Sesame Named New 9th Major Allergen

Sesame just became the 9th major food allergen. What do dietitians and nutrition companies need to know about their clients/consumers?

Since it seems everyone is going gluten or dairy free these days, it can be difficult to keep track of news on allergies and sensitivities. Sesame was recently named the ninth major food allergen. Many dietitians and nutrition companies are wondering, what do I need to know about sesame being added to the major allergen list?

The food allergy community has been advocating for sesame allergens to be listed for a long time. Dietitians can help clients by remaining aware, participating in advocacy, and providing individualized and applicable counseling methods. Nutrition companies can cater to customer needs by complying with the new regulations and participating in awareness and advocacy as well.

Read on for everything you need to know about the ninth major allergen, sesame.

Sesame Allergies vs. Sesame Sensitivities

While not as widely publicized as peanut allergies, sesame can cause just as serious a reaction. Sesame, which comes commonly in seed or oil form, can cause a medical emergency in those who experience an allergic reaction.

The main difference between an allergy and a sensitivity is:

• Allergy - creates an immune response (proteins in sesame bind to IgE antibodies) and chemical cascade as a result of ingesting the allergen (anaphylaxis or anaphylactic shock can be induced)

• Sensitivity- creates discomfort during digestion

Signs of allergy can set in suddenly and immediately. Shock brought on by the allergen can cause sharp drops in blood pressure and constricted airways that make breathing difficult.

Severe food allergies, when caught and treated promptly, can generally be managed without lasting or permanent consequences. Mild allergies may be treated with an antihistamine

Sensitivities, on the other hand, are typically less serious but can cause significant discomfort. Symptoms usually set in after ingesting an allergen, but most symptoms are limited to the gut (intestine) since that is where the allergen food is being primarily digested.

How Common Is a Sesame Allergy?

Sesame seeds are edible and a common ingredient in many cuisines of the world. They are used in multiple dishes, from breakfast baked goods to dinner sushi dishes. Recent research shows that sesame is not only a common ingredient, but also a relatively common allergy that affects patients of all ages.

The number of people receiving a sesame allergy diagnosis is rising, especially in recent years. One possible reason for the rise is that sesame is incorporated in many health and food products, such as the following:

• Vegetarian dishes - tempeh, burgers, soups

• Sauces, spreads & dressings - Salad dressings, dipping sauces, hummus, margarine, gravies, marinades

• International cuisine- Middle Eastern dishes, Asian dishes, sushi, Pasteli (Greek dessert), Falafel, Turkish cake, Japanese snack mix and rice cakes, Goma-dofu (Japanese dessert)

• Bread products - bread crumbs, bagels, breadsticks, hamburger buns, rolls

• Processed or snack foods- chips, crackers, protein/energy bars, meats and sausages

• Flavored foods - rice, noodles, risotto, shish kebab, stew, stir-fry

• Cereals- granola, muesli

• Other - pharmaceutical items and medications, cosmetic soaps and creams, skin lotion, pet food, nutritional supplements, spice and seasoning blends

A recent study reports that 17% of children with IgE-mediated food allergy are affected by sesame allergy. Studies also show that most children don’t outgrow a sesame allergy.

Does a Sesame Allergy Co-Occur with Other Allergies?

Often, sesame allergy can co-occur with peanut/tree nut sensitivity or allergy.

Those with the following allergies or sensitivities may have an accompanying sesame allergy:

• Seeds

• Nuts- hazelnuts, Brazil nuts, almonds, pistachios

• Grain- rye

What are the Symptoms of an Allergic Reaction to Sesame?

It’s important to be aware of sesame allergy symptoms. Even the most careful consumer can come into contact with an allergen, so it is helpful to be aware of what unpredictable side effects can look like.

Symptoms of Sesame Allergy

• Difficulty breathing

• Anaphylaxis

• Coughing

• Flushing or hives

• Low pulse rate (drop in blood pressure)

• Nausea or vomiting

• Itching sensation inside of mouth

• Abdominal pain

Symptoms can be mild to very severe, making it crucial to recognize and treat a known allergy with quick care.

Do Dietitians Diagnose & Treat Sesame Allergies?

Dietitians are generally a key part of the healthcare team that treats sesame allergies. Since allergic reactions can be life-threatening, emergency healthcare providers are often the first line of defense during diagnosis. Usually, epinephrine (adrenalin) or auto-injectors like an Epi-Pen are used to quickly calm the reaction and reverse the course of the body’s allergy response.

