Substance Info: (and synonyms)
Sesame / Sesame seed

Background Info:

Species of sesame seed: S. indicum, S. radiatum, S. schum, S thoron

Sesame is a very old cultivated tropical crop thought to have originated in Africa or the Middle East up to 4,000 years ago. It may be the first seasoning ever used. The Chinese burned Sesame oil for light and to make soot for their ink blocks. African slaves brought Sesame seeds to America. Japan uses Sesame seed as a health food and leads the world in Sesame seed imports, followed by Europe and the US.

The fruit is in the form of a small capsule containing many seeds, which are black, white, yellow or red. Sesame seeds are used whole, crushed, for their oil, and as cakes (the solid residue left after processing of the oil). About 70% of the world’s Sesame seed is processed into oil and meal.

The seed is available packaged in supermarkets and can be found in bulk in Middle Eastern markets and health-food stores. Sesame seeds often feature in candies and baked goods, and are a common ingredient in savory dishes of ethnic cuisines. A special process produces a clear white seed that is common on hamburger buns.

The seed can also be ground into a powder and used as a flour, or as a butter or 'tahini'. It can also be fermented into 'tempeh', or ground into a powder and mixed with a sweetener to make 'halva'. The seeds can also be sprouted and used in salads. An edible oil is obtained from the seed. It is used for cooking or in margarines, etc.

Sesame has bactericidal activities, and it also acts as an antioxidant that can inhibit the production and absorption of cholesterol. It is believed to help prevent and/or combat cancer and heart disease and to have antidiabetic, anti-ulcer and laxative properties. The lecithin in Sesame is a treatment for dermatitis and dry skin. Other uses include the treatment of blurred vision, dizziness, headaches, and nasal mucosa dryness. In addition, Sesame features in a huge variety of folk remedies, with purposes ranging from burn treatment to increasing milk production in nursing mothers.

Sesame is used in the production of perfumes, cosmetics, toiletries (especially UV-barrier creams), drugs, lubricants, insecticides and fungicides. The oil is sometimes burned for lighting. Sesame oil is a solvent for intramuscular injections. Sesame meal is excellent feed for poultry and livestock.

Allergic reactions to seed or oil in approximately 1% of individuals, but this seems to be increasing. (Kanny 1996 ref.817 02) Probably because of increased use of vegetarian dishes.

Pastries containing sesame and not sold may be "recycled" and then become a hidden allergen. (Woltsche-Kahr 2001 ref.4020 7)

Emmental cheese, milk, sesame seeds, and spinach, are calcium-rich foodstuffs. (Karkkainen 1997 ref.7450 3) Sesame seed is rich in unsaturated fatty acids, calcium, protein, and vitamins A, B and E.


Adverse Reactions:


[ 1 / 42 ]

Case 1: 67-years-old woman with pollen allergy noticed oppressive feeling of chest and back, and heart burn after accidental ingestion of her dental filling and dental treatment. Peripheral blood eosinophils increased to 38.0%. Cedar and cypress specific IgE were positive. Case 2: a 42-years-old-woman with pollen allergy and asthma experienced repeated urticaria, heartburn, diarrhea and peripheral eosinophilia (25%). Specific IgE was positive only for cypress. High infiltrates of eosinophils in the mucosa of alimentary tract resulted in a diagnosis of eosinophilic gastroenteritis in both. In case 1, based on the history and patch-test-positive finding of formalin and 2-hydroxyethyl methacrylate, these were diagnosed as the causative allergens. In case 2, a patch-test-positive finding of garlic and sesame and improvement after removal of the two allergens, led to the conclusion that these two may be causative allergens. The authors conclude that in these two cases, patch test was useful to identify the allergens. (Adachi 2010 ref.24996 5)

Adachi A. Two cases of eosinophilic gastroenteritis whose causative allergens are usefully diagnosed by patch test. [Japanese] Arerugi 2010 May;59(5):545-551

[ 2 / 42 ]

This USA study examined the correlation of sesame ImmunoCAP and SPT results with oral challenge outcomes in children, aged 2-12 years, suspected of having a sesame food allergy. Thirty-three oral sesame challenges were conducted. Of the 33 challenges performed, 21% (n=7) failed and 79% (n=26) passed. A sesame-specific IgE level of > or = 7 kU(A)/L showed specificity of >90%. An SPT wheal size of > or = 6 mm showed specificity of >90%. This study represents the largest number of sesame challenges performed to evaluate the diagnostic value of both sesame-specific IgE and SPT. The authors suggest, that based on this sample, both tests are not good predictors of true sesame allergy as determined by an oral challenge. The study was unable to establish a threshold with a 95% positive predictive value for both sesame-specific IgE and SPT. (Permaul 2009 ref.24492 7)

Permaul P, Stutius LM, Sheehan WJ, Rangsithienchai P, Walter JE, Twarog FJ, Young MC, Scott JE, Schneider LC, Phipatanakul W. Sesame allergy: role of specific IgE and skin-prick testing in predicting food challenge results. Allergy Asthma Proc 2009 Nov;30(6):643-648

[ 3 / 42 ]

