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Assessment of sesame seed tolerance in children with sesame allergy
Ramin Beheshti1, Jennifer Dantzer1, Jackie Isola1
1Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland.
Background:
Whether children with reactivity to concentrated forms of sesame can tolerate intact sesame seeds remains unclear, and data to guide clinical decision-making are limited.
Objective:
To evaluate the tolerability of intact sesame seeds in children with sesame allergy having prior reactions to concentrated sesame products.
Methods:
We conducted a retrospective chart review of pediatric patients with IgE-mediated sesame allergy (based on clinical history plus sensitization). Participants who had allergic reactions to concentrated sesame during infancy or early childhood and then underwent oral food challenges (OFCs) to intact sesame seeds were included. The OFCs were performed using a standardized, stepwise dosing protocol to a cumulative target dose of 1 to 3 teaspoons of sesame seeds. Demographic characteristics, clinical history, sesame-specific IgE levels, and challenge outcomes were analyzed.
Results:
A total of 27 children were included. The OFCs occurred within 6 months to 4 years (median: 2 years) after their most recent sesame reaction. There were 23 patients (85%) who tolerated intact sesame seeds without clinically significant symptoms. Four patients (15%) developed objective allergic reactions requiring treatment after ingesting 50 to 500 mg of sesame protein.
Conclusion:
Most children with clinical reactivity to concentrated sesame products tolerated intact sesame seeds during supervised OFCs, supporting the role of OFCs in individualized dietary counseling for sesame-allergic children.
