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Sesame allergy is fairly common in some countries, including Australia and Israel, and it would appear to be on the increase in the UK. Occasionally symptoms are severe, including breathing difficulties and
anaphylaxis. Even when reactions are mild or moderate, it must be assumed that a future reaction may be severe and medical advice should be sought in all cases. Where there is a real risk of an extreme reaction, injectable adrenaline should be prescribed and should be carried at all times.
This factsheet aims to answer some of the questions that you and your family might have about sesame allergy. Our aim is to provide information that will help those affected to understand their allergy and minimise risks. If you know or think you are allergic to sesame, the most important message is to visit your GP and ask for a referral to an allergy specialist.
Throughout the text you will see brief medical references given in brackets. More complete references are published towards the end.
How many people in the UK have sesame allergy?
No one knows for sure. The Anaphylaxis Campaign currently has 745 members who are registered as allergic to sesame. This is out of a total membership of 5,738 (March 2013). The rise in sesame allergy is probably linked to its increased use. People affected must seek to avoid it completely, as even a tiny amount may trigger a severe reaction.
Sesame allergy is particularly common among people with peanut and tree nut allergy, where around 25% also react to sesame. Those with sesame allergy occasionally react to other seeds such as poppy seeds as well as to rye and kiwi. (Vocks, et el 2012).
Sesame allergy tends to appear early in life and, according to at least one study, persists in 80% of the cases. Those who outgrow it are likely to have done so by the age of around six (Cohen A, et al 2007).
Symptoms triggered by sesame
The symptoms of a food allergy, including sesame allergy, may come on rapidly. Mild symptoms may include nettle rash anywhere on the body (otherwise known as hives or urticaria), or a tingling or itchy feeling in the mouth. More serious symptoms are uncommon but remain a possibility for some people. These may include:
In extreme cases there could be a dramatic fall in blood pressure (anaphylactic shock). The person may become weak and floppy and may have a sense of something terrible happening. This may lead to collapse and unconsciousness.
Getting a diagnosis of sesame allergy
Because symptoms can be severe, it is important to see your GP as soon as possible if you suspect you have sesame allergy. Some GPs have a clear understanding of allergy, but allergy is a specialist subject so it is more likely that your doctor will need to refer you to a specialist allergy clinic. Your GP can locate an allergy clinic in your area by visiting the website of the British Society for Allergy and Clinical Immunology (www.bsaci.org).
Once you get a referral, the consultant will discuss your symptoms with you in detail as well as your medical history. The consultant may also perform skin prick tests and blood tests as part of the diagnostic process.
In many cases, doctors cannot easily determine whether a food allergy is mild or severe. However, there will be certain clues. For example, the severity of the reaction you suffered and the amount of food that caused it are important factors. If you reacted extremely to a very small amount of a food containing sesame, this suggests your allergy is severe.
Also, the presence of asthma – especially when poorly-controlled – has been shown to be a major risk factor for the occurrence of more severe allergic reactions.
If your allergy is thought to be severe, then you may be prescribed adrenaline (also known as epinephrine). The two adrenaline injectors prescribed in the UK are EpiPen and Jext. These injectors are easy to use and designed for self-administration. If you are prescribed an injector, it should be available at all times – with no exceptions. If an injector is used the patient must go to their local Accident and Emergency department for medical assessment and monitoring for 6-12 hours. Children are likely to be kept in overnight. This is because symptoms may return and more than one injection of adrenaline may be required to control the reaction.
If you are prescribed an adrenaline injector, you will need to know how and when to use it. Ask your GP or allergist for advice. You can also find help on the website relevant to the injector you carry.
Where is sesame found?
People with sesame allergy have reported allergic reactions to vegeburgers, breadsticks, crackers, burger buns, cocktail biscuits, Middle Eastern foods, Chinese, Thai and Japanese foods, stir-fry vegetables, salad dishes and health food snacks containing sesame.
Dishes containing sesame include tahini, gomashio, hummus and halvah. It is in the seasoning called Furikake. Chinese stir-fry oils sometimes contain sesame oil. Sometimes it is found in the drink Aqua Libra. Other sesame-containing foods include some noodles, dips, soups, sausages, samosas, processed meats, chutneys, salad dressings, mixed spices, spreads and confectionery bars.
