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Sensitization to sesame was more likely in children with positive SPT to peanuts (odds ratio [OR] = 6.7, 95% confidence interval [CI] [2.7–16.8], p < 0.001) and tree nuts (OR = 10.5, 95% CI [4.0–27.7], p < 0.001). Children with histories of both peanut and tree nut reaction were more likely to have a history of sesame reaction (OR = 10.2, 95% CI [2.7–38.7], p < 0.001).
Dr. Wanda Phipatanakul, of Children's Hospital Boston, and her colleagues studied the medical records of 191 children
Between 13 percent and 15 percent of peanut and tree nut allergic children were actually allergic to sesame
The rate of sesame allergy jumped up to 50 percent for children allergic to both nuts
she recommends education specific to sesame should be provided to primary care physicians, parents and day care and school personnel. She also advocates for the food industry being subjected to stricter labeling guidelines on this emerging food allergen.
Wood adds that sesame is a raw oil, and as a result can be just as allergenic as the seeds themselves.
can still be hidden as “tahini”, “spices” or “natural flavouring”.
government agency not only looks at which allergens are the most common, but which ones are mostly likely to produce the most severe reactions
Thanks for these resources.
have progressed from 'anecdotal' to a serious worldwide health problem
Although specific IgE to peanut were higher than for sesame, peanut-induced allergic reactions were mild, in contrary to sesame where anaphylaxis was the only clinical manifestation.
Recently, sesame has been recognized as an increasingly frequent and potentially severe allergen.
Recruitment occurred at childhood immunization sessions in Melbourne, Australia.
Amongst 2848 infants (73% participation rate), the prevalence of any sensitization to peanut was 8.9% (95% CI, 7.9-10.0); raw egg white, 16.5% (95% CI, 15.1-17.9); sesame, 2.5% (95% CI, 2.0-3.1); cow's milk, 5.6% (95% CI, 3.2-8.0); and shellfish, 0.9% (95% CI, 0.6-1.5). The prevalence of challenge-proven peanut allergy was 3.0% (95% CI, 2.4-3.8); raw egg allergy, 8.9% (95% CI, 7.8-10.0); and sesame allergy, 0.8% (95% CI, 0.5-1.1).
A 9-mm wheal after skin prick testing provided a 95% positive predictive value for egg or peanut allergy in an analysis of data from 5,000 12-month-old infants
71 with sesame challenges. None of the wheal sizes after sesame challenges reached a 95% positive predictive value for allergy, said Dr. Gurrin of the University of Melbourne.
reviewed 22 months worth of successive open OFCs performed at a university-based pediatric allergy outpatient clinic (Mount Sinai School of Medicine, New York, NY)
The survey involved 40,104 children; of these, investigators identified 3339 children with food allergy.
oral food challenge was done in just 15.6% of children
Formal diagnoses were most frequently confirmed by oral food challenge for milk allergy (22.4%), soy (19.2%), peanut (16.1%), wheat (15.5%), shellfish (14.4%), tree nut (12.6%), egg (12.4%), sesame (11.2%), and fin fish (9.1%).
Although our study is limited by a small sample of cases, there is an inclination for predicting the outcome of a sesame food challenge with SPT based on our results
Notably, 29% of sesame allergic patients had a sesame-specific IgE < 0.35 kUA/L. This is in contrast to the findings of Zavalkoff et al. who reported a cut-off < 0.35 kUA/L as being useful in excluding a diagnosis of sesame allergy.
Data from 125 positive oral challenges to egg, 103 to peanut, 59 to milk and 12 to sesame seeds were analysed. Haemodynamic modifications were observed in 2%, 3%, 1.7%, and 8% of the oral challenges (OCs) to egg, peanut, milk and sesame, respectively. Respiratory symptoms were observed in 12%, 20%, 10% and 42% of egg, peanut milk and sesame allergies, respectively. A cumulative reactive dose inferior or equal to 65 mg of solid food or 0.8 mL of milk characterized 16%, 18%, 5% and 8% of egg, peanut, milk and sesame allergies, respectively. 0.8% of egg allergies, 3.9% of peanut allergies, and 1.7% of milk allergies reacted to 10 mg or less of solid food or to 0.1 mL for milk. The lowest reactive threshold has been observed at less than 2 mg of egg; 5 mg of peanut, 0.1 mL of milk and 30 mg of sesame seed. Ten out of 29 OC with peanut oil, two out of two OC with soy oil and three out of six OC with sunflower oil were positive. Five out six OC with sesame oil were positive: 1 and 5 mL induced an anaphylactic shock.
Evidence was found for increased reporting of sesame allergy during the past 5 decades, with reports mostly from developed countries. Clinically, most sesame allergy was presented in at least 2 major forms: (1) immediate hypersensitivity, often expressed as systemic anaphylaxis, associated with positive skin prick test and/or IgE antibody test results to sesame proteins with some cross-reactivity with other foods, and (2) delayed hypersensitivity to lignin-like compounds in sesame oil clinically expressed as contact allergic dermatitis. There were a few cases of immediate hypersensitivity to sesame with negative skin prick test and/or IgE antibody test results that were confirmed by oral challenge tests.
Oleosins have been described by others [2], and are important allergens from sesame seed. Since they are hydrophobic, they are not present at commercial extracts or extract prepared from sesame seed in saline, or the CAP system extract.
a significant proportion of sesame-seed-allergic children were able to tolerate low amounts of sesame ingestion. This seems to be a common clinical finding in sesame allergy, perhaps reflecting peculiarities of sesame allergens and digestive processing thereof.
tolerance of loose seeds does not always confirm tolerance of sesame concentrates
Sesame should be identified clearly as an ingredient and separately from nuts and peanuts when it may be an allergen contaminant. People at potential risk need clear allergy diagnosis and informed guidance to enable them to avoid this key allergen more easily.
I think your summary of the literature suggesting that we do not have a great deal of detail on the cross reactivity of ingested seeds is a fair assessment. The 2S, 7S, 11S storage proteins are common to many seeds and could provide cross reactivity. However, the clinical evidence of the importance of this cross-reactivity is not well substantiated.