Abstract
Sesame is a potentially potent allergen that can trigger skin,
gastrointestinal, and respiratory tract symptoms, and anaphylaxis. Only
20% to 30% of sesame-allergic children develop tolerance. The
prevalence of sesame allergy depends on local diets and ranges from
0.1% to 0.9%. A high risk of accidental exposure to sesame has
resulted in mandatory food labeling in many countries. More than half of
patients with sesame allergy are also allergic to peanut/tree nuts.
Serum specific IgE testing with a quantitative Ses i 1 component can be
performed safely and has higher clinical specificity and better positive
predictive value for oral food challenge (OFC) than whole sesame extract
or skin prick testing (SPT). Compared with SPT or OFC, in vitro
Ses i 1 testing requires no special techniques and carries no risk of
reactions. Diagnosis of suspected sesame allergy begins with a thorough
history and physical examination. A positive sesame extract test (≥0.1
kU A/L) should prompt further testing. In patients with
a high probability of reacting, results of component testing may
facilitate a decision about performing an OFC. In a Japanese study of
OFC and Ses i 1, there was a 5% probability of a positive OFC with Ses
i 1 sIgE levels <0.13 kU A/L, and a 50%
probability of a positive OFC with levels >32.0 kU
A/L. Most patients could safely consume sesame if sIgE
levels were <0.13 kU A/L. Ses i 1 testing can
be used to guide appropriate management (avoidance, emergency
medication, and oral immunotherapy).