Sesame allergies: clinical significance, diagnosis, and therapy
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Sesame (Sesameum indicum) belongs to the pedalium family (Pedaliaceae) and is used primarily in the preparation of food, especially in oriental and Asian cuisine. As a so-called emerging allergen, it is becoming increasingly relevant in the everyday routine of physicians active in the field of allergology in the wake of the globalization of dietary habits and the general trend towards vegetarian and vegan lifestyles. Due to the increased occurrence of anaphylactic reactions to sesame, the European Union has included sesame in the list of food allergens requiring labeling. In addition to its use in private and industrial food preparation, sesame is also utilized in the cosmetics and pharmaceutical industries.
Materials and methods
This paper is an overview of selected scientific articles and is based on research in PubMed and specialist databases.
Immediate-type IgE-mediated reactions (type I according to Coombs and Gell), as well as delayed-type contact allergic reactions (type IV according to Coombs and Gell), to products containing sesame and sesame oil have been described. The clinical spectrum is broad and ranges from contact urticaria and dermatitis to fatal anaphylaxis. Important allergens in immediate-type allergy include albumins, vicilins, oleosins, and globulins; relevant contact allergens include sesamolin, sesamin, and sesamol. The diagnostic work-up for suspected sesame allergy includes skin tests, which should preferentially be carried out with native allergens due to their higher sensitivity and specificity, as well as determination of sesame-specific IgE antibodies. However, lipophilic oleosins in particular are underrepresented in analytical methods. Differentiated, component-based IgE diagnostic testing is desirable. Oral provocation is the gold standard, whereby it is important to ensure low and safe initial doses as well as adequate maximum doses.
Beside diagnostic measurements including skin tests, detection of IgE antibodies and oral provocation tests, the education of patients with sesame allergy is of particular importance. This serves, firstly, to prevent recurrence of allergen exposure and, secondly, should contain information on self-management in the case of repeated reactions. The value of oral tolerance induction and preventive measures such as early introduction as a dietary supplement remains to be clarified in the future.
KeywordsSesame Sesame seeds Sesame oil Oleosins Allergy Anaphylaxis Cross-reactivity
Working Group on Anaphylaxis Training and Education (Arbeitsgemeinschaft Anaphylaxie—Training und Edukation)
Basophil activation test
Study on Adult Health in Germany (Studie zur Gesundheit Erwachsener in Deutschland)
Negative predictive value
Oral provocation test
Positive predictive value
Wheat-dependent exercise-induced anaphylaxis
Conflict of interest
S. Mühlenbein and W. Pfützner declare that they have no competing interests.
- 2.Köhler FE. Köhler’s Medizinal-Pflanzen, naturgetreue Abbildungen mit kurz erläuterndem Texte: Atlas zur Pharmacopoea germanica, austriaca, belgica, danica, helvetica, hungarica, rossica, suecica, Neerlandica, British pharmacopoeia, zum Codex medicamentarius, sowie zur Pharmacopoeia of the United States of America. Gera-Untermhaus: F. E. Köhler; 1883. URL: http://www.botanicus.org. Accessed 6 Aug 2017.
- 3.Fuller DQ. Further evidence on the prehistory of sesame. Asian Agrihist. 2003;7:127–37.Google Scholar
- 11.Contraindication for dronabinol. AIDS Patient Care STDS 2006;20:815.Google Scholar
- 21.Lemerdy P, Moneret-Vautrin DA, Rance F, Kanny G, Parisot L. Prevalence of food allergies in pediatric and adult populations. CICBAA Databank Alim’Inter. 2003;8:5–7.Google Scholar
- 28.Gravett CM, Motala C. Food-dependent exercise-induced anaphylaxis associated with sesame seed ingestion – a case report. Curr Allergy Clin Immunol. 2007;20:216–7.Google Scholar
- 33.Bigdeli Shamloo MB, Nasiri M, Dabirian A, Bakhtiyari A, Mojab F, Alavi Majd H. The effects of topical sesame (sesamum indicum) oil on pain severity and amount of received non-steroid anti-inflammatory drugs in patients with upper or lower extremities trauma. Anesth Pain Med. 2015;5:e25085.CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Ebermann R, Elmadfa I. Lehrbuch Lebensmittelchemie und Ernährung. Wien: Springer; 2008.Google Scholar
- 58.Rycroft RJ, Menné T, Frosch PJ, Lepoittevin JP. Textbook of contact dermatitis. Berlin, Heidelberg: Springer Science & Business Media; 2013.Google Scholar
- 59.Ring J, Beyer K, Biedermann T, Bircher A, Duda D, Fischer J, et al. Guideline for acute therapy and management of anaphylaxis: S2 guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB). Allergo J Int. 2014;23:96–112.CrossRefPubMedPubMedCentralGoogle Scholar