Anaphylaxis to sesame. A 70-year-old white man with 2 episodes of anaphylaxis within 6 months associated with sesame ingestion. Fifteen minutes after consumption of sesame-poppy-raisin sweets or sesame bread, the patient developed generalized urticaria with periorbital,
periocular, and laryngeal edema associated with severe hypotension and unconsciousness. Skin prick-to-prick tests, both with sesame seed and sesame oil, revealed a pronounced positive reaction. Sesame seed specific IgE was 6.37 kUA/L. A double-blind placebocontrolled food challenge starting with 25 mg of sesame seeds in bread porridge was conducted. Fifteen minutes after a dose of 100 mg of backed sesame seed, acute disseminated urticaria, pruritus, and periorbital and periocular edema occurred without reaction of the upper or lower airways. (Guenova 2008 ref.22193 7)

Guenova E, Genova S, Voykov B, Novakova S, Mitev V. Immunoglobulin E-Mediated anaphylaxis to sesame. WAO Journal 2008;1(8):134

[ 4 / 42 ]

A 22-year-old female athlete with food-dependent exercise-induced anaphylaxis associated with sesame seed ingestion. She started running 2 hours after she had eaten a bread roll containing sesame seed. Thirty minutes later, she suffered from cutaneous erythema with itching, urticaria, angio-oedema of the face and dyspnoea. She reported episodes of urticaria and angio-oedema with postprandial exercise previously - on both occasions after ingestion of a bread roll with sesame seeds. Of note was the fact that she had had a sesame seed roll once before without any adverse effects (had not exercised on this occasion). SPT was not performed for sesame (no commercial reagents available). Specific IgE to sesame seed was 0.69 kU/l but negative to wheat and milk. An open challenge test with wheat (plain bread roll) and 10 grams sesame seed in the resting state was negative. Treadmill ergometric stress in a fasting state and 60 minutes after ingestion of a plain bread roll (without sesame seed) gave negative results. Exercise challenge test 60 minutes after ingestion of a sesame seed was positive, showing mild diffuse erythema and small wheals on the face and trunk. (Gravett 2007 ref.20842 3)

Gravett CM, Motala C. Food-dependent exerciseinduced anaphylaxis associated with sesame seed ingestion – a case report. Current Allergy and Clinical Immunology 2007;20(4):216-219

[ 5 / 42 ]

Two sesame seed allergens (Ses i 6 and Ses i 7) were evaluated using sera from 24 patients with sesame seed allergy. Clinical reactions involved the skin in 19 patients mostly with urticaria or angioedema, the gastrointestinal tract in 11 patients, and the respiratory system in 6 patients. One patient had a decrease in blood pressure. Twelve patients had more than one organ system involved. Sesame seed-specific IgE levels ranged from 0.73 to greater than 100 kU/L. (Beyer 2007 ref.20166 7)

Beyer K, Grishina G, Bardina L, Sampson HA. Identification of 2 new sesame seed allergens: Ses i 6 and Ses i 7. J Allergy Clin Immunol 2007 Jun;119(6):1554-1556

[ 6 / 42 ]

Sesame food allergy (SFA) in children is an increasingly recognized one in many countries. Seventy-four patients sensitized to sesame were evaluated and categorized into three groups: group A: patients who experienced allergic reaction after ingestion of sesame-containing food (n = 45); group B: patients evaluated for atopic dermatitis and found to be sesame SPT-positive (n = 11); group C: patients with sensitization to sesame allergen (n = 18). Analysis revealed that 76% of patients in group A developed the allergy by the age of 2 - median age at onset of allergy was 1 yr. Immediate reaction to a minimal amount of sesame was characteristic. Skin was the most common site of involvement, followed by respiratory and gastrointestinal systems. Tolerance developed in only 20% of the patients. High sIgE (>0.15 IU) was demonstrated only in 75% of those in which it was examined. Oral sesame food challenge was performed in 16 and positive in 88%. In conclusion, SFA tends to appear early in life, but unlike cow's milk and egg allergy, persists in 80% of the cases. (Cohen 2007 ref.16525 7)

Cohen A, Goldberg M, Levy B, Leshno M, Katz Y. Sesame food allergy and sensitization in children: the natural history and long-term follow-up. Pediatr Allergy Immunol 2007 Mar 7;

[ 7 / 42 ]

A 21-year-old woman with asthma and confirmed food allergy to sesame who had 2 severe systemic reactions after the inadvertent ingestion of tahini, a paste made with ground sesame seeds. On the first occasion, the symptoms were generalized itching, facial erythema, breathlessness, cough, and sneezing. The systemic manifestations on the second occasion, 2 weeks later, were more severe: vomiting, cough, tightness in the chest, generalized itching, and laryngeal edema. SPT was positive to sesame. A double-blind placebo-controlled food challenge confirmed the allergy to tahini in our patient. (Caminiti 2006 ref.16681 3)

Caminiti L, Vita D, Passalacqua G, Arrigo T, Barberi S, Lombardo F, Pajno GB. Tahini, a little known sesame-containing food, as an unexpected cause of severe allergic reaction. J Investig Allergol Clin Immunol 2006;16(5):308-310

[ 8 / 42 ]

Recent studies have indicated that tolerance to peanut can occur in patients with a history of peanut allergy. Tree nut and sesame allergies have been reported to occur at increased incidence in patients with peanut allergy. Although the coexistence may be simply due to a predisposition to food allergy in these individuals, cross-reactivity has been demonstrated between peanut and tree nuts and between peanut and sesame seed. This study describes 3 patients previously sensitized but tolerant to peanut who were subsequently diagnosed as having either tree nut or sesame allergy. The study concludes that demonstration of tolerance to peanut may falsely reassure patients and physicians that patients no longer need to avoid tree nuts or sesame. Tree nut and sesame allergies can exist or develop in patients despite the development of tolerance to peanut. (Beausoleil 2006 ref.16007 3)

