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Sesame allergy is a common food allergy to foods made with sesame seeds. Prevalence estimates for the allergy is in the range of 0.1-0.2% of the general population, and is higher in the Middle East and other countries where sesame seeds are used in traditional foods.
Reporting of sesame seed allergy has increased in the 21st century, due either to a true increase from exposure to more sesame foods or an increase in awareness. Increasing sesame allergy has induced more countries to regulate food labels to identify sesame ingredients in products and the potential for allergy. In the United States, sesame will become the ninth food allergen with mandatory labeling, effective January 1, 2023.
The allergic reaction is an immune hypersensitivity to proteins and lipophilic proteins in sesame seeds and foods made with sesame seeds, including sesame oil. Sesame seed oil is used in cosmetics products, and can cause allergic rashes. Symptoms can be either rapid or gradual in onset, possibly occurring over hours to days. Rapid allergic reaction may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. Other presentations may include atopic dermatitis or inflammation of the esophagus. For food labeling requirements established in many countries, sesame is among the eight common food allergens responsible for 90% of allergic reactions to foods: cow's milk, eggs, wheat, shellfish, peanuts, tree nuts, fish, and soy beans.
In addition to water-soluble allergenic proteins, sesame seeds share with peanuts and hazelnuts a class of allegenic proteins known as oleosins. Commercially prepared sesame extracts lack these lipophilic proteins, and so can present false negative skin prick test results even though the oleosins can be responsible for a range of allergic reactions, including anaphylactic shock.