Sesame Allergy Risk in Children with Multiple Food Allergies
Yes, sesame should be considered a likely allergen in a child with allergies to eggs, milk, peanuts, tree nuts, and legumes, as this child has multiple food allergies and atopic disease, which are strong risk factors for developing additional food sensitivities including sesame.
Why Sesame is a Likely Allergen in This Child
Multiple Food Allergies Increase Risk
Children with multiple food allergies have significantly higher risk of additional food sensitivities. Approximately 30.4% of children with reported food allergy have multiple food allergies, and patients with one atopic condition are predisposed to developing multiple allergic conditions 1.
The presence of peanut and tree nut allergies specifically correlates with other food sensitivities. Peanut-allergic patients show 19-79% sensitization to soy and other legumes, and when lupine challenges were performed in peanut-sensitized patients, 28-30% reacted clinically 1.
Sesame allergies frequently coexist with peanut and tree nut allergies. Studies demonstrate that allergies to peanuts, sesame, and tree nuts coexist in 60% of cases 2.
Atopic Disease as a Risk Factor
This child's multiple food allergies indicate underlying severe atopic disease. Up to 37% of children younger than 5 years with moderate-to-severe atopic dermatitis have IgE-mediated food allergy 3, 4.
Family history of atopy and presence of atopic dermatitis are established risk factors for developing both sensitization to food and confirmed food allergy 3.
Children with food allergy have 4 times higher odds of having asthma, and 44% of children diagnosed with asthma have an existing food allergy 1.
Geographic Recognition of Sesame as Major Allergen
Sesame is recognized as a major allergen in the European Union, alongside celery, mustard, lupine, and molluscan shellfish, reflecting its clinical significance 3, 5.
The globalization of the food supply and exposure to new foods or culinary practices may lead to increases in the number of major food allergens in the United States 3.
Clinical Approach to This Child
Testing Considerations
Do not perform routine screening for sesame without clinical indication. Testing should only be done if the child has experienced symptoms (anaphylaxis, hives, facial swelling, vomiting, respiratory symptoms) within minutes to hours of ingesting sesame, or if symptoms occur repeatedly 3, 4.
If testing is indicated, use skin prick testing rather than serum IgE, as IgE testing results in considerably higher rates of sensitization and unnecessary oral food challenges 4.
Remember that sensitization is not equivalent to allergy. A positive skin prick test or specific IgE without clinical symptoms does not constitute food allergy 5, 4.
Introduction Strategy
For standard-risk infants, introduce allergenic foods around 6 months but not before 4 months without prior testing 4.
However, this child is NOT standard-risk given multiple existing food allergies. Consider evaluation by an allergist before introducing sesame, particularly if the child has severe eczema or has experienced reactions to other foods 4.
Critical Warnings
Avoid excessively restrictive diets without documented clinical allergy. Unnecessary elimination can cause serious harm including weight loss, poor growth, calcium deficiency, hypovitaminosis, and kwashiorkor 4.
The severity of allergic reactions cannot be predicted by food-specific IgE levels or skin test wheal size, though the likelihood of reaction is directly related 4.
If sesame allergy is confirmed, this child should be provided with an epinephrine autoinjector, as children with multiple food allergies and asthma have increased risk of severe reactions and fatal anaphylaxis 1, 6.