Beausoleil JL, Spergel JM. Late diagnosis of tree nut and sesame allergy in patients previously sensitized but tolerant to peanut. Ann Allergy Asthma Immunol 2006 Oct;97(4):443-445

[ 9 / 42 ]

Cases of severe allergy to sesame seed lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown. In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. Ten patients had negative prick tests and CapSystem-FEIA. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera. Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa). (Leduc 2006 ref.13643 3)

Leduc V, Moneret-Vautrin DA, Tzen JT, Morisset M, Guerin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006 Mar;61(3):349-356

[ 10 / 42 ]

This review is an up-to-date synopsis on the global prevalence, natural history, nature of allergens, and immune mechanisms of sesame allergy based on a literature search using the PubMed database. (Gangur 2005 ref.12327 5)

Gangur V, Kelly C, Navuluri L. Sesame allergy: a growing food allergy of global proportions? Ann Allergy Asthma Immunol 2005 Jul;95(1):1-11

[ 11 / 42 ]

In a British study of sesame allergy, 17% of respondents had suffered potentially life-threatening allergic reactions symptoms, with 65% of severe reactions happening on first known exposure. (Derby 2005 ref.11383 7)

Derby CJ, Gowland MH, Hourihane JO. Sesame allergy in Britain: A questionnaire survey of members of the Anaphylaxis Campaign. Pediatr Allergy Immunol 2005;16(2):171-5.

[ 12 / 42 ]

This paper presents a case of a 6-year-old child who developed anaphylactic reaction after eating bread and sesame paste. (Panizzolo 2005 ref.11398 0)

Panizzolo C, Tura M, Barbato A. Anaphylaxis to sesame paste. Allergie et immunologie 2005;37(1):34-5.

[ 13 / 42 ]

Allergenicity can vary considerably between different varieties of the same species. For example, differences in allergenicity have been confirmed between varieties of apple (Vieths 1994 ref.844 11), olive pollen (Carnes 2002 ref.5664 7), sesame seed (Fremont 2002 ref.6669 8) and dates (Kwaasi 2000 ref.4671 7).

Lucas JS, Lewis SA, Trewin JB, Grimshaw KE, Warner JO, Hourihane JO. Comparison of the allergenicity of Actinidia deliciosa (kiwi fruit) and Actinidia chinensis (gold kiwi). Pediatr Allergy Immunol 2005 Dec;16(8):647-54.

[ 14 / 42 ]

This article describes 14 children with a diagnosis of sesame allergy based on a convincing clinical history and positive skin prick tests and/or an elevated sesame specific IgE. The median age at the beginning of sesame seed allergy was 5 years (range from 5 months to 16 years old). All patients reacted immediately after sesame seed consumption and presented as a first manifestation: edema (9 cases, 48%), urticaria (5, 27%), and one of each of the following symptoms (vomiting, rhinitis, conjunctivitis, asthma and anaphylactic shock). One patient had recurrent anaphylactic shocks and another an anaphylactic shock after subsequent sesame seed exposure; these 2 patients were asthmatic. In SPTs, the commercial sesame seed extract was less sensitive than the native seed. Sesame seed IgE ranged from 0.35 to 100 kUA/L (median 5.58 kUA/L). Three patients outgrew their food allergy with a decrease in sesame seed IgE and skin prick-tests becoming negative. (Agne 2004 ref.11080 0)

Agne PS, Bidat E, Agne PS, Rance F, Paty E. Sesame seed allergy in children. Allergie et immunologie 2004;36(8):300-5.

[ 15 / 42 ]

In 2002, 107 cases were reported to the French Allergy Vigilance Network of which 59.8 % were cases of anaphylactic shock (one being fatal), 18.7% systemic reaction, 15.9% laryngeal angio-edema, 5.6% serious acute asthma (one fatal). Adults represented 69% of cases (74 cases). The most frequent causal allergens were peanut (14), nuts (16), shellfish (9) latex group fruit (9 patients), and most often in-patients allergic to latex: avocado (4), kiwi (2), fig (2), and banana (1). Next came lupine flour (7), wheat flour (7), celery (5) and snails (5), sesame (4), milk (3), buckwheat (3), fish (3), peach (2), chicken (2). Single observations included sulfites, quinine (an additive in a tonic drink), mustard, lentils, kidneys, pork, melon, grapes, pears, chicory, artichokes, oranges and Anisakis simplex. Four patients had an immediate post-prandial shock and were reported as idiopathic shock. The allergen was present in a masked form in 13% of cases: peanut (6 - with one fatal), lupine (4), sesame (3), and hazelnut (1).
In 4 cases of which one lethal a severe anaphylactic reaction occurred after consumption of macaroon in which the almonds have been replaced by peanuts paste without an adequate labeling. Two cases of anaphylactic shocks in hospitalized children were due to chocolate drink containing lupine flour. Both children were allergic to peanuts and AS occurred by cross allergy. A case of food allergy to hazelnuts is due to a mislabeling on chocolate packaging at Halloween. Two cases of severe anaphylaxis by proxy are reported: the incriminated allergenic peanuts. The patient presented the allergic reaction by contact with another person eating peanuts. (Moneret-Vautrin 2004 ref.10176 0)

