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Nutrition, Health & Wellness
After years of rising sesame allergies in the US, sesame has finally been recognized as a major food allergen. This has led to changes in food labeling starting in 2023. So, what does this mean for you if you have—or think you might have—a sesame allergy?
Let’s dive in and explore the ever-changing world of sesame allergies. We’ll look at how sesame is connected to other food allergies, explore a new testing option, learn how to stay safe during the food labeling transition, and discuss a promising treatment for overcoming sesame allergy.
The FDA takes action on sesame
In 2021, the US Food and Drug Administration (FDA) added sesame1 to the top 9 common allergens, alongside milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. This means manufacturers must now clearly label any sesame ingredients on food packaging, which is an important step to protect the health of adults and kids who are allergic to sesame.
Why the rise in sesame allergies?
Sesame allergies are on the rise, growing at a faster rate compared with other allergies. Why? The exact reason behind this increase is still unknown. However, several factors could contribute to this phenomenon.
Worldwide popularity and a surge in availability
The first possible reason is the increased global consumption of sesame. Sesame is gaining popularity in the US from the demand for global cuisines that use this ingredient. Another factor could be that sesame production2 has more than doubled worldwide over the last 2 decades, making it easier to access.
Abundance of sesame in more than food
It’s not just food. Manufacturers increasingly use sesame in cosmetics, medications, nutritional supplements, perfumes, and pet foods. The widespread use and unclear labeling make it harder to avoid sesame. Until now, decoding labels was confusing, as sesame could be hidden in vague or unfamiliar ingredient terms like “spices” or “tahini.”
The global impact of sesame
The impact of the rise in sesame allergies is substantial. Today, about 1.5 million US children and adults may be affected,3 compared with a 2010 estimate of only 300,000 affected.
Interestingly, this issue is not limited to the US alone. Israel has also seen a dramatic jump in food allergies, particularly sesame allergies, from just 0.85% of the population to 2.8%.4 The US has joined the ranks of numerous countries in implementing laws that require labeling of sesame food products.
Sesame allergies tend to be more severe
As with any other allergen, a sesame allergy can range from mild symptoms like a rash to life-threatening reactions such as anaphylaxis. What makes sesame allergies unique is 2 out of 3 individuals3 with sesame allergies require emergency department treatment. This high potential of severe reactions is another major reason the FDA now includes sesame on food labels.
The relationship between sesame and other food allergens
Sesame allergies rarely appear by themselves. Over 75% of those with sesame allergies also have an allergy to 1 or more other common food allergens.3 In fact, 60% of people with sesame sensitivity may also have sensitization to peanuts and tree nuts.5 Sensitization means you test positive for the immunoglobulin E (IgE) antibodies for a food allergen, but you may not have a physical reaction.
The connection among multiple food allergens is called cross-reactivity: small protein components in sesame, called peptides, are often similar to the peptides in other allergens. If the peptides are unable to break down enough during digestion, they become the culprits behind allergic reactions from any food that contains that type of peptide.
If you have a sesame allergy, getting tested for other food sensitivities can help you make smart choices for your diet and avoid potential cross-reactive allergens.
When should you get tested?
While sesame allergies are becoming more common, you don’t have to dash out and get tested unless:
You’re experiencing symptoms
You have allergy symptoms after eating sesame: skin rash; itching; hives; swelling of the lips, tongue, or throat; shortness of breath; trouble breathing; wheezing; stomach pain; vomiting; or diarrhea.
You have a family history
You have a parent with a food or sesame allergy3 that may have been passed down in your genes.
You have other allergies
You have other food allergies, especially peanuts or tree nuts.
An alternative testing option
Confirming sesame allergies is traditionally done through various testing methods, including skin-prick testing, blood tests, or oral food challenges. But beware, oral food challenges can put you at risk for severe reactions, such as life-threatening anaphylaxis, because you consume small amounts of sesame.
To address this risk, a promising alternative known as the basophil activation test (BAT)6 is gaining recognition in identifying food allergies. During this test, your blood sample (instead of yourself!) is exposed to potential allergens in the lab and then analyzed for cells that can indicate an allergic reaction.
However, basophil activation testing alone (or any allergy test) is not the only answer you need for a diagnosis. Your doctor will also consider your symptoms and medical history when diagnosing an allergy.
