Most patients with sesame allergy may safely consume small amounts of intact seeds
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Most patients with an allergy to sesame were able to tolerate small quantities of intact sesame seeds, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Adi Ovadia, MD, and colleagues at the Pediatric Allergy and Immunology Clinic of Wolfson Medical Center in Holon, Israel, reviewed all the oral food challenges administered with intact sesame seeds at the center from October 2017 to April 2019.
Clinicians at the center performed OFCs with increasing doses of 10, 20, 40 and 50 intact sesame seeds at 20-minute intervals using small pretzel snacks that had about 20 sesame seeds each, or about 50 mg of sesame seeds, and 12 mg of sesame protein per pretzel.
The analysis included 51 children (median age, 4.2 years; age range, 1.6-15.7 years; 65% boys) with sesame allergy, which were diagnosed when children were aged 5 months to 54 months (median age, 4.2 years), with a median time from diagnosis to OFC of 3.2 years.
Also, 41 (80.4%) of these children were diagnosed after an allergic reaction to tahini, or ground sesame butter, and 10 (19.6%) were diagnosed based on positive skin prick test results during evaluation for another food allergy.
According to the findings, 38 of 41 (92.7%) patients reported allergic reactions involving the skin, 10 (24.4%) reported gastrointestinal symptoms and six (14.6%) had respiratory symptoms.
Further, seven (17%) experienced an initial anaphylactic reaction, and four (7.8%) developed anaphylaxis after accidental exposure following diagnosis.
The researchers additionally found that 40 (78.4%) had an additional atopic manifestation, including atopic dermatitis (64.7%) and asthma (51%).
The findings also showed that 41 (80.4%) successfully completed the OFC and consumed an average of 3.1 pretzels, or approximately 150 mg of sesame seeds, whereas 10 (19.6%) reacted to the OFC with gastrointestinal symptoms, mild rash and/or mild rhinorrhea.
Four patients required oral antihistamines; none of them required adrenaline. A diagnosis of asthma (P = .011) was the only statistically significant difference between the patients who passed or failed the OFC.
The clinicians told the patients to keep eating the same amount of sesame seeds as challenged at least three or four times a week. Also, the clinicians told the patients to stop avoiding foods that may include traces of sesame. None of the patients who passed the OFC and who kept incorporating intact sesame seeds in their diet reported any allergic reactions.
Currently, doctors recommend that allergic patients completely avoid sesame. However, the researchers concluded that because 80.4% of their participants tolerated a small quantity of intact sesame seeds, and all the children who failed the OFC experienced only mild allergic reactions, OFCs involving small quantities of intact sesame seeds are safe and continuous exposure may promote future tolerance.
Such treatment would be beneficial because children with food allergies have a worse quality of life than those with other chronic diseases, the researchers wrote, as food allergies often are associated with anxiety about accidental exposure. Consuming small quantities of sesame, then, may positively impact their quality of life.
Perspective
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Scott H. Sicherer, MD, FAAP
The results did not surprise me because we see many children who had been tolerating seeds on breads, crackers and other foods who come to attention because they reacted to a concentrated sesame product, such as tahini in hummus.
Allergy to food is not all or nothing when it comes to threshold. Even for a food such as peanut, whereas some people have allergic symptoms to a small speck of peanut, others can eat many peanuts before symptoms start.
However, there have not really been formal studies about this issue with sesame. Those seeds are small and pack just a tiny bit of protein. I typically have a conversation with families about whether they can continue having the separate seeds and I, like in this report, sometimes do a supervised feeding of seeds after discussing the risk or benefit with families.
This report is a nice start to formalizing what might be expected when determining if a person with sesame allergy can get away with eating separate seeds but avoiding concentrated forms.
There are limitations to the report. It was a “look back” at children selected for testing, which may have biased toward those who were “less allergic,” and they were not formally tested to look at their sensitivity to sesame eaten in larger amounts. Although these biases probably selected for a less sensitive group that included patients who are more likely to tolerate the low amount of protein in seeds over the high amount of protein in sesame paste, it is still notable that about one in five reacted to these smaller amounts. Therefore, taking this approach carries risks that are not entirely worked out just yet. This requires thoughtful discussions regarding this approach, and clearly there is more to look into research-wise.
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