Moneret-Vautrin DA, Kanny G, Morisset M, Rance F, Fardeau MF, Beaudouin E. Severe food anaphylaxis: 107 cases registered in 2002 by the Allergy Vigilance Network. Allerg Immunol (Paris) 2004;36(2):46-51

[ 16 / 42 ]

Three Sesame-allergic subgroups were identified (n = 32). Group I (n = 23, M/F; 14/9) consisted of cases with IgE-mediated sesame allergy. The mean age of the first allergic reaction was 11.7 months. Although the main clinical manifestation was urticaria/angiedema (n = 14, 60%), anaphylaxis was the presenting symptom in seven (30%) patients; all of them were younger than 1 year. Sixteen (70%) were found to be allergic to other foods, and other atopic diseases were identified in 18 (78%) patients. Three patients 'outgrew' their allergy within 1-2 years. Group II (n = 2) included cases in whom sesame allergy was ruled out based on a negative skin prick test (SPT) together with a negative open oral challenge. Group III (n = 7) consisted of patients that were found to be SPT positive for sesame as part of a screening for other food allergies. (Dalal 2003 ref.8322 1)

Dalal I, Binson I, Levine A, Somekh E, Ballin A, Reifen R. The pattern of sesame sensitivity among infants and children. Pediatr Allergy Immunol 2003;14(4):312-6

[ 17 / 42 ]

The goal of this study was to identify and characterise the major allergen(s) of sesame seed. Sera from 28 subjects diagnosed as allergic to sesame was used. Twenty-four of the 28 subjects had sesame-specific IgE. (Wolff 2003 ref.20234 0)

Wolff N, Cogan U, Admon A, Dalal I, Katz Y, Hodos N, Karin N, Yannai S. Allergy to sesame in humans is associated primarily with IgE antibody to a 14 kDa 2S albumin precursor. Food Chem Toxicol 2003 Aug;41(8):1165-74.

[ 18 / 42 ]

An anaphylactic reaction to cashew nut developed in a nonatopic 60-year-old man 25 days after receiving a liver allograft from a 15-year-old atopic boy who died of anaphylaxis after peanut ingestion. The liver recipient had no history of nut allergy. Posttransplantation skin prick test results were positive for peanut, cashew nut, and sesame seed, and the donor had allergen-specific IgE antibodies to the same 3 allergens. This illustrates that transfer of IgE-mediated hypersensitivity can occur after liver transplantation and have potentially serious consequences. (Phan 2003 ref.7439 1)

Phan TG, Strasser SI, Koorey D, McCaughan GW, Rimmer J, Dunckley H, Goddard L, Adelstein S. Passive transfer of nut allergy after liver transplantation. Arch Intern Med 2003;163(2):237-9

[ 19 / 42 ]

Sesame seeds were responsible for 3% of life-threatening allergic reactions to foods in France in 2002. (Moneret-Vautrin 2003 ref.11782 5) A prevalence of sesame seed allergy was 2.14% in children and 5.81% in adults. (Lemerdy 2003 ref.11783 5)

Lemerdy P, Moneret-Vautrin DA, Rance F, Kanny G, Parisot L. Prevalence of food allergies in pediatric and adult populations. CICBAA Databank Alim'Inter 2003;8:5-7

[ 20 / 42 ]

Sesame to be a major cause of IgE-mediated food allergy in Israel. In fact, it is second only to cow’s milk as a cause of anaphylaxis. (Dalal 2002 ref.11238 7)

Dalal I, Binson I, Reifen R, Ballin A, Somekh E. Sesame is a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. [Poster: XXI Congress of EAACI] Allergy 2002;57 Suppl 73:79-84.

[ 21 / 42 ]

Systemic urticaria, facial erythema, dizziness and loss of consciousness in a 36 year old baker. Commercial skin prick tests and CAP RAST tests were negative but a skin prick test done with crushed sesame seeds in sodium chloride solution was positive. (Woltsche-Kahr 2001 ref.4020 4)

Woltsche-Kahr I, Aberer W. Recurrent anaphylactic reactions following hidden ingestion of sesame seed. [Abstract] 8th International Symposium on Problems of Food Allergy, Venice. 2001, March 11-13.

[ 22 / 42 ]

The number of reported cases of immediate hypersensitivity to sesame seed has risen I recent years, probably because of the increasing consumption of sesame-seed-containing foods. This study reports on 10 patients with allergy to sesame seed seen at an Israeli clinic. Seven were less than 2 years of age. The food most implicated appeared to be tehina, made from sesame seed. Symptoms included urticaria, angiodema, wheezing, and in particular, atopic dermatitis. (Levy 2001 ref.7442 1)

Levy Y, Danon YL. Allergy to sesame seed in infants. Allergy 2001;56(2):193-4

[ 23 / 42 ]

The seed storage 2S albumin, has been identified in the most diffused edible seeds and nuts, such as mustard, sesame, Brazil nut, walnut and peanut. In particular, a strong correlation between IgE-binding to these proteins and food-induced anaphylaxis has been demonstrated for Brazil nut and sesame seeds. (Pastorello 2001 ref.4135 7)

Pastorello EA, Pompei C, Pravettoni V, Brenna O, Farioli L, Trambaioli C, Conti A. Lipid transfer proteins and 2S albumins as allergens. Allergy 2001;56(S67):45-47

[ 24 / 42 ]

