Sesame Allergy: Characteristics and Outcomes

Sesame is the 9th common food allergen in the US. The course of sesame allergy requires further evaluation. Using an I2B2 search, we identified sesame-allergic patients who were evaluated at the Allergy Program at Boston Children’s Hospital (BCH). A retrospective chart review was performed extracting information about demographics, sesame skin-prick test (SPT) and specific-IgE, food challenge outcome, and atopic disease diagnosis. 1,394 patients were included (mean follow-up 4 years). 38.1% were females and 61.9% males. Mean age at diagnosis was 4.2 years, and most common reason for testing (53%) was other food allergy. 94% had a tree nut and/or peanut allergy diagnosis. Only 37.2% of all patients had at least 1 confirmed allergic reaction while only 9.8% of them had anaphylaxis to sesame.67% of patients had allergic rhinitis and 73% had eczema. Resolution was documented in only 8.4% of patients and was negatively associated with an ongoing history of peanut (p<0.001) or tree nut allergy (p<0.001) or a history of sesame reactions (p=0.035).Most recent SPT≥8mm wheal was associated with history of allergic reaction (p<0.001), history of anaphylaxis to sesame (p<0.001) and eczema (p=0.016). Most recent sesame IgE ≥10kU/L was associated with use of epinephrine (p=0.022), emergency visits (p=0.031), allergic rhinitis (p=0.006), eczema (p=0.001), and asthma (p=0.013). This is the largest retrospective study evaluating sesame-allergic patients. More than half were evaluated because of other food allergies and only about a third only had an allergic reaction to sesame. Patients without peanut and/or tree nut allergies are at higher odd of resolution.