Sesame Allergy Rates Are Increasing: Here’s What to Know
Allergies to sesame can be a tough one to deal with since it’s in so many different foods and is still not required to be listed on food labels. The ninth most common allergy, it may end up being up to individual states to pass legislation mandating sesame to be added to the list of eight allergens now required to be labeled. Meanwhile promising research is taking place by exposing children to sesame who are under six months of age and are at risk of developing this allergy, such as being allergic to another type of food.
By Kristen Fischer
August 2, 2019
Sesame allergy is more common than most people may think, according to a new study (Prevalence and Severity of Sesame Allergy in the United States) published today in JAMA Network Open.
More than 1 million children and adults in the United States have the allergy, estimates the new data — higher than what was previously reported.
At that number, it’s the ninth most common allergy in the United States.
And that makes experts concerned about exposure risk — since only the top eight allergens are reported on food labels.
More Americans have a sesame allergy
The Food Allergen Labeling and Consumer Protection Act of 2014 requires food manufacturers to only report on the top eight allergens, which include milk and peanuts. This means sesame seeds don’t have to be included on food labels.
“It is important to advocate for labeling sesame in packaged food. Sesame is in a lot of foods as hidden ingredients. It is very hard to avoid,” said Dr. Ruchi Gupta, professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine, a physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, and lead author of the new study.
More than 1.5 million Americans, or 0.49 percent of the population, may have a sesame allergy. And 0.34 percent of the population, or 1.1 million children and adults, are likely to have a diagnosed sesame allergy or a history of sesame allergic reaction symptoms, according to Gupta’s report.
Four in five patients with sesame allergy have at least one other food allergy. More than half have a peanut allergy, a third are allergic to tree nuts, a quarter are allergic to eggs, and 1 in 5 are allergic to cow’s milk. Data came from a survey of about 80,000 Americans, so it was self-reported or reported on behalf of children.
Sesame in the spotlight
The study findings come as the Food and Drug Administration (FDA) considers adding sesame to the list of eight food allergens that require labeling.
In other countries, including Australia, Canada, and Europe, sesame-containing products must be labeled.
Illinois recently passed a bill requiring sesame to be labeled on all packaged goods. The move could drive other states — or the whole country — to adopt the same standards, some say.
“[The] Asthma and Allergy Foundation of America believes the FDA has authority to add sesame to the list of major allergens, and we encourage them to do so,” said Sanaz Eftekhari, vice president of corporate affairs and research at the AAFA.
“It is difficult for consumers to avoid an allergen that isn’t labeled in plain language by its common name. It can also be difficult to identify the cause of an allergic reaction if you are unsure of all of the ingredients in a food that triggered a reaction,” she said.
Why sesame allergies are rising
Dr. Michael Pistiner, director of food allergy advocacy, education, and prevention at MassGeneral Hospital for Children, believes one reason for the rise in sesame allergies is due to more people in the United States eating sesame-containing products.
“Years ago it wasn’t so available, and now it’s readily available,” Pistiner told Healthline.
Depending on the child, the exposure could sensitize them, be mild, or cause a reaction that may be fatal. “Patients do not realize how prominent this allergy is since it does not have the same public awareness of peanut and tree nuts, although it is just as dangerous,” added Dr. Stacey Galowitz, an allergy specialist in New Jersey.
“They also do not often realize how prevalent sesame is in everyday foods and what types of products their kids may react to,” Galowitz said.
In addition to seeds, sesame is also in hummus. Recently, a combination of ingredients that top “everything bagels” — including sesame seeds — became popular as a sprinkle-on topping for a variety of foods. Some foods only list the word “spices” on the ingredient list. Sesame can be in there without a person with the allergy having the opportunity to know, Pistiner says.
Sesame may be labeled in a variety of potentially confusing ways, such as tahini or its scientific name, Sesamum indicum, explains Christopher M. Warren, PHD, a fellow author and epidemiologist the Northwestern University Feinberg School of Medicine’s Center for Food Allergy & Asthma Research.
“It is frequently present in Japanese spices and seasonings, most notably furikake or shichimi togarashi, which are common table spices analogous to our salt and pepper, and often imported, so therefore don’t have sesame labeled in English,” he told Healthline.
Sesame is used by restaurants as well, and in ways that aren’t so obvious, explains Dr. Scott H. Sicherer, a fellow study author and professor of pediatrics and director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai.
“Many ethnic and vegetarian foods and snack foods could have sesame mixed into foods as tahini (sesame paste) or oils, and so the individual seeds would not be seen,” Sicherer said.
Studies have shown that most people with food allergies can safely eat highly refined oils made from those foods. But sesame oil isn’t refined, so people allergic to it must avoid it completely, Galowitz notes.
Sesame can also be in pet food and cosmetics, adds Dr. Aikaterini Anagnostou, director of the Food Immunotherapy Program at Texas Children’s Hospital.
Preventing and treating sesame allergies
Families who use sesame products should talk to their pediatricians about if or when they should introduce the potential allergen.
If a child doesn’t have high risk for the allergy, Pistiner recommends introducing sesame-containing foods that aren’t a choking hazard by the time a baby is 6 months old.
Families who have children with a risk for allergies in general should talk to their doctors about if and when to try to introduce sesame.
The National Institute of Allergy and Infectious Diseases (NIAID) has Guidelines for Clinicians and Patients for Diagnosis and Management of Food Allergy in the United States for introducing peanuts to prevent peanut allergies. Standards don’t exist for any of the other top allergens, including sesame. When there’s enough evidence, the NIAID may create guidelines for sesame, Pistiner says.
More research and specific guidelines could help those with allergies avoid accidental ingestion. Also, people may not have to restrict as many foods as previously thought, he adds.
The popular LEAP study, which focused only on peanuts, paved the way for the NIAID guidelines. Follow-up research known as the EAT study looked at the effects of early introduction of peanut, sesame, fish, milk, egg, and wheat.
There were no cases of sesame allergy in those who ate it early, but 0.6 percent of children who ate it after six months developed an allergy. This indicates early introduction can be effective, Warren explains. “However, since many families didn’t follow the study protocol as well as was planned, the statistical comparisons between the two groups were limited… Further studies are still needed before the evidence is likely to be deemed strong enough for the sesame-introduction guidelines to be changed,” Warren said.
Doing a comparable study on sesame allergy would require more people, as it’s less common than peanut allergy. As such, it may not be “feasible” for many researchers, Warren adds.