Sesame seeds are often present in gluten-free foods used to treat celiac patients. This report documents the case of a celiac patient with anaphylaxis due to sesame ingestion. (Pajno 2000 ref.3534 5) (Pajno 2000 ref.7444 6)

Pajno GB, Passalacqua G, Magazzu G, Barberio G, Vita D, Canonica GW. Anaphylaxis to sesame. Allergy 2000;55(2):199-201

[ 25 / 42 ]

With the increasing use and consumption of eastern and Asian cuisine, with foodstuffs such as sesame, paranuts or cashew nuts, these allergies are more frequent than they were formerly. Peanut allergy has become an epidemic problem in the United States. In this article allergic reactions to nuts, seeds and grains are discussed. Illustrative cases are presented. and a 1-year-old boy, who had suffered from erythema and periorbital angioedema after inadvertently putting a macadamia nut into his mouth, is described. SPT with fresh macadamia nut was positive. (Senti 2000 ref.7443 5)

Senti G, Ballmer-Weber BK, Wuthrich B. Nuts, seeds and grains from an allergist's point of view. [German] / Nusse, Samen und Kerne aus allergologischer Sicht. Schweiz Med Wochenschr 2000;130(47):1795-804

[ 26 / 42 ]

Anaphylaxis. Cross-reactive IgE binding to proteins with molecular mass of 10-12 kD between sesame and poppy protein extracts was demonstrated, suggesting that either Ses i 1 or Ses i 2 cross-reacts with a 2S albumin from poppy seed. (Asero 1999 ref.7446 1)

Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of sesame seed-induced anaphylaxis. Allergy 1999;54(5):526-7

[ 27 / 42 ]

Immediate hypersensitivity to sesame in foods and cosmetics has been reported. (Pecquet 1998 ref.7448 4)

Pecquet C, Leynadier F, Saiag P. Immediate hypersensitivity to sesame in foods and cosmetics. Contact Dermatitis 1998;39(6):313

[ 28 / 42 ]

This study investigated serum responses of 12 sesame sensitized patients (seven with food allergy, five with food sensitization), to a sesame protein extract.

Patient 1: Baker's asthma; frequent handling of sesame 13.2 kU/L. SPT +
DBPCFC with 10g: urticaria, asthma

Patient 2: Atopic dermatitis, Asthma >100kU/L. SPT +
DBPCFC 7g: vomiting, abdominal pain, conjunctivitis, eczematous rash.

Patient 3: Angioedema 6.7 kU/L. SPT +-
Oral challenge not done. Positive labial challenge

Patient 4: Angioedema RAST ND. SPT + Commercial extract -ve
DBPCFC 7.11 g: urticaria - 2+

Patient 5: Anaphylactic shock RAST: negative LHRT: positive. SPT +. Commercial extract -ve
DBPCFC 100 mg: urticaria

Patient 6: Anaphylactic shock RAST: negative LHRT: positive. SPT +
Oral c-hatlenge not done. Positive labial challenge

Patient 7: Laryngea! Angioedema induced by cookies. RAST: negative. SPT +
Challenge ND.
(Kolopp 1997 ref.1248 7)

Kolopp Sarda MN, Moneret Vautrin DA, Gobert B, Kanny G, et al. Specific humoral immune responses in 12 cases of food sensitization to sesame seed. Clin Exp Allergy 1997;27(11):1285-91

[ 29 / 42 ]

This study investigated serum responses of 12 sesame sensitized patients (seven with food allergy, five with food sensitization), to a sesame protein extract. Sesame protein extracts were prepared from black, white and brown sesame seeds. Electrophoretic analysis showed similar protein patterns in the three extracts. Nineteen protein bands were observed. Using the whole extract, significant antisesame IgG, IgA and IgE-responses were observed in the serum of sensitized individuals. Two proteins, respectively, 14 kDa and 25 kDa were mostly involved in sesame IgE-dependent hypersensitivity, the 25 kDa band presenting several characteristics of a major allergen. (Kolopp 1997 ref.1248 9)

Kolopp Sarda MN, Moneret Vautrin DA, Gobert B, Kanny G, et al. Specific humoral immune responses in 12 cases of food sensitization to sesame seed. Clin Exp Allergy 1997;27(11):1285-91

[ 30 / 42 ]

Anaphylaxis. This study reports on 9 cases of IgE-dependent allergy to sesame seed and/or sesame seed oil. Skin test results draw attention to the poor quality of a commercial sesame seed extract and the good sensitivity of skin prick tests made with a freshly prepared sesame seed flour extract. The diagnosis of this food allergy was established by double-blind oral provocation tests, with doses of sesame seed flour ranging from 100 mg to 10 g. Allergy to sesame seed oil was also demonstrated in some cases. Growing problem, and a possible hidden allergen. (Kanny 1996 ref.817 02)

This may explain why generalised urticaria as a result of sesame seed could not be confirmed using skin prick tests or serum specific IgE. (Eberlein-Konig 1995 ref.7453 3)

Kanny G, De Hauteclocque C, Moneret Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. [Review] Allergy 1996;51(12):952-7

[ 31 / 42 ]

Allergic reactions to seed or oil in approximately 1% of individuals, but this seems to be increasing. (Kanny 1996 ref.817 02) Probably because of increased use of vegetarian dishes.

