TOPLINE

Most children with a clear history of sesame allergy and reactions to concentrated sesame products, such as tahini and hummus, tolerated whole sesame seeds, with 85% of them successfully passing an oral food challenge (OFC) of one to three teaspoons of intact seeds.

METHODOLOGY

• Researchers retrospectively reviewed data of 27 children (median age at first sesame reaction 1 year; 18.5% girls) with immunoglobulin E (IgE)-mediated sesame allergy to assess whether they could tolerate intact sesame seeds after prior reactions to concentrated sesame products.
• All participants had a convincing history of an immediate allergic reaction to a concentrated sesame product during the first 2 years of life and subsequently underwent an OFC to intact sesame seeds within 4 years of their most recent reaction.
• The OFC used six stepwise doses of 5%, 10%, 15%, 20%, 25%, and 25% of the target dose, given at approximately 15-minute intervals. Goal doses ranged from one to three teaspoons of intact sesame seeds (approximately 500-1500 mg of sesame protein).
• The primary outcome was the cumulative tolerated dose during the OFC. A passed challenge was defined as the completion of the goal dose without developing allergic symptoms that required treatment; a failed challenge was defined as the development of allergic symptoms that necessitated discontinuation and/or pharmacologic intervention.

TAKEAWAY

• Overall, 85% of patients passed the OFC, tolerating the full cumulative dose of intact sesame seeds, without developing clinically significant reactions.
• All participants with goal doses of 500 mg and 1500 mg tolerated the OFC. Among the 21 participants with a 1000-mg goal dose, 17 (81%) tolerated the full challenge; the remaining four failed the OFC, developing reactions at cumulative doses of 50-500 mg sesame protein.
• Among the four patients who failed the OFC, the most common symptoms were cutaneous and gastrointestinal. Perioral rash or maculopapular eruptions were observed in two patients, whereas vomiting and hives were each seen in two patients.
• All four patients received cetirizine, and one also received epinephrine and oral prednisone.

IN PRACTICE

“This high pass rate is clinically meaningful, indicating that for many children complete sesame avoidance may be unnecessarily restrictive, and supervised food challenges can play a pivotal role in reclassifying risk,” the authors wrote.

SOURCE

Ramin Beheshti, MD, with the Johns Hopkins University in Baltimore, was the corresponding author of the study, which was published online on June 26 in Annals of Allergy, Asthma & Immunology.

LIMITATIONS

The small sample size limited how widely the results could be applied and reduced the ability to detect small associations, such as those between sesame-specific IgE levels and reaction dose.

DISCLOSURES

This study was supported by a grant from the National Institutes of Health and the American Academy of Allergy, Asthma, and Immunology Foundation Faculty Development Award. Some authors disclosed receiving research support, royalties, and grant funding from various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.