Sesame seed
Summary
Sesamum indicum is one of the oldest oilseed plants belonging to the family Pedaliaceae and widely grown species in Sesamum genus. Asia and Africa hold 96% of world sesame seed production. It is commonly used in Middle Eastern cuisine and in Mediterranean diet and is increasingly being used in various foods in US like breads, sauces like tahini or confectionaries like halva. The prevalence of sesame allergy in USA, Mexico, Canada and Europe is reported 0.1% and 0.8% in Australia. It is considered ninth most common childhood food allergy in US while third most common food allergen and second most common food to cause anaphylaxis in children in Israel. Australia, Canada, Europe and New Zealand have recognized sesame as priority food allergen which required food labeling, but it is not currently mandatory in USA. Oral ingestion of sesame seeds either whole or in food preparations can lead to symptoms ranging from oral food allergy presented by recurrent episodes of wheezing and dyspnea to asthma, atopic dermatitis to anaphylaxis. Sesame skin prick test was found to be more accurate predictor than sesame serum specific IgE levels. The World Health Organization(WHO)/International Union of Immunological Societies(IUIS) Allergen Nomenclature Subcommittee has registered seven sesame allergen components: four storage proteins including two 2S albumins (Ses i 1 and Ses i 2) and two 11S globulins (Ses i 6 and Ses i 7), sesame extract also contains two oleosins (Ses i 4 and Ses i 5) and one vicilin-like 7S globulin (Ses i 3). Sesame allergy was reported as commonly co-existent in patients with peanut and tree nut (pine nut, macadamia nut, brazil nut and hazelnut) allergies.
Epidemiology
Worldwide distribution
The prevalence of sesame allergy in the USA, Mexico, Canada and Europe is reported 0.1% and 0.8% in Australia. Recently, it is considered as the ninth most common childhood food allergy in the US with 0.23% prevalence in a population survey. Sesame was responsible for allergy in 9.8% of food allergic patients in the UK as per Pronuts study.
It is the third most common food allergen and the second most common food to cause anaphylaxis in children in Israel with a prevalence of 0.93%.
Allergy to sesame occurs in individuals ranging from infants to adults including de novo sensitization in adults. The age-specific prevalence reported convincing sesame allergy in 0.21% children and 0.24% adults in the US while probable sesame allergy in Canada was found in 0.23% children and 0.05% adults.
Risk factors
Sesame allergy has been reported to co-exist in 50-54% of patients with both peanut and tree nut allergy. Thus, peanut and tree nut allergies could pose a risk for sesame allergy.
Route Of Exposure
Main
Oral ingestion of sesame seeds either whole or in food preparations can lead to symptoms ranging from oral food allergy to atopic dermatitis to anaphylaxis.
Secondary
Certain cases have reported allergic symptoms like contact dermatitis due to mucosal contact or severe respiratory symptoms due to inhalation.
Clinical Relevance
Sesame allergy can manifest symptoms ranging from oral food allergy syndrome presented by recurrent episodes of wheezing and dyspnea to atopic dermatitis and anaphylaxis.
Anaphylaxis and food allergy
Allergic manifestations in patients with sesame allergy found skin symptoms to be most common followed by gastrointestinal, respiratory and cardiovascular symptoms along with anaphylaxis in few patients. However, among several nuts evaluated, sesame was found to produce allergic symptoms with the highest severity and more involvement of the lower respiratory tract or cardiovascular/neurological system. 2.8% of cases in Canada and 43% in Israel reported sesame induced anaphylaxis among the total cases of food-induced anaphylaxis. Anaphylactic symptoms were prominent in sesame allergic patients as seen from studies reporting 41% in Japan and 61.7% in North America and Canada. Further, 5 cases of food protein-induced enterocolitis syndrome (non-IgE mediated hypersensitivity) induced by sesame in children in Israel were reported, presented as acute repetitive vomiting, lethargy, and pallor.
Allergic rhinitis
A study conducted in the UK on 33 adult patients (16-81 years) who underwent sesame oral food challenge (OFC) reported allergic rhinitis in 48% of patients.
Asthma
Asthma was reported in 28.3% of sesame allergic children in Japan while in 36% of UK adults who underwent OFC. It was also reported in 25.4% of patients with positive sesame OFC in Israel. Bronchospasm was reported in 2 cases of bakers and a young girl due to sesame seeds through inhalation route.
Atopic dermatitis
Li, Gunawardana reported atopic dermatitis in 30% of patients in the UK study while Maruyama, Nakagawa reported in 66.3% sesame allergic Japanese children. Atopic dermatitis was found to be positively associated with positive sesame OFC with 56.7% of patients affected having positive sesame OFC. Lignin like allergens, sesamol and sesamin in sesame oil has been identified to cause allergic contact dermatitis.
Other diseases
Contact urticaria was reported in one case to sesame by oral mucosal contact manifested as oral edema, erythema, and blood-tinged vesicles. Delayed hypersensitivity as contact dermatitis was also reported in a patient who received progesterone injection in sesame oil manifested as respiratory symptoms several days after receiving the injection.
Diagnostics
Main methods
Koppelman, Söylemez developed a sensitive ELISA for detection and quantification of sesame seed residue in food with a lower limit of 0.5 ppm and no cross-reactivity with 92 other food or food ingredients. This may be helpful for detection in highly allergic individuals.
Skin prick tests
Sesame skin prick test (SPT) was found to be a more accurate predictor than sesame serum specific IgE while Ses i 1 IgE levels were found better than SPT in another study.
Prevention And Therapy
Other topics
Australia, Canada, Europe and New Zealand have recognized sesame as a priority food allergen that required food labeling, but it is not currently mandatory in the USA. Sesame food allergy has been shown to resolve in 20-30% of patients.
Cross-Reactivity
Sesame allergy was reported as commonly co-existent in patients with peanut and tree nut (pine nut, macadamia nut, brazil nut and hazelnut) allergies. Cross reactivity and co-sensitizations have been reported among allergens in sesame and other foods like peanuts, hazelnut, walnut, black walnut, cashew, macadamia, pistachio, kiwi, rye and poppy seeds.
IgE cross-reactivity between 7S and 11S globulins from sesame and peanuts is common. The homology between peanut 7S globulin (Ara h 1) and 11 S globulin (Ara h 3) and sesame proteins is high with Ses i 3 showing 36% homology to Ara h 1while IgE binding epitopes of peanut 2S albumin (Ara h 2) has limited sequence identity with sesame 2S albumin (Ses i 1). This may give false positive sesame IgE based diagnosis. Further, Albunni, Wessels reported cross-sensitization between chia seeds and sesame seeds by demonstrating the strong inhibition of anti-sesame antibodies by chia globulin fraction.
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