Background:
Sesame is the third most common food allergen in Israel, and a cause of fatal allergic reactions. According to current literature sesame allergy is unlikely to resolve, hence allergen avoidance is the prime and only management recommended. Diagnosis of food allergy requires the performance of allergy tests, including a food challenge. Sesame challenge is frequently not performed because this allergy is considered persistent and of very high-risk. In this study we describe the results of evaluating sesame allergy in a tertiary center.
Methods
Children with a history of an immediate reaction to sesame were included in this study. All children underwent skin prick test (SPT) and a gradual open food challenge with sesame regardless of SPT results.
Results
A cohort of 38 children with sesame allergy, 17(45%) girls and 21(55%) boys, 14months – 17years of age, were evaluated. Of which 15(40%) exhibited sesame allergy following challenges while 23(60%) were sesame tolerant. Sesame allergy was associated with concomitant allergy to nuts (p=0.02), specifically hazelnut (p=0.04), fish (p=0.04) as well as the size of SPT to thina (p=0.01) but not to commercial reagent. Notably time from last accidental exposure was 2 times longer in tolerant compare to allergic children (7month vs. 3.5month respectively), although this did not reach statistical significance.
Conclusion: Open food challenge, although of high risk, is essential for the diagnosis of sesame allergy. Up to 60% of children could tolerate sesame following challenge. Prior sensitization to hazelnut and fish were associated with lack of tolerance to sesame.
