Sesamum indicum is one of the oldest oilseed plants belonging to the family Pedaliaceae and widely grown species in Sesamum genus. Asia and Africa hold 96% of world sesame seed production. It is commonly used in Middle Eastern cuisine and in Mediterranean diet and is increasingly being used in various foods in US like breads, sauces like tahini or confectionaries like halva. The prevalence of sesame allergy in USA, Mexico, Canada and Europe is reported 0.1% and 0.8% in Australia. It is considered ninth most common childhood food allergy in US while third most common food allergen and second most common food to cause anaphylaxis in children in Israel. Australia, Canada, Europe and New Zealand have recognized sesame as priority food allergen which required food labeling, but it is not currently mandatory in USA. Oral ingestion of sesame seeds either whole or in food preparations can lead to symptoms ranging from oral food allergy presented by recurrent episodes of wheezing and dyspnea to asthma, atopic dermatitis to anaphylaxis. Sesame skin prick test was found to be more accurate predictor than sesame serum specific IgE levels. The World Health Organization(WHO)/International Union of Immunological Societies(IUIS) Allergen Nomenclature Subcommittee has registered seven sesame allergen components: four storage proteins including two 2S albumins (Ses i 1 and Ses i 2) and two 11S globulins (Ses i 6 and Ses i 7), sesame extract also contains two oleosins (Ses i 4 and Ses i 5) and one vicilin-like 7S globulin (Ses i 3). Sesame allergy was reported as commonly co-existent in patients with peanut and tree nut (pine nut, macadamia nut, brazil nut and hazelnut) allergies.

Worldwide distribution

The prevalence of sesame allergy in the USA, Mexico, Canada and Europe is reported 0.1% (6, 7) and 0.8% in Australia (8). Recently, it is considered as the ninth most common childhood food allergy in the US (5) with 0.23% prevalence in a population survey (8). Sesame was responsible for allergy in 9.8% of food allergic patients in the UK as per Pronuts study (9).

It is the third most common food allergen and the second most common food to cause anaphylaxis in children in Israel (10) with a prevalence of 0.93% (11).

Allergy to sesame occurs in individuals ranging from infants to adults including de novo sensitization in adults (12). The age-specific prevalence reported convincing sesame allergy in 0.21% children and 0.24% adults in the US while probable sesame allergy in Canada was found in 0.23% children and 0.05% adults (8).

Risk factors

Sesame allergy has been reported to co-exist in 50-54% of patients with both peanut and tree nut allergy (13). Thus, peanut and tree nut allergies could pose a risk for sesame allergy. 

Living environment

Sesame adapts well to environmental variations like water and light intensity and grows throughout the year (14). Tropical and temperate climate conditions with stored soil moisture and minimal irrigation or rainfall may produce high-quality yields for sesame seeds under high temperatures (15).

Worldwide distribution

The sesame plant has been found to have its origin in Africa and India (2, 15). Asia and Africa hold 96% of world sesame seed production where it is an important part of the human diet. The country with the highest sesame seed consumption is Tanzania followed by China, Sudan, Myanmar, India, Ethiopia, and Nigeria (16). The black and white sesame varieties are most consumed in Western countries (17). It is commonly used in Middle Eastern cuisine and included in the Mediterranean diet but now increased usage in the US in various foods like bread, sauces like tahini, or confectionaries like halva. Sesame oil is widely used in the pharmaceutical and cosmetic industry in addition to the food industry (12). 

Main

Oral ingestion of sesame seeds either whole or in food preparations can lead to symptoms ranging from oral food allergy to atopic dermatitis to anaphylaxis (12, 18, 19).

Secondary

Certain cases have reported allergic symptoms like contact dermatitis due to mucosal contact or severe respiratory symptoms due to inhalation (20).

Main methods

Koppelman, Söylemez (17) developed a sensitive ELISA for detection and quantification of sesame seed residue in food with a lower limit of 0.5 ppm and no cross-reactivity with 92 other food or food ingredients. This may be helpful for detection in highly allergic individuals.

Sesame allergy can manifest symptoms ranging from oral food allergy syndrome presented by recurrent episodes of wheezing and dyspnea to atopic dermatitis and anaphylaxis (12).

Anaphylaxis and food allergy

Allergic manifestations in patients with sesame allergy found skin symptoms to be most common followed by gastrointestinal, respiratory and cardiovascular symptoms along with anaphylaxis in few patients (18, 19). However, among several nuts evaluated, sesame was found to produce allergic symptoms with the highest severity and more involvement of the lower respiratory tract or cardiovascular/neurological system (9). 2.8% of cases in Canada and 43% in Israel reported sesame induced anaphylaxis among the total cases of food-induced anaphylaxis (21). Anaphylactic symptoms were prominent in sesame allergic patients as seen from studies reporting 41% in Japan (19) and 61.7% in North America and Canada (22). Further, 5 cases of food protein-induced enterocolitis syndrome (non-IgE mediated hypersensitivity) induced by sesame in children in Israel were reported, presented as acute repetitive vomiting, lethargy, and pallor (21).

Allergic rhinitis

A study conducted in the UK on 33 adult patients (16-81 years) who underwent sesame oral food challenge (OFC) reported allergic rhinitis in 48% of patients (23).

Asthma

Asthma was reported in 28.3% of sesame allergic children in Japan (19) while in 36% of UK adults who underwent OFC (23). It was also reported in 25.4% of patients with positive sesame OFC in Israel (18). Bronchospasm was reported in 2 cases of bakers and a young girl due to sesame seeds through inhalation route (20).

Atopic dermatitis

Li, Gunawardana (23) reported atopic dermatitis in 30% of patients in the UK study while Maruyama, Nakagawa (19) reported in 66.3% sesame allergic Japanese children. Atopic dermatitis was found to be positively associated with positive sesame OFC with 56.7% of patients affected having positive sesame OFC (18). Lignin like allergens, sesamol and sesamin in sesame oil has been identified to cause allergic contact dermatitis (20).

Other diseases

Contact urticaria was reported in one case to sesame by oral mucosal contact manifested as oral edema, erythema, and blood-tinged vesicles. Delayed hypersensitivity as contact dermatitis was also reported in a patient who received progesterone injection in sesame oil manifested as respiratory symptoms several days after receiving the injection (20).

Skin prick tests

 Sesame skin prick test (SPT) was found to be a more accurate predictor than sesame serum specific IgE (24) while Ses i 1 IgE levels were found better than SPT in another study (5, 25).

Other topics

Australia, Canada, Europe and New Zealand have recognized sesame as a priority food allergen that required food labeling, but it is not currently mandatory in the USA (8). Sesame food allergy has been shown to resolve in 20-30% of patients (5).

Author: Turacoz Healthcare Solutions

Reviewer: Dr. Magnus Borres

Last reviewed: November 2020