Sesame eliciting and safe doses in a large sesame allergic population
Liat Nachshon, Joost Westerhout, W. Marty Blom, Benjamin Remington, Michael B. Levy, Michael R. Goldberg, Naama Epstein‐Rigbi, Yitzhak Katz, Arnon Elizur- Immunology
- Immunology and Allergy
Abstract
Background
Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited.
Methods
All sesame oral food challenges (OFCs), performed either for diagnosis or for threshold identification before the beginning of sesame oral immunotherapy (OIT) between November 2011 and July 2021 in Shamir medical center were analyzed for reaction threshold distribution. Safe‐dose challenges with 90–120 min intervals were also analyzed.
Results
Two hundred and fifty patients underwent 338 positive OFCs, and additional 158 safe‐dose OFCs were performed. The discrete and cumulative protein amounts estimated to elicit an objective reaction in 1% (ED01) of the entire cohort (n = 250) were 0.8 mg (range 0.3–6.3) and 0.7 mg (range 0.1–7.1), respectively, and those for 5% of the population (ED05) were 3.4 mg (range 1.2–20.6) and 4.5 mg (range 1.2–28.8), respectively. Safe‐dose OFCs showed similar values of ED01 (0.8, 0.4–7.5 mg) and ED05 (3.4, 1.2–22.9 mg). While doses of ≤1 mg sesame protein elicited oral pruritus in 11.6% of the patients, no objective reaction was documented to this amount in any of the challenges, including safe‐dose OFCs.
Conclusions
This study provides data on sesame reaction threshold distribution in the largest population of allergic patients studied, with no right or left censored data, and with validation using a safe‐dose OFC. It further supports the current methods for ED determination as appropriate for establishing safety precautions for the food industry.