Kanny G, De Hauteclocque C, Moneret Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. [Review] Allergy 1996;51(12):952-7

[ 32 / 42 ]

In a review of previous reports on sesame seed allergy prior to this study, in 19 of 26 cases reported in the literature a skin test was done. 17 of 19 patients showed a scratch, prick, or intracutaneous test reaction to sesame. The skin tests were usually done with self-made sesame seed extracts. In the two patients with negative skin test responses, specific IgE antibodies could be demonstrated in the serum. Altogether, sesame-specific serum IgE was demonstrable in 15 of 18 patients evaluated in this manner. (James 1991 ref.487 62) (Vocks 1993 ref.123 36) (Kagi 1991 ref.297 37) (In: Eberlein-Konig 1995 ref.2442 5)

Eberlein-Konig B, Rueff F, Przybilla B. Generalized urticaria caused by sesame seeds with negative prick test results
and without demonstrable specific IgE antibodies. J Allergy Clin Immunol 1995;96(4):560-1

[ 33 / 42 ]

A 58-year-old man reported facial erythema and swelling, generalized wheals, and itching all over the body about 30 min after he had eaten a slice of crisp bread with sesame seeds and one small salami sausage. About 2 months later, a similar reaction occurred after ingestion of a buttered slice of bread containing sesame seeds. Sesame SPT serum specific IgE were negative. Challenges were performed with 200 mg, 1 g, and 2 gm of sesame seeds (each 30 minutes apart). Twenty-five minutes after ingestion of 2 gm of sesame seeds, the patient experienced flushing of the head, generalized itching, and whealing. Six days after the oral challenge with sesame seeds, the test was repeated after the patient had taken 200 mg of sodium cromoglycate 90 and 180 minutes before he ingested 1 and 2 gm of sesame seeds, respectively. No clinically apparent symptoms occurred, and he only felt "shivering" 2 hours after the last ingestion of sesame seeds. (Eberlein-Konig 1995 ref.2442 7)

Eberlein-Konig B, Rueff F, Przybilla B. Generalized urticaria caused by sesame seeds with negative prick test results
and without demonstrable specific IgE antibodies. J Allergy Clin Immunol 1995;96(4):560-1

[ 34 / 42 ]

Generalised urticaria as a result of sesame seed could not be confirmed using skin prick tests or serum specific IgE. (Eberlein-Konig 1995 ref.7453 3)

Eberlein-Konig B, Rueff F, Przybilla B. Generalized urticaria caused by sesame seeds with negative prick test results and without demonstrable specific IgE antibodies. J Allergy Clin Immunol 1995;96(4):560-1

[ 35 / 42 ]

Anaphylaxis in a 30-year-old woman who had ingested a minute amount of sesame seed paste in a salad dressing. She immediately developed a burning sensation in her mouth and flushing. Within minutes she developed generalized itching, urticaria, swelling of her lips and face, protruding tongue, wheezing and severe respiratory distress, requiring urgent treatment and crico-thyroidectomy. She had previously only experienced a burning sensation with swelling of her lips following contact with sesame seed on bread but had never had an anaphylactic reaction. A RAST for sesame was >17.5 PRU. (James 1991 ref.487 92)

James C, Williams Akita A, Rao YAK, Chiarmonte LT, Scheider AT. Sesame seed anaphylaxis. New York State J Med 1991;91:457-458

[ 36 / 42 ]

Anaphylaxis to sesame seed and oil. (Chiu 1991 ref.298 87)

Chiu JT, Haydik IB. Sesame seed oil anaphylaxis. J Allergy Clin Immunol 1991;88:414-415

[ 37 / 42 ]

A 23-year-old woman felt an immediate burning sensation in her mouth after taking the first bite of a chickpea falafel burger. Pharyngeal oedema soon developed, followed by dyspnoea, Quincke's oedema, widespread urticaria, nausea, diarrhoea, and chill. Skin prick tests was strongly positive with the white sauce, containing sesame seed paste. Scratch tests with sesame seeds elicited a severe local wheat reaction with flare, pruritus, and pseudopods. Specific IgE to sesame seeds was class 3 (8.5 units/ml). The use of a commercial spice mixture containing sesame seeds; rhinitis, itching eyes, and burning skin developed every time she added the spice during cooking. In a large retrospective study of 173 consecutive cases of food allergy at this Swiss allergy unit from 1978 to 1982 there were 4 cases (2-3%) of sesame seed anaphylaxis. In 1991 alone, three cases of anaphylactic reaction to falafel vegetable burgers in patients allergic to sesame seeds was recorded. (Kagi 1991 ref.297 12)

Kagi MK, Wüthrich B. Falafel burger anaphylaxis due to sesame seed allergy. Lancet 1991;338:582

[ 38 / 42 ]

Two cases of allergy due to the ingestion of sesame seeds are described. Sesame seeds cause severe allergic reactions with pruritus, generalized erythema, angio-oedema of the uvula, clinical shock and wheezing. Such reactions are usually preceded by milder ones, which, if promptly and correctly diagnosed and treated, may prevent clinical progression of symptoms. The author suggested that Sesame seed must be considered to be an extremely potent allergen. (Steurich 1989 ref.1252 8)

Steurich F. Allergy to sesame seeds. [German] Pneumologie 1989;43(12):710-4

[ 39 / 42 ]

