When the first case of sesame allergy was reported in 1950, the allergen was considered anything but ordinary. It has since proven its predominance, impinging upon a growing population worldwide. But despite giving the "top eight" allergens in the U.S. some serious competition, sesame allergy has yet to be regarded by the Food and Drug Administration (FDA) as a major food allergen.
Today, the FDA's food allergen awareness program consists of eight common foods that cause serious allergic reactions: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. Canada and the European Commission include sesame in their lists of major allergy-causing substances. But in the U.S., the allergen hasn't made the cut.
It could be sesame hasn't been traditionally as prominent in Americans' diets, suggested Todd D Green, MD, Assistant Professor of Pediatrics, Allergy and Immunology at the Children's Hospital of Pittsburgh.
"Whether allergy to a particular food is common in a society may relate to how widely consumed that food is. For instance, [researchers] several years ago drew attention to sesame allergy in Israel, where foods heavy in sesame seed are commonly eaten by infants in their first year of life," he stated. They found sesame was the third-leading cause of food allergy in Israel, and the number two cause of anaphylaxis there.
But awareness of sesame allergy in the U.S. is growing as eating habits become increasingly internationalized, noted Dr. Green. Since sesame is not considered one of the major food allergens at this time, the Food Allergy Labeling and Consumer Protection Act (FALCPA) does not include sesame among the foods whose presence in a food product mandates clear labeling. Even the current feeding recommendations from the American Academy of Pediatrics don't advise the delayed introduction of sesame or other seeds.
Sesame can be a hidden ingredient in foods in places such as "spices" or "natural flavors." It is also in sesame oil, an ingredient found health and beauty products such as skin cream and lip gloss.
So, what should you do about sesame exposure in children at high risk for food allergies? "That question is a difficult and evolving one," said Dr. Green. With the knowledge of its potential role as an allergen, physicians and families should at least consider sesame among the other commonly implicated foods when looking for a cause of a suspected allergic reaction.
"Certainly if a child has been avoiding sesame because of concerns of allergy, it is worth discussing with a physician whether evaluation through testing or a food challenge is indicated," he said. But, like any food, a positive skin or blood test to sesame doesn't always mean a child will react to ingestion. Testing someone with no history of a sesame reaction can potentially lead to unnecessary dietary restrictions.
Ultimately more research is needed to answer the question of whether sesame should be avoided in children at risk of food allergy. "At this point there does not seem to be a clear answer and parents should discuss this with their physician to make the best decision for their child," advised Dr. Green.
Dalal I., Binson I., Reifen R., Amitai Z., Shohat T., Rahmani S., Levine A., Ballin A., Somekh E. (2002). Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. Allergy. 57(4), 362-5.
American Academy of Pediatrics, Committee on Nutrition. (2000). Hypoallergenic infant formulas. Pediatrics. 106, 346-9.
Gangur V., Kelly C., Navuluri L. (2005). Sesame allergy: a growing food allergy of global proportions? Annals of Allergy, Asthma and Immunology. 95, 4.
Approved by KFA Medical Advisory Team March 2008.