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Published on: May 31, 2021
Natural history of sesame allergy in pediatric patients: Insight from a retrospective analysis
Alp Kazancioglu1, Melike Ocak1, Umit Murat Sahiner1
1Department of Pediatric Allergy, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Persistent sesame allergy (PSA) in children is common, with larger initial skin prick test (SPT) reactions and higher reaction severity predicting long-term persistence. These factors aid in managing PSA and selecting candidates for oral immunotherapy (OIT).
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Immunology
- Food Allergy Research
Background:
- Sesame allergy (SA) is an increasing health concern due to its association with severe reactions.
- Limited knowledge exists regarding the long-term outcomes of childhood sesame allergy.
- Understanding risk factors for persistent SA (PSA) is crucial for effective management.
Purpose of the Study:
- To identify risk factors associated with persistent sesame allergy (PSA) in children.
- To improve management strategies for children with SA.
- To identify suitable candidates for oral immunotherapy (OIT).
Main Methods:
- Retrospective analysis of electronic medical records for 84 children with confirmed SA.
- Defined SA by consistent clinical reactions and IgE-mediated sensitization.
- Followed patients for a median of 56.5 months.
Main Results:
- Persistent SA (PSA) was observed in 82.1% of patients.
- Independent risk factors for PSA included larger SPT wheal size at the first reaction and allergic reaction grade ≥2.
- Patients with sustained SPT wheal size or specific IgE levels were more likely to have PSA.
Conclusions:
- Novel risk factors for PSA, including SPT wheal size, reaction severity, and sensitization markers, have been identified.
- These findings can guide management strategies and OIT candidate selection.
- Further long-term studies are needed to understand the natural history of SA and evaluate early interventions like OIT.
Background:
Sesame allergy (SA) is a growing concern because of its association with severe reactions and the limited knowledge of long-term outcomes.
Objective:
This retrospective study aimed to identify the risk factors influencing persistent SA (PSA) in children to improve management and select suitable candidates for oral immunotherapy (OIT).
Methods:
We analyzed the electronic medical records of 84 children with confirmed SA, as defined by consistent clinical reactions and immunoglobulin E (IgE)-mediated sensitization. Patients were followed for a median (IQR) of 56.5 (46.0-82.5) months.
Results:
Most participants were male (72.6%) with concurrent food allergies (71.4%). They experienced a median (IQR) of 3.0 (2.0-3.7) allergic episodes, with 46.4% experiencing at least one anaphylactic reaction. PSA was observed in 82.1% (69/84) of the patients. A larger skin prick test (SPT) wheal size at the first reaction (adjusted OR = 1.79, CI:1.05-3.04; p = .03) and allergic reaction grade≥2 (adjusted OR = 19.93, CI:1.37-289.13; p = .02) were independent risk factors for persistence. A 3-fold increase in the likelihood of persistence was observed in patients with SPT results greater than 6.7 mm at first reaction compared with those with results less than 6.7 mm during follow-up (HR = 3.08; CI:1.17-8.12; p = .02). Patients with sustained or increased SPT wheal size (93% remained allergic) and specific IgE (95% remained allergic) at the final visit were more likely to have PSA, whereas those with decreased levels (37% and 39% developed natural tolerance, respectively) were less likely to have resolved SA.
Conclusions:
This study identified novel risk factors for PSA, including SPT wheal size at the first reaction, reaction severity, and sustained sensitization markers. These findings can inform management strategies and the selection of OIT candidates. Further long-term studies are crucial to elucidate the natural history of SA across populations and to evaluate early interventions, such as OIT.
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