Sesame Immunotherapy: A Systematic Review and Narrative Synthesis

Sesame allergy is associated with severe allergic reactions, low rates of spontaneous resolution, and significant psychosocial burden. Current management relies on strict avoidance and emergency treatment. Allergen-specific immunotherapy, particularly oral immunotherapy (OIT), has emerged as a potential disease-modifying approach, but evidence for sesame allergy remains limited. A systematic search was conducted through August 2025. Eligible studies included participants of any age with confirmed sesame allergy treated with allergen immunotherapy. Primary outcomes were desensitization and sustained unresponsiveness assessed by oral food challenge. Secondary outcomes included adverse events, epinephrine use, quality of life, and mortality. Risk of bias was evaluated using Joanna Briggs Institute tools. Nine studies met the inclusion criteria, including one study identified through citation searching. The evidence consisted, primarily small cohort studies and case series. Single-allergen sesame OIT achieved high desensitization rates (approximately 85%-97%) across heterogeneous protocols and age groups. Sustained unresponsiveness was reported in a limited number of mainly pediatric cohorts. Most adverse events were mild to moderate; severe reactions requiring epinephrine were uncommon, and no deaths were reported. Adjunctive omalizumab improved tolerability in high-risk adults. Sesame OIT shows promising efficacy with an acceptable safety profile in specialized settings. However, evidence is limited by small sample sizes, heterogeneity, and short follow-up. Randomized controlled trials are needed to define optimal protocols and long-term outcomes. TRAIL REGISTRATION: The protocol for this systematic review was prospectively registered in PROSPERO (International Prospective Register of Systematic Reviews; Registration number: CRD420251087250).