What is a sesame allergy, and what are sesame allergy symptoms? Why is sesame such a difficult allergen to avoid, and what should you look for on food labels to make sure you don't by sesame products for your food allergic child? We'll answer these questions and more in this parent's guide.
Sesame allergies are the ninth-most common food allergy in the United States. They are estimated to affect over 1.5 million people in the United States. And like all food allergies, allergic reactions to sesame can sometimes cause life-threatening anaphylaxis.
Even though sesame allergies are very common, sesame allergies aren't recognized in the same way as the top 8 food allergens in the United States. Unlike the top 8 food allergens, sesame isn't required to be clearly labeled as a food ingredient under federal law.
Today, we'll cover what parents need to know about sesame allergies, including how to spot and avoid hidden sesame ingredients.
What Is a Sesame Allergy?
A sesame allergy is an allergy to the sesame plant, as well as any products that come from the plant (like sesame seeds) or that are made from the plant (like sesame oil).
Normally, our immune systems protect our bodies from harmful invaders, like bacteria and viruses. When someone has a sesame allergy, though, their immune system treats the proteins in sesame seeds like harmful invaders.
The immune system over-defends the body against sesame proteins, and causes the body to develop an allergic reaction whenever the person eats a food that contains sesame.
Why does the body respond this way when someone is allergic to sesame?
People with sesame allergies' immune systems make special allergy antibodies to help fight sesame proteins off.
These antibodies are called sesame-specific IgE antibodies, because they detect and respond only to sesame protein.
The IgE antibodies trigger symptoms of an allergic reaction seconds to hours after the person eats a food containing sesame.
Learn more from Food Allergy Research and Education (FARE) about managing a sesame allergy:
Symptoms of Sesame Allergies
Symptoms of a sesame allergy can include:
- Skin redness
- Itching
- Itchy, watery eyes
- Hives (red raised bumps)
- Vomiting
- Swelling of the eyes, lips, face tongue, or throat
- Congestion
- Runny nose
- Wheezing
- Trouble swallowing
- Trouble breathing
- Nausea
- Diarrhea
- Abdominal pain
- Dizziness
- Fainting
Symptoms of a sesame allergy usually develop seconds to minutes after eating sesame, and almost always within 2 hours.
Sesame allergic reactions can range from mild to severe. When the symptoms of a sesame allergic reaction are severe, and involve more than one organ system, the reaction is classified as anaphylaxis. And anaphylaxis can be life-threatening.
Swelling of the face, tongue or throat, wheezing, breathing difficulty, and significant cardiovascular symptoms may be signs of an anaphylactic reaction. If your child shows signs of anaphylaxis, give epinephrine (use an Epi-Pen) immediately, and call 911.
Testing for Sesame Allergies
There are three ways for an allergist to test for, and diagnose, sesame allergies. These include a skin prick test, a blood test, and an oral food challenge.
During a skin prick test, your child's forearm is pricked with a needle containing sesame protein. Then, the allergist monitors your child to see if an allergic reaction develops around the area where your child's skin was pricked.
During a blood test, your child's blood is checked for IgE antibodies that respond to sesame proteins.
During an oral food challenge, your child will eat small amounts of sesame at a time, and an allergist will closely watch to see if your child develops an allergic reaction. This is the most accurate way to diagnose a sesame allergy.
Sesame Allergy Trends
Sesame allergies are estimated to affect over 1.5 million people in the United States---both children and adults (between 0.2% and 0.5% of the general population).
Sesame allergies most often develop in children, but they can develop at any age. Only around 20-30% of childhood sesame allergies are eventually outgrown. And sesame is the ninth-most common food allergy in the United States.
According to a study presented at the 2019 Annual Meeting of the American Academy of Allergy, Asthma, and Immunology, which involved a survey of over 50,000 households:
- 38% of people with sesame allergies reported that they have had at least one severe sesame allergic reaction.
- Around 33% of people with sesame allergies have used an Epi-pen to treat a sesame allergic reaction.
- Around 80% of people with sesame allergies have at least one other food allergy. So, someone who already has another food allergy is more likely to develop sesame allergies.
And another study has found that, specifically, sesame allergies often develop alongside peanut allergies and tree nut allergies in children.
The Sesame Allergy Dilemma: Not Recognized Like The Top 8 Allergens
Even though sesame allergies are extremely common, sesame isn't recognized in the same way as the top 8 allergens are.
Food products containing any of the top 8 allergens must clearly be labeled with the allergens they contain under federal law.
But since sesame isn't recognized as one of the top 8 allergens affecting Americans, sesame currently isn't required to be listed clearly on ingredient labels. This can make it very difficult for people with sesame allergy and their families to identify the foods that contain sesame, and that could cause an allergic reaction.
