The diagnostic challenge of sesame allergy: A review of sesame oral food challenges in a pediatric clinic

We read, with great interest, 3 recent publications in The Annals regarding sesame allergy, 1 Ocak M Sahiner UM Soyer O Sekerel BE. The role of diagnostic tests and oral food challenge results to predict sesame allergy. Ann Allergy Asthma Immunol. 2022; 128: 46-52 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 2 Mahlab-Guri K Guri A Kadar L Asher I Sthoeger Z Elbirt D et al. Characteristics of patients with spontaneous resolution of sesame allergy. Ann Allergy Asthma Immunol. 2022; 128: 206-212 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 3 Sillcox C Gabrielli S Clarke AE Morris J Gravel J Lim R et al. Sesame-induced anaphylaxis in pediatric patients from the cross-Canada anaphylaxis registry. Ann Allergy Asthma Immunol. 2022; 129: 342-346 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar which are relevant given its increasing prevalence. 4 Warren CM Chadha AS Sicherer SH Jiang J Gupta RS. Prevalence and severity of sesame allergy in the United States. JAMA Netw Open. 2019; 2e199144 Crossref Scopus (46) Google Scholar Ocak et al 1 Ocak M Sahiner UM Soyer O Sekerel BE. The role of diagnostic tests and oral food challenge results to predict sesame allergy. Ann Allergy Asthma Immunol. 2022; 128: 46-52 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar evaluated the diagnostic ability of sesame-specific IgE (ssIgE) and sesame skin prick testing (sSPT) in 92 Turkish patients and found that ssIgE did not predict oral food challenge (OFC) outcomes, whereas sSPT did, with a threshold of 5.25 mm. In a review of 190 patients with allergy to sesame in Israel, Mahlab-Guri et al 2 Mahlab-Guri K Guri A Kadar L Asher I Sthoeger Z Elbirt D et al. Characteristics of patients with spontaneous resolution of sesame allergy. Ann Allergy Asthma Immunol. 2022; 128: 206-212 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar found spontaneous resolution in approximately one-third of patients. In Canada, Silcox et al 3 Sillcox C Gabrielli S Clarke AE Morris J Gravel J Lim R et al. Sesame-induced anaphylaxis in pediatric patients from the cross-Canada anaphylaxis registry. Ann Allergy Asthma Immunol. 2022; 129: 342-346 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar reported increased epinephrine administration among children seen in the emergency department for sesame reactions. We believe our study of sesame allergy in a large clinical population in Denver, Colorado mirrors these findings while highlighting an important clinical scenario.