Sesame seeds can often be found on bread buns. Sometimes someone with a sesame allergy will accidently eat these buns and then be surprised that they did not react. They may think it means they are no longer allergic when in fact it’s because the seeds weren’t broken open during eating. If you find you have had accidental exposure to sesame and you did not react please raise this with your allergist.
Food products in which the seeds have been crushed, such as tahini and sesame oil, are likely to be particularly high risk because the allergenic proteins (the part of the seed that causes the reaction) will be released from the seed under these circumstances.
Heating does not destroy the allergenicity of sesame and so cooked food containing sesame cannot be viewed as safe.
Sesame oil should be regarded as extremely risky because it is almost certain that it will be unrefined and therefore contain the proteins that trigger allergic reactions.
Sesame seeds are difficult to control in the food industry. They often become ‘electrostatic’, causing them to cling to charged surfaces such as other foods and clothing, which make it difficult to prevent cross-contamination. If a food product is marked with a warning, such as “may contain sesame”, take this seriously.
All pre-packaged food sold within the EU must declare the presence of sesame when it’s used as a deliberate ingredient, even if sesame appears in minute quantities.
Food sold in catering establishments such as restaurants, pubs and takeaways do not generally carry full ingredient lists. It is necessary to be very direct with serving staff, making it clear that even small quantities of sesame may cause a reaction.
Special care is needed when what you buy is sold loose, such as at delicatessen counters or in-store bakeries. As with the catering sector, there may not be a full ingredient list. Bread and other products bought from in-store bakeries must be viewed as particularly suspect because these may be contaminated by sesame seeds from other bread. The seeds may not be obvious – they may be in the dough or on the bottom.
Sesame is sometimes used in cosmetics and other personal care products and in such cases may be labelled under the Latin name sesamum indicum. Sesame oil may occasionally be present in pharmaceutical products. Always ask your pharmacist to obtain full ingredients of any prescribed medicine.
Survey of Anaphylaxis Campaign members
A 2005 survey of members of the Anaphylaxis Campaign who reported sesame allergy documented the experiences of 150 people of all ages including babies.
The key messages are:
People with sesame allergy can be assured that with proper management, the risks will be minimal. Central to any management strategy are proper medical advice, care and vigilance, a commitment to ask for accurate ingredient information and an understanding that prescribed medication must be carried at all times.
E. Vocks, A. Borga, C. Szliska, H. U. Seifert, B. Seifert, G. Burow, S. Borelli (1993) Common allergenic structures in hazelnut, rye grain, sesame seeds, kiwi, and poppy seeds, Allergy.48 (3); 168-172 http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.1993.tb00708.x/abstract
CJ Derby, MH Gowland , J O’B Hourihane. (2005) Sesame allergy in Britain: A questionnaire survey of members
of The Anaphylaxis Campaign. Pediatr Allergy Immunol: 16 (2): 171–175.
Cohen A, Goldberg M. Levy B. Leshno M. Katz Y. (2007) Sesame food allergy and sensitization in children: the natural history and long-term follow-up. Pediatr Allergy Immunol 18 (3): 217-223.
The content of this Fact Sheet has been peer reviewed by Dr. Adam Fox, Consultant and Honorary Senior Lecturer in Paediatric Allergy, Evelina Children’s Hospital, Guy’s & St Thomas’ Hospitals NHS Foundation Trust and Sue Clarke, Nurse Adviser to the Anaphylaxis Campaign.
Disclaimer – The information provided in this Factsheet is given in good faith. Every effort has been taken to ensure accuracy. All patients are different, and specific cases need specific advice. There is no substitute for good medical advice provided by a medical professional.
About the Anaphylaxis Campaign: Supporting people with severe allergies
The Anaphylaxis Campaign is the only UK wide charity to exclusively meet the needs of the growing numbers of people at risk from severe allergic reactions (anaphylaxis) by providing information and support relating to foods and other triggers such as latex, drugs and insect stings. Our focus is on medical facts, food labelling, risk reduction and allergen management. The Campaign offers tailored services for individual, clinical professional and corporate members.
The Information Standard
The information contained within this factsheet has been certified by the Information Standard as reliable information. The Information Standard is a certification scheme for health and social care information. It has been established by the Department of Health to help patients and the public make informed choices about their lifestyle, their condition and their options for treatment and care.