Sesame Oral Desensitization Outcomes in a Pediatric Cohort

Oral desensitization is an emerging treatment option for food allergy. Limited data exists on sesame oral desensitization outcomes in the United States. A retrospective chart review of pediatric patients undergoing oral desensitization to sesame was conducted at a pediatric food allergy referral center. Eighty-six patients with allergist-diagnosed sesame allergy (median age 5 years) underwent oral desensitization to sesame. Oral desensitization involved initial low dose oral food challenge (OFC) to crushed sesame seeds or tahini with incremental dose escalation until patients reached a maintenance dose, usually 1 teaspoon of tahini (1000mg sesame protein). Fifty-one (59.3%) achieved maintenance. Twenty-six patients (30.2%) were still in the build-up phase. Nine patients (10.5%) discontinued desensitization due to reactions (n=3), uncontrolled asthma (n=1), difficulty with daily dosing (n=1), or unknown (n=4). Twenty-five patients (29.1%) experienced allergic reactions with daily dosing with only 1 reaction requiring epinephrine. Ten patients who reached maintenance dosing also completed a full dose OFC to 1 tablespoon of tahini (3000mg sesame protein); all had negative OFCs (100%). All ten patients then underwent a sustained unresponsiveness OFC to 1 tablespoon of tahini after discontinuing daily sesame dosing for 4-6 weeks. All 10 (100%) sustained unresponsiveness OFCs were negative. Oral desensitization to sesame with crushed sesame seeds and tahini can be a safe and effective way to desensitize sesame-allergic pediatric patients.