If the reactions are serious but not life-threatening, dietitians can diagnose the allergy and prescribe treatment. A food challenge (also known as an oral food challenge or OFC) is considered the gold standard of diagnosis -- the suspect food is eaten in small to increasingly larger amounts while symptoms are documented and recorded to establish a clear evaluation.

Dietitians can help clients with allergies to successfully manage their diet and avoid allergens by consulting responsible allergy references, resources, and referrals. They can also help the public and those with sensitivities understand the difference between allergies and sensitivities, as well as why it is important to not limit allergen foods unless necessary.

Are there tests that can help me find out if I have a sesame allergy?

A dietitian can order sesame-specific IgE-levels to help with the diagnosis and disease management process. However, food challenges or OFCs are the gold standard. Even with the unpredictable severity and risk of reaction, OFCs help to establish IgE sensitization.

In other words, establishing a diagnosis usually requires a combination of symptom history and immune response testing. For infants, research supports the use of skin prick testing.

What Products Should Have a Sesame Allergen Clearly Labeled?

In parts of the world where labeling laws require identification of sesame as an allergen ingredient, sesame must be included on labels. The following countries, now including the United States, are regions where sesame is considered a major allergen and is listed as such on food labels:

• United States

• European Union (EU)

• Australia

• Canada

• Israel

Sometimes sesame can be a sneaky ingredient. Consumers and companies alike should be aware of the different names and forms sesame takes:

Pictured above is Tahini Sauce, which is another name for sesame paste.

Common & Uncommon Names of Sesame

• Sesame

• Sesame seed

• Sesame oil

• Sesame salt (gomasio)

• Tahini (sesame paste), tahina, tehina

• Benne, benne seed, or benniseed

• Gingelly or gingelly oil

• Halvah

• Sesame flour

• Sesamol

• Sesamum indicum

• Sesemolina

• Sim sim

• Til

• Proprietary spice blends

The Food Allergy Research and Education (FARE) organization advocates that major food allergens list named ingredients in plain language on their ingredient labels. They have a helpful guide for reading a label for sesame-free diets. Access it by scanning the QR code here:

Rules & Regulations for Manufacturers

Manufacturers have 20 months to make the necessary changes reflected on their products and packages. Starting January 1, 2023, sesame should be listed on the label as a major allergen.

Some companies, such as General Mills and Hershey’s, are already including sesame allergen alerts on ingredient labels. In the meantime, families or individuals with a sesame allergy can use the following tips.

Eight Easy Tips for Managing Sesame Allergies

1. Have a perspective of plenty - It can be tempting to focus on the foods you have to avoid. However, there are so many healthy oils, products, and foods that don’t contain sesame allergens. Set your sights on the vast variety of foods that nourish you without exposing you to your allergens.

2. Play detective - Especially when ordering at restaurants, ask questions when you have doubts about certain ingredients.

3. Look at labels - Identifying allergens on the label is a simple yet effective way to find potential allergens and avoid allergic reactions before they happen.

4. Reduce the risk- You can greatly reduce the odds of a reaction by completely avoiding products that contain sesame seeds, oil, or any of its other variants.

5. Make a call to the manufacturer- If you are iffy about ingredients, such as undeclared or proprietary blends or spice mixes, reach out to the manufacturer. Be sure to ask not only about ingredients, but whether or not the manufacturing process includes contact with surfaces shared with sesame products.

6. Stick with your support system- Don’t do it alone! Managing an allergy can make life feel complicated. Remember that it’s okay to reach out to support groups, friends and family to make managing your allergy easier and more efficient.

7. Wear a Medical ID - Medical ID badges, bracelets, and other identifiers can help guardians or healthcare professionals quickly and carefully diagnose the situation at hand.

8. Prep a plan for when allergies attack - During the allergic reaction is not the best time to come up with a plan. Be sure to have at least two types of emergency medication on hand. Instruct a specific individual to call for help as soon as possible after the reaction begins.

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References

Athas E. 5 Takeaways From the New Food Allergy Law. Nytimes.com. Published April 26, 2021.

Food Allergy Research & Education (FARE). Sesame Allergy. Foodallergy.org. Accessed April 2021.

Foong RX, Dantzer JA, Wood RA, Santos AF. Improving Diagnostic Accuracy in Food Allergy. J Allergy Clin Immunol Pract. 2021;9(1):71-80. doi:10.1016/j.jaip.2020.09.037

Roland J. Understanding Sesame Allergies. Healthline.com. Published September 17, 2018.

Sokol K, Rasooly M, Dempsey C, et al. Prevalence and diagnosis of sesame allergy in children with IgE-mediated food allergy. Pediatr Allergy Immunol. 2020;31(2):214-218. doi:10.1111/pai.13143