FeaturesJune/July 2010 Issue

Parent Alert: Sesame Seed Allergy

Sesame is sprouting into a major food allergen

 

One of my childhood jobs was to sit at the kitchen table and carefully scan the bottoms of the bagels for errant sesame seeds. My father was severely allergic to sesame and I was always on the lookout for him. Ingesting even one tiny seed would make him violently ill, sending him to the hospital with gagging spasms.

At that time, sesame was a rare, unheard-of allergy. Growing up in a working-class family in Philadelphia in the ’40s, Dad’s exposure to sesame was limited. The family seldom went out to restaurants and rarely ate ethnic food. For years, he thought he was allergic to fancy crackers.

“When I was a kid, sesame wasn’t in as many things,” he tells me, ticking off the times he vomited after eating seeded crackers, Italian bread, halvah and hamburger buns before he finally figured out what was causing the problem.

Some of those episodes are etched in my memory. Once we were at a cocktail party when he unwittingly ate a dip that contained sesame oil. As he began to heave and choke, my mother whisked him from the buffet table to the emergency room, leaving me behind at the party.

A Growing Concern

Sesame allergy first appeared in the medical literature in 1950. By 2005, a study published in Annals of Allergy, Asthma & Immunology called sesame allergy a “significant, serious and growing problem” not only in the United States but in many countries around the globe.

In just 50 years, sesame allergy has rocketed toward the top of the food allergy charts in developed countries. It’s No. 3 in Israel, where children are fed sesame products for protein and iron. In Australia, it’s No. 4. Canada and the European Commission now require sesame to be listed as a major allergen on food labels. Here in the United States, sesame is not yet in the category of Big 8 food allergens (milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat) required to be declared on product labels.

Although precise prevalence data is not available, medical clinicians report that incidence of the allergy is on the rise.


“It’s remarkably common to see sesame allergy and to see severe reactions to it,” says Robert Wood, MD, chief of pediatric allergy and immunology at the Johns Hopkins University School of Medicine in Baltimore. Wood estimates it’s the fourth or fifth most common allergy in his patient population of 4,000 kids with severe food allergies. It’s true that food allergies are increasing overall, yet Wood says that sesame allergy “appears to have increased somewhat more than the others.”

“It is definitely increasing,” says Paul Detjen, MD, who has a private allergy practice in Kenilworth, Illinois, and is co-founder of Mobile C.A.R.E. Foundation. “The relative rarity of sesame allergy in the distant past and the relative new recognition of it make it stand out more.”

Consuming More

Why the increase? One reason may be that Americans are eating more sesame than ever before. The more common a food becomes in everyone’s daily diet, the more people will report an allergy to it.  

In the past, the most likely place you’d encounter sesame was at a McDonald’s restaurant. Remember the Big Mac jingle? Two all-beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun. These days, we’re getting sesame on a lot more than hamburger buns—hummus, falafel, granola, bread sticks, pizza, cookies, salad dressing, sesame noodles, certain spices and flavorings. Even lipsticks, moisturizing creams and massage oils can contain sesame.

Detection isn’t always easy. “My issue with sesame is that it’s hidden,” says Ali Cole, whose 6-year-old son Ezra is allergic to sesame seeds, tree nuts and mustard. “People don’t always realize that hummus and tahini, for example, contain sesame. It’s very scary, because it’s more pervasive than you might think.”

Part of the problem is that sesame oil can lurk in a product unseen. It can show up in unexpected places, like tomato sauce (Hunt’s roasted garlic sauce), hand cream (Bliss), lipstick (L’Oreal Colour Riche) and even progesterone shots for fertility treatments.

“Sesame oil is used in pharmaceutical and cosmetic industries because it is thought to have many desirable properties, such as being stable, neutral, inert, nonirritating, not too viscous, heat resistant, and nonsweating effects,” writes Venu Gangur, a Michigan State University researcher who authored a 2005 study published in the Annals of Allergy, Asthma and Immunology.

Unlike soy oil, sesame oil is not highly processed or refined, which means that some of the protein remains intact, creating potential for a reaction in sensitive people.

The Body’s Response

Depending on sensitivity, symptoms of sesame allergy range from hives to itchy mouth to anaphylaxis, a life-threatening reaction that can lead to a rapid drop in blood pressure, breathing problems, respiratory failure and even death. The reaction occurs upon ingestion and, for some, it occurs from skin contact—the sesame oil in certain cosmetics can bring on a rash.

“I see sesame allergy fairly regularly. The typical story is, ‘My kid gets hives when he eats hummus,’” Detjen says.   

When my father gets hit with a reaction, he says the uvula at the back of his throat swells up. “I can feel it resting on my tongue. I feel a tremendous itching in my throat, like something I want to get rid of and expel. I almost always throw up,” he says.


