Sesame could be added to the list of allergens on food packaging

By Sally Robertson, B.Sc.Aug 2 2019Reviewed by Kate Anderton, B.Sc. (Editor)

Researchers in the United States have recently estimated the prevalence of sesame allergy across the country in answer to a request from the Food and Drug Administration. Following the investigation, the administration is considering taking regulatory action to ensure sesame is labeled as an allergen on food packaging.

Sesame Seeds, by Mr.Nakorn on Shutterstock

Using a cross-sectional population-based survey that was administered to a nationally representative sample of US households, the researchers found that an estimated 0.23% of adults and children have a current sesame allergy accompanied by a history of convincing IgE-mediated symptoms.

“The findings suggest that sesame allergy is a relatively common, frequently comorbid food allergy that affects patients of all ages, resulting in severe reactions and health care utilization,” says study author Ruchi Gupta from the Center for Food Allergy and Asthma Research at Northwestern University Feinberg School of Medicine.

Sesame allergy is a growing public health concern in the US

Food allergy is a serious public health problem in the US, reportedly affecting around 8% of children and 10% of adults and resulting in significant psychosocial, economic, and physical health burdens.

The FDA currently only mandates labeling of the eight most common allergenic foods, namely peanut, milk, shellfish, tree nuts, egg, soy, fish, and wheat.

Although the eight most common food allergies have been established for some time, given that the proportion of people affected by food allergies is growing across the US, it is important to consider other food allergies that may be having a substantial impact on the population. A better understanding of this population-level effect is urgently needed.

One food allergen that is of growing concern is sesame, which has already been regulated in many other countries. The decision to omit sesame was made when the eight established allergens were thought to account for 90% of food allergies.

However, the current lack of data on sesame allergy recently prompted the FDA to issue a request for epidemiological data on “the prevalence and severity of sesame allergies in the United States to inform possible regulatory action that would require sesame to be labeled as an allergen on packaged foods.”

Gathering nationally representative data on sesame allergy

Now, Gupta and team have assessed data on sesame allergy among children and adults across the nation and reported current estimates on the prevalence, severity, distribution, and clinical characteristics.

“This study is the first, to our knowledge, to comprehensively characterize the population-level burden of sesame allergy among US children and adults,” writes the team.

The cross-sectional study evaluated data obtained through web-and telephone-based food allergy surveys that included participants recruited from the National Opinion Research Center at the University of Chicago’s probability-based AmeriSpeak panel, as well as participants recruited through Survey Sampling International.

Responses from 40,453 adults and 38,408 children among a nationally representative sample of 51,819 US households were included. The surveys were conducted between October 1, 2015 and September 31, 2016 and data were analyzed between January 1, 2017, and May 1, 2019.

The main outcome was self-reported sesame allergy that was considered convincing if reported symptoms were consistent with an IgE-mediated reaction. Other main outcomes were a diagnostic history of specific allergens and use of food allergy-related healthcare services.

As reported in JAMA Network Open, an estimated 0.49% of the population reported a current sesame allergy and 0.23% had a history of convincing IgE-mediated symptoms. A further 0.11% had a sesame allergy reported as physician-diagnosed but did not have convincing reaction symptoms.

Among those who did have convincing symptoms, between 23.6% and 37.2% had previously experienced a severe sesame-allergic reaction, depending on the definition used, and 81.6% had at least one other convincing food allergy. Approximately one-third of patients with convincing sesame allergy reported having previously used epinephrine to treat the reaction.

Sesame allergy a greater health burden than previously thought

The authors say the findings suggest that overall, a total of 0.49% of the US population or more than 1.5 million children and adults, may have a current sesame allergy, which represents a greater perceived health burden than has previously been acknowledged.

The team says their data also extends previous work suggesting that allergic reactions to sesame are potentially severe, by showing that allergic reactions result in substantial use of health care services.

Gupta and team write:

Together, the present data indicate a substantial economic, psychosocial, and physical health burden experienced by individuals with sesame allergy living in North America. Moreover, the relatively low rates of physician diagnosis observed among individuals with convincing IgE-mediated sesame allergy seem to indicate the need for clear diagnosis and appropriate management.”

‘Sesame allergen labeling may be increasingly important in coming years’

Currently, the Food Allergen Labeling and Consumer Protection Act of 2004 only mandates labeling of the eight established allergenic foods and the proteins derived from them. While Europe, Canada, Australia, and New Zealand all require clear labeling of sesame as an ingredient on food packaging, the United States currently has no such requirement, despite it having similar rates of allergy.

“This issue of sesame allergen labeling may be increasingly important in coming years, given that sesame consumption appears to be increasing domestically and abroad,” concludes the team.