Sesame allergic patients can tolerate a non-crushed sesame seed food challenge

Sesame is increasingly recognized as an important allergen worldwide. It is the third most common food allergen in Israel and the second most common cause of severe IgE-mediated food-allergic reactions among infants and young children. Most of the allergic reactions are to tahini paste or halva (sesame seed-based dip and sweets), which are added to the diet of most Israeli children in the first year of life as good sources of calories and bio-available iron. Sesame allergy is usually lifelong, with tolerance developing in approximately 20% to 34% of patients. The purpose of our study was to investigate whether sesame allergic patients can tolerate a non-crushed sesame seed food challenge.

Patients and Methods: Diagnosis of sesame allergy was based on convincing clinical symptoms together with a positive skin prick test or serum specific IgE, or positive oral food challenge. Patients were challenged with 2-6 small pretzel snacks covered with non-crushed sesame seeds (~20 sesame seeds each).

Results: Forty-three patients with an average age of 5.7 years (range 1.5 – 15.7 years) took part in the challenge. Thirty-three (77%) patients had an additional atopic disease, 29 (67%) had atopic dermatitis, 19 (44%) had asthma, and 24 (55%) had an allergy to other foods (mainly peanuts and tree nuts). Thirty-three patients (77%) passed the oral challenge while 10 (23%) failed the challenge with only mild symptoms. None required adrenaline.

Conclusions: The majority of sesame allergic patients can tolerate a non-crushed sesame seed food challenge. Our results may suggest an easier and safer option of oral immunotherapy for sesame allergic patients.