Managing a Sesame Allergy
Any amount of sesame could cause someone with sesame allergy to develop an allergic reaction. And any allergic reaction could develop into life-threatening anaphylaxis. So, it's vital that children with sesame allergies avoid all products containing sesame.
Avoiding sesame can get complicated, though, since sesame isn't required to be labeled clearly on food products. So, it's extremely vital that you read food labels carefully to protect your child from a sesame allergic reaction.
Even worse, sesame is sometimes listed under very vague names on ingredient lists. In fact, sesame ingredients are sometimes listed as "natural flavors" in some food products. This can make it very difficult for your family to identify the foods that contain sesame, and that could cause your child to develop an allergic reaction.
Always check a label for sesame three times, to keep your child safe.
Check an ingredient label:
- At the store before you buy
- After you get home from the store, before you put away the food
- When you get the food out, before you plan to prepare and serve it
If your child has a sesame allergy, they will need to avoid these products:
- Sesame seeds
- Sesame flour
- Sesame salt
- Sesame paste
- Sesame oil (*Sometimes, people with sesame allergies can tolerate highly refined sesame oil. Talk to your allergist to learn more.)
Watch out for these "hidden" sesame ingredients on food labels. Your child will need to avoid these forms of sesame as well:
- Tahini/Tahina/Tehina (toasted sesame paste, often used in hummus)
- Gomasio (sesame salt)
- Halvah (fudge-like candy made from sesame paste)
- Gingelly / Gingelly oil (gingelly is another name for sesame)
- Sesamol / Sesemolina (more ways to say "sesame")
- Benne/ Benne seed / benniseed (other ways to say "sesame seed")
- Sesamum indicum / Sesamum (the scientific name for the sesame plant)
- Sim sim ("sesame" in Arabic)
- Til (another name for sesame seed)
Also, keep in mind that foods like these sometimes contain hidden sesame---read labels very carefully!
- Bread/rolls/buns
- Breadsticks
- Bread crumbs
- Bagels
- Cereals
- Granola
- Muesli
- Chips, including bagel, pita, and tortilla chips
- Crackers
- Melba toast
- Baba ghanoush
- Hummus
- Other dipping sauces
- Dressings
- Gravies
- Marinades
- Sauces
- Stir fry
- Stews and soups
- Flavored rice
- Risotto
- Flavored noodles
- Shish kebabs
- Falafel
- Margarine
- Energy/protein bars
- Processed meats
- Sausages
- Pretzels
- Rice cakes
- Candies
- Japanese snack mix
- Sushi
- Tempeh
- Vegetarian and vegan "burgers"
If you aren't sure whether a product contains sesame, sometimes it's better to call the food manufacturer first, before you purchase the product.
Avoiding cross-contamination
Certain Asian restaurants may be particularly dangerous for people with sesame allergies, because sesame is such an important part of these cuisines. Indian cuisine uses sesame constantly, and Chinese, Japanese and Korean restaurants often cook their foods in sesame oil.
And even if you order a food that you're sure does not contain sesame, there's also a high risk of cross-contamination. This is the accidental mixing of a food with sesame into a food that didn't originally contain sesame.
Because of the sesame seeds that they use, bakeries that make bread and bagels also pose a high risk of sesame cross-contamination.
In fact, any restaurant, and anywhere else that food is prepared outside the home, could pose a risk of cross-contamination. After all, so many foods contain sesame, and there are so many ways that sesame could be hidden in foods.
So, every time your child is about to eat food that someone else prepares, be sure to:
- Confirm that a dish does not contain sesame
- Alert your server that your child has a sesame allergy, to avoid cross-contamination
- Alert the person preparing the food that your child has a sesame allergy, to avoid cross-contamination
Giving the restaurant or other location a "chef card" can help you with this process.
Packaged foods could also be processed on equipment that processes sesame, so there's a cross-contamination danger with these types of foods as well. And often, it's difficult to know when a food was processed on the same equipment as sesame products.
Manufacturers may alert you to cross-contamination by stating "may contain sesame" on their labels, but they aren't required to do so. If you aren't sure whether there was possible cross-contamination, call the food manufacturer to ask about how the food was processed.
Spice blends and flavorings
Sesame may also appear in spice blends and flavorings without being listed as an ingredient. Many spice and flavoring blends are considered proprietary, so manufacturers may not share the entire ingredient list. However, if you call the manufacturer, specifically ask if their spice blend contains sesame, and mention that you're asking because of a food allergy, the manufacturer will be able to tell you if they use sesame in that spice blend. Also ask about manufacturing processes---is the blend processed on equipment that also processes sesame?
Hope for Clearer Sesame Labeling
The FASTER Act, a 2019 bill with bipartisan Congress support, aims to make life easier for food allergy families. If the FASTER Act is passed, manufacturers will be required to clearly label products that contain sesame.
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