In this study, 102 patients with the initial diagnosis of idiopathic anaphylaxis were evaluated with a battery of 79 food-antigen skin prick tests selected to include foods reported or suspected of provoking anaphylaxis. Thirty-two patients (31%) had positive tests to one or more food antigens. In five of these patients, subsequently eating a food that elicited a positive test provoked an anaphylactic reaction. Two patients eliminated the foods completely, stopped having reactions, and refused challenge. In these seven patients, 10 different antigens provoked anaphylaxis: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom, shrimp, sunflower, and walnut. We conclude that a battery of selected food-antigen skin prick tests provided a useful method for identifying an offending antigen in these patients and that some (7% in our series) cases of "idiopathic" anaphylaxis by history are not truly idiopathic.
The 10 antigens with positive clinical correlation
Antigens A B C
Aniseed 1 5 20
Cashew nut 1 2 50
Celery 2 4 50
Flaxseed 1 1 100
Hops 1 2 50
Mushroom 1 3 33
Mustard 2 3 66
Shrimp 1 3 33
Sunflower seed 1 3 33
Walnut 1 1 100
A = Total No. of positive skin tests with positive correlation
B = Total No. of positive skin tests
C = Percent of positive skin tests with positive correlation

Total number of positive skin prick tests.
2 - Almond
5 - Aniseed
1 - Artichoke
1 - Baker's yeast
1 - Beet
1 - Brazil nut
2 - Brewer's yeast
1 - Caraway seed
2 - Cashew nut
5 - Castor bean
4 - Celery
8 - Chamomile
2 - Chestnut
1 - Chicory
1 - Clam
2 - Coconut
1 - Cottonseed
2 - Crab
1 - Fennel
4 - Filbert (hazelnut)
I - Flaxseed
1 - Garbanzo bean
2 - Ginger
1 - Halibut
1 - Honey
2 - Hops
3 - Horseradish
1 - Lentil
1 - Lima beans
2 - Lobster
2 - Mango
1 - Milk
5 - Millet
3 - Mushroom
3 - Mustard
1 - Nutmeg
2 - Pea
1 - Pistachio
3 - Poppy seed
2 - Sesame seed
3 - Shrimp
3 - Sunflower
1 - Thyme
1 - Tumeric
1 - Walnut
None for Allspice, Apple, Banana, Bay leaf, Black pepper, Buckwheat, Cantaloupe, Chicken, Chili pepper, Chocolate, Cinnamon, Clove, Cod, Corn, Cumin seed, Dill seed, Egg, Garlic, Juniper berry, Orange, Oyster, Peach, Peanut, Potato, Psyllium seed, Raspberry, Sage, Salmon, Soybean, Strawberry, Sweet potato, Tangerine, Tapioca, Vanilla.
7 patients with positive clinical correlation to a SPT
1 : Aniseed
2 : Shrimp
3 : Mustard, flaxseed
4 : Celery, hops
5 : Celery, mustard, sunflower
6 : Walnut, cashew nut
7 : Mushroom
(Stricker 1986 ref.9 3606)

Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with "idiopathic anaphylaxis". J Allergy Clin Immunol 1986;77:516-519

[ 40 / 42 ]

Four patients with history of systemic anaphylaxis or angiodema and urticaria after ingestion of sesame seed or sesame oil-containing products were studied. Three were found to be positive by RAST. The most active allergens appeared to be 8 - 62 kDa in size.

Patient 1. 72-yr-old woman developed hypotension, urticaria, and angioedema minutes after eating halvah candy; another episode of systemic anaphylaxis occurred after eating hamburger on sesame seed bun. RAST 1+

Patient 2. 31-yr-old man with history of asthma and hay fever noted urticaria, throat fullness, and bronchial asthma shortly after eating salad containing sesame seed oil; he had also had 6 or 7 episodes of systemic anaphylaxis requiring emergency-room treatment, usually attributable to sesame seed products, peanuts, or almonds. RAST 2+

Patient 3. 33-yr-old woman developed angioedema of lips and mouth with pharyngeal pruritus after ingestion of sesame seeds, sesame flour, or halvah candy. RAST 4+

Patient 4. 45-yr-old man claimed he had angioedema of lips and tongue if he placed one sesame seed on his tongue; he has conspicuously avoided sesame seed products for many years. RAST -
(Malish 1981 ref.296 91)

Malish D, Glovsky MM, Hoffman DR, Ghekiere L, Hawkins JM. Anaphylaxis after sesame seed ingestion. J Allergy Clin Immunol 1981;67:35-38

[ 41 / 42 ]

Contact dermatitis due to varicose ulcer medication. (Malten 1974 ref.1251 7)

Malten KE, Kuiper JP. Contact cutaneous allergy in 100 cases of varicose ulcers [French] Phlebologie 1974;27(4):417-20

[ 42 / 42 ]

Three cases of hypersensitivity to sesame seed is described. The clinical picture and progression of symptoms are consistent: oral and palatal pruritus, angioedema, urticaria or wheezing, and in some cases hypotension and shock. (Torsney 1964 ref.12421 7)

Torsney PJ. Hypersensitivity to sesame seed. J Allergy Clin Immunol 1964;35:514 –519.

