but follow-up questions about specific ingredients should be asked, including what ingredients are in the drink and what ingredients are in the ingredients.

Participants in food-serving training courses are taught about cross-contamination and the necessity of changing out ladles, waffle-irons and toasters. However, bartending stations and supplies such as shakers and strainers are rarely, if ever, mentioned.

A final danger for young adults in particular is mixed drinks at parties. It is possible that no one knows what all is in those drinks, and anything could be hiding in it, even if it looks safe.