Sesame allergy often resolves in patients with mild reactions at young ages

Researchers found that sesame allergy spontaneously resolved in approximately one-third of patients who had a mild first reaction at a young age, according to a study published in Annals of Allergy, Asthma & Immunology.

The prevalence of food-induced anaphylactic reactions related to consumption of sesame is especially common in the Middle East, but rates have increased recently in Europe, America and Australia following its use becoming more common in food products.

“Data on the natural history of sesame allergy are sparse,” Keren Mahlab-Guri, MD, of Hebrew University of Jerusalem and Kaplan Medical center, both in Israel, and colleagues wrote. “Knowing the natural history of sesame allergy will help to improve the management of those patients with sesame allergy.”

To better understand the clinical characteristics of sesame allergy and its resolution, Mahlab-Guri and colleagues conducted a retrospective review of 190 patients (66.8% male) seen and treated for sesame allergy in an allergy clinic between January 2015 and June 2019.

The mean age of patients at the time of their first sesame allergic reaction was 11.04 months. Most patients had a mild allergic reaction with a mean severity score of 1.23 according to the World Allergy Organization subcutaneous immunotherapy systemic reaction grading system. The researchers also found that 79 patients had concomitant food allergies, most commonly eggs and peanuts.

Sixty-one patients had spontaneous resolution of sesame allergy during a mean follow-up period of 3.86 years. Diagnosis of resolution was based on negative oral food challenge in 49 patients or, for 12 patients, based on report of dietary consumption of sesame by the patient or family.

Patients with spontaneous resolution of sesame allergy were younger at the time of their first reaction (9.18 vs. 11.93 months; P = .005) and had milder reactions based on severity scores (1.08 vs. 1.3; P = .008).

Analysis of patients with persistent sesame allergy showed higher rates of concomitant food allergies compared with those with spontaneous resolution (51.9% vs. 32.8%; P = .01). Persistent sesame allergy correlated with tree nut allergy (13.2% vs. 3.3%; P = .03), but not with milk, egg or peanut allergies.

Mahlab-Guri and colleagues noted limitations to the study, particularly the retrospective nature. Because of the study design, there was a limit to OFC data from baseline and, of those performed, they were open and not double-blind placebo controlled.

Based on the data reviewed, they concluded that patients with an early, mild reaction with small skin prick test wheal diameter and without concomitant other food allergies had a higher chance for natural tolerance development and that oral immunotherapy is not needed for most of these patients.

“Larger prospective studies with longer follow-up period are still needed to better define the clinical features that can predict spontaneous resolution of sesame allergy and to improve the management of patients with sesame allergy,” the researchers wrote.