Ilana Meisler, a 10-year-old living in the Minneapolis suburbs, has a similar story. When she was 3 and trying new foods, she complained of an itchy mouth. It raised the suspicions of her mother, Michele Meisler, a nurse.

“Ilana would start crying, saying, ‘My tongue is itching! My mouth is itching!’” recalls Meisler, who consulted an allergist about it. Ilana took an inconclusive blood test followed by a skin test, which pointed to a sesame and hazelnut allergy. Meisler removed both foods from the little girl’s diet and the complaints stopped.

Neither blood tests nor allergy skin tests provide a definitive diagnosis, cautions Scott Sicherer, MD, professor of pediatrics at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York. False positives are likely, he says, so kids shouldn’t eliminate sesame seeds from their diet based solely on these tests. Instead, allergists rely on a history of immediate allergic reactions to a food, followed by skin tests, then blood tests. If all of that is inconclusive, specialists perform an oral challenge in which a patient ingests the food in a controlled setting.

Allergy to sesame can develop at any age but it tends to appear early in life. According to a 2007 Israeli study, it is seldom outgrown, persisting into adulthood in 80 percent of cases. In this respect, sesame allergy is like nut and peanut allergies. Only about 20 percent of peanut-allergic children outgrow their allergy and about 10 percent outgrow tree nut allergy.

There is some cross-reactivity between sesame allergy and peanut and tree nut allergies but doctors do not recommend automatically avoiding sesame if a patient is allergic to either peanuts or tree nuts. Given the cross-reactivity, however, Wood says the increase being noted in peanut allergy may spur more reactions to sesame.

Carmela Mele, mother of three children with multiple food allergies, learned this the hard way. Her oldest son Joey, now 12, was diagnosed with a tree nut allergy when he was two.
“They didn’t test for sesame at that time because it was not on the list of top 8 food allergens,” says Mele, who lives in Seattle.

A couple years later, when Joey was 4½, they were on a plane when flight attendants passed out bags of tortilla chips instead of nuts. Mele was thrilled that she didn’t have to deal with the nut or peanut issue—but her happiness didn’t last long. Halfway through eating the bag of chips, Joey started clearing his throat. Before long, he was coughing and then vomiting.

“I flipped the bag over and saw there was sesame,” Mele says. “That’s the only thing that stuck out. I knew that was the only ingredient he’d never had.” She gave him Benadryl on the plane, which fortunately resolved his symptoms. Later, a skin test was positive for sesame.

Mele’s youngest, Mikey, 6, also tested positive for sesame, as well as for dairy, eggs, peanuts and tree nuts. But Mikey hasn’t been exposed to sesame yet, so there’s been no reaction to confirm the diagnosis. Mele has now added sesame to the list of foods her children must carefully avoid.  

“Certain bagels used to be safe for my kids. Now we don’t eat them and don’t visit the bagel shop because of the risk of cross-contamination. Sesame seeds fly all over the place,” she says. In addition, they steer clear of Asian, Middle Eastern and Greek restaurants, cuisines that traditionally use a lot of sesame seeds and oil.

“We also can’t eat my mother’s homemade Italian sesame cookies,” she says.

No Longer Alone

Being seriously allergic to sesame his entire life, my father, now 72, has witnessed the once-rare condition move out of medical obscurity to a place of prominence. When dining out, he used to give waiters a lengthy explanation of his allergy. Lately, he’s found the tables are turned as he overhears other diners facing the same issues.

“I used to think I was the only person who was allergic to sesame,” he says. “Now I’ve got a lot of company.”

Eve Becker, creator of glutenfreenosh.com, lives in Chicago with her two children.

 


Sesame-Free Hummus

MAKES 1 CUP

Most hummus contains tahini, a sesame butter. This allergy-friendly dip is a crowd-pleasing appetizer that can be whipped up in less than five minutes. Serve it with gluten-free pita bread, chips or veggies.

1     (15-ounce) can garbanzo beans or chickpeas, rinsed and drained
¼    cup water
1     clove garlic, crushed
1     tablespoon fresh lemon juice
¼     teaspoon ground cumin
½    teaspoon coarse kosher salt
2     tablespoons olive oil
-    Dash paprika, for garnish

1. In a food processor, combine garbanzo beans, water, garlic, lemon juice, cumin, salt and oil. Process for 2 full minutes, until mixture is smooth and creamy.
2. Transfer to serving bowl and garnish with dash of paprika.

Each tablespoon contains 47 calories, 2g total fat, 0g saturated fat, 0g trans fat, 0mg cholesterol, 79mg sodium,6g carbohydrate, 1g fiber, 1g protein.

TIP Gluten-free pita is available from Rose’s Wheat Free Bakery, rosesbakery.com.

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