1. a growing food allergy in adults
Sesame allergy:
a growing food allergy in adults
Barbarroja-Escudero, Jose; Antolin-Amerigo, Dario; Sanchez-Gonzalez, Maria-Jose; Alvarez-Mon Soto, Melchor; Rodriguez-Rodriguez, Mercedes
Hospital Universitario Príncipe de Asturias, Allergy Division. Immune System Diseases & Oncology Service, Alcalá de Henares. Madrid, Spain
Background
Sesame is a growing cause of severe IgE-mediated food allergic reactions among infants, young children and adults. The aim of this study was to define the value of skin prick test (SPT) to commercial sesame, prick-by-prick to freshly prepared sesame extract (sesame paste), prick-by-prick to sesame oil, and serum specific IgE against sesame in a group of adults allergic to sesame. 
Clinical data 1 2 3 4 5
Sex/age
male/73
male/56
male/55
female/75
No episodes 6 8
Clinical history
urticaria/
angioedema
anaphylaxis
Skin prick test to commercial sesame
negative
Prick-by-prick to sesame (paste or oil)
negative (paste/oil)
positive (oil)
positive (paste) nd
Serum total IgE (UI/ml)
175 49 53
646
<15.30
Serum specific IgE against sesame (kU/L)
0.09
0.05
0.04
0.33
0.07
Serum tryptase (µg/L)
3.81
5.72
6.80
Methods
Five adults (4 men/1 woman) were recruited in a period of 1 year. We performed a battery of SPT to aeroallergens and commercial sesame, prick-by-prick to sesame paste and sesame oil, and in vitro tests (serum total and specific IgE against sesame, and serum tryptase determinations).
Result
We present 5 cases of immediate hypersensitivity to sesame with negative skin prick testing and IgE antibody test results in all cases. Five patients had a convincing clinical history. It is of note that most severe cases were confirmed by prick-by-prick to sesame paste or to sesame oil. Patient number 4 suffers from colorectal carcinoma and he is receiving chemotherapy treatment, so prick-by-prick to sesame paste or sesame oil has not yet been performed. 
Conclusion
Men showed the most severe reactions, but suspicion was not made until several episodes. Hence, commercial sesame seed extract might have an unsatisfactory quality, achieving a better sensitivity with the employment of freshly prepared sesame extracts or sesame oil, to assess severe cases of sesame allergy in adults. Existing specific IgE against sesame seed may not meet the standards and could not be suitable to evaluate severe cases of sesame allergy in adults.
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