Help protect yourself after diagnosis
Navigating through all the information can be overwhelming if you’re newly diagnosed or have just discovered your child has a sesame allergy. However, there are steps you can take to effectively manage a sesame allergy and stay safe:
Meet with your healthcare team, including a dietitian and possibly a behavioral therapist. They can provide valuable guidance and help you understand the allergy in-depth. Together, you can create a care plan tailored to your specific needs.
Vigilance is key when managing a sesame allergy. It is essential to read ingredient labels meticulously and avoid foods containing sesame. Steer clear of products made in facilities where sesame is present to minimize the risk of accidental exposure.
Continue scrutinizing labels for potential “hidden” sesame ingredients while manufacturers transition to the new food labeling regulations. The new FDA law does not apply to food products already on their way to the store or in stock before 2023.
Double-check labels of previously safe foods due to a trend in food manufacturers adding sesame to their products to bypass cross-contamination cleaning rules.7
Ensure that your family, work colleagues, and close circle know about your allergy.
Be careful at events and restaurants when you don’t have access to food ingredients. Be prepared and call ahead if needed.
Always have an epinephrine pen on hand, which can reverse an anaphylactic reaction.
There’s hope for sesame allergy sufferers
With the rise of sesame allergies and their significant physical, mental, and social impact on adults and children, finding a way to “cure” this allergy has become a hot topic. While there is no true cure for sesame allergies, a potential solution may be to desensitize the body’s reaction to sesame by retraining the immune system.
Desensitization treatment is commonly known as oral immunotherapy. It is administered only under the care of a medical professional after carefully weighing the benefits and risks. Oral immunotherapy involves gradually exposing you to small amounts of sesame over time. Doing so retrains your body to be less sensitive to sesame, reducing allergic reactions. This process allowed an impressive 88.4% of patients involved in an oral immunotherapy study8 to overcome their sesame allergy and experience fewer allergic symptoms.
Adding sesame to the list of common food allergens labeled on food packaging by the FDA was a smart move, considering the severity and increase of sesame allergies in the US. Uncovering a sesame allergy diagnosis through testing can help you or your child manage the condition as food labeling practices evolve.
1Allergic to sesame? Food labels now must list sesame as an allergen. US Food and Drug Administration. Published Jan. 1, 2023. Accessed July 15, 2023. https://www.fda.gov/consumers/consumer-updates/allergic-sesame-food-labels-now-must-list-sesame-allergen
2 Gangur V, Acharya HG. The global rise and the complexity of sesame allergy: Prime time to regulate sesame in the United States of America? Allergies. 2021;1(1):1-21. doi:10.3390/allergies1010001
3 Warren CM, Chadha AS, Sicherer SH, et al. Prevalence and severity of sesame allergy in the United States. JAMA Netw Open. 2019;2(8):e199144. doi:10.1001/jamanetworkopen.2019.9144
4 Garkaby J, Epov L, Musallam N, et al. The sesame-peanut conundrum in Israel: Reevaluation of food allergy prevalence in young children. J Allergy Clin Immunol Pract. 2021;9(1):200-205. doi:10.1016/j.jaip.2020.08.010
5 Brough HA, Caubet JC, Mazon A, et al. Defining challenge-proven coexistent nut and sesame seed allergy: A prospective multicenter European study. J Allergy Clin Immunol. 2020;145(4):1231-1239. doi:10.1016/j.jaci.2019.09.036
6 Santos AF, Bergmann M, Brough HA, et al. Basophil activation test reduces oral food challenges to nuts and sesame. J Allergy Clin Immunol Pract. 2021;9(5):2016-2027.e6. doi:10.1016/j.jaip.2020.12.039
7 To comply with a new sesame allergy law, some businesses add—sesame. The Washington Post. Published April 11, 2023. Accessed July 15, 2023. https://www.washingtonpost.com/wellness/2023/04/11/sesame-allergy-law-consequences/
8 Nachshon L, Goldberg MR, Levy MB, et al. Efficacy and safety of sesame oral immunotherapy—a real-world, single-center study. J Allergy Clin Immunol Pract. 2019;7(8):2775-2781.e2. doi:10.1016/j.jaip.2019.05.031