Non-Immune reactions

[ 1 ]

The aim of this study was to identify clinical correlations between sesame seed allergic (SSA) and other food allergies and predictive factors associated with SSA with regard to skinprick testing (SPT) and specific IgE (Sp-IgE) testing in children. Of 79 patients, 42 (53.2%) met the study definition for SSA. As compared with children without SSA, those with SSA had a significant association with allergy to other seeds, especially poppy seed. SSA was also significantly associated with tree-nut allergies but not peanut allergy. A high sensitivity and specificity for determining SSA could be obtained using a SPT cut-off of 2 mm (sensitivity 70.1% and specificity 73.1%) and a Sp-IgE level cutoff of 1.7 IU/ml (sensitivity 76.5% and specificity 84.6%). SSA had been outgrown in 8/79 (10.1%) of the children who at the time of the questionnaire did not have SSA. Low amounts of sesame ingestion (median 0.43 g (range 0-19.71 g)) were tolerated by 7/42 (16.7%) SSA children; the majority of allergic reactions occurred to foods containing high amounts of sesame protein. (Foong 2013 ref.29033 7)

Foong RM , Logan K, Fox AT, du Toit G. Clinical characteristics of and predictive diagnostic factors for sesame seed allergy in foodallergic children Current Allergy and Clinical Immunology 2013;26(2):78-81

[ 2 ]

A 79 year old man with a known benign anastomotic stricture presenting with large bowel obstruction. At laparotomy the obstruction was found to be caused by a large sesame seed bezoar. (Shaw 2007 ref.21103 5)

Shaw AG, Peacock O, Lund JN, Tierney GM, Larvin M, Speake W. Large bowel obstruction due to sesame seed bezoar: a case report. J Med Case Reports 2007 Nov 29;1:159.

[ 3 ]

In November 2002, the first of three outbreaks of Salmonella Montevideo infection in Australia and New Zealand was identified in New South Wales, Australia. Imported tahini was rapidly identified as the source of infection. A second outbreak was identified in Australia in June-July 2003 and another in New Zealand in August 2003. In a total of 68 S. Montevideo infections, 66 cases were contacted. Fifty-four (82%) reported consumption of sesame seed-based foods. Three products in Canada and one in the United Kingdom were positive for Salmonella spp., demonstrating the value of international alerts when food products have a wide distribution and a long shelf life. (Unicomb 2005 ref.20224 3)

Unicomb LE, Simmons G, Merritt T, Gregory J, Nicol C, Jelfs P, Kirk M, Tan A, Thomson R, Adamopoulos J, Little CL, Currie A, Dalton CB. Sesame seed products contaminated with Salmonella: three outbreaks associated with tahini. Epidemiol Infect 2005 Dec;133(6):1065-72.

[ 4 ]

An international outbreak of multiresistant Salmonella Typhimurium DT 104 that was correlated to the consumption of halvah (made from sesame seed). Several sesame seed products were evaluated for the occurrence of Salmonella. Of 117 ready-to-eat food items containing sesame, salmonellae was isolated from 11 (9.4%) samples. Different Salmonella Typhimurium strains were also isolated out of halvah from other manufacturers and countries of origin, as well as Salmonella Offa, Salmonella Tennessee, and Salmonella Poona from sesame paste (tahini) and sesame seed, which is sold for raw consumption in cereals. (Brockmann 2004 ref.20226 7)

Brockmann SO, Piechotowski I, Kimmig P. Salmonella in sesame seed products. J Food Prot 2004 Jan;67(1):178-80.

[ 5 ]

Non-IgE mediated anaphylactic reactions. A 45-year-old woman experienced facial erythema, flushing, generalized pruritus, and conjunctivitis after she had eaten crackers. Similar symptoms occurred several times after ingestion of sesame oil in different preparations. Within minutes after ingestion of sesame-dressed chicken, she had flushing, generalized itching, nausea, vomiting, and dizziness. Skin prick and intra-cutaneous tests were all negative for common allergens. Prick and scratch tests with native sesame oil (cold-pressed and heat-extracted) and raw, peeled, crushed, and unpeeled sesame seeds did not show any skin reaction. Serum specific IgE for sesame seeds were negative, as well as for common allergens. In an oral challenge, ten minutes after two bites of bread masking 10 g crushed sesame seeds and 10 g sesame oil, the patient developed generalized flushing, itching, and conjunctival symptoms. Serum tryptase remained normal but urinary histamine increased. (Stern 1998 ref.1249 1)

Stern A, Wüthrich B Non-IgE-mediated anaphylaxis to sesame. Allergy 1998;53(3):325-6

Occupational reactions

[ 1 ]

Occupational asthma caused by sesame seed exposure in a baker previously allergic to wheat flour. Symptoms of rhinitis and urticaria started 10 mins after handling sesame seed. Skin prick test was very positive. Bronchospasm occurred soon after, resolved, and a secondary response at 5 hrs. The allergen was a probable 2S albumin on the basis of its SDS-PAGE appearance of an intact protein at approximately 14 kd and a large and small subunit. (Alday 1996 ref.1253 8)

Alday E, Curiel G, Lopez Gil MJ, et al. Occupational hypersensitivity to sesame seeds. Allergy 1996;51(1):69-70

[ 2 ]

Occupational asthma, rhinitis and urticaria due to sesame seed. (Moneret-Vautrin 1994 ref.2564 8)

Moneret-Vautrin DA, Kanny G, Lagrange A Occupational asthma caused by organic substances (French) Rev Med Interne 1994;15 Suppl 2:216s-225s

[ 3 ]

Occupational asthma, rhinitis and urticaria due to sesame seed. (Keskinen 1991 ref.2443 1)

Keskinen H, Ostman P, Vaheri E, Tarvainen K, Grenquist-Norden B, Karppinen O, Nordman H. A case of occupational asthma, rhinitis and urticaria due to sesame seed. [Letter] Clin Exp Allergy 1991;21(5):623-4

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