Life is about to change, but rest assured, food allergies can be managed. It helps if you to adopt a cautious, not fearful, approach and develop a plan. Allergy management is a journey, but one most navigate quite successfully.

Experts in the allergy field advocate for a triple AAA rating when it comes to allergy management: Awareness, Avoidance, and Action (in the case of emergency). This three-pronged approach should give you some assurance and a good foundation to manage your sesame allergy. Your child’s allergies may even include other seeds such as sunflower, mustard, flax, or even perilla or hempseed.

Awareness: Educating Others

Sesame and seed allergies are on the rise, but many still find them unusual. It’s important that your family, friends, child’s coaches and teachers all know about the sesame or other seed allergy. Most people who care about your child will want to help out, although they might forget from time-to-time and offer foods that he or she can’t eat. That’s to be expected.

The concept of “tell, show, do” is a good one for building awareness. You can tell people about the allergy, and even print out a brochure about sesame that’s available from Health Canada. You can show them the auto-injector (and how it’s used) and the MedicAlert bracelet, or print off information about sesame allergy.

Make sure you fill out all the necessary anaphylaxis emergency plan form with photo for your child. Provide an auto-injector, and meet with teachers to discuss allergies and your strategy.

Make it your goal to build support and create a safe circle around you. Be helpful: Do volunteer to bring sesame and seed alternative foods to group parties: such as the buns without sesame or bring eggplant dip instead of hummus dip which often uses ground sesame. This helps you continue to fit in, and assists those who may be nervous about feeding your child.

Avoidance: Get Alternatives

Not eating or otherwise ingesting sesame (or other seeds) is the key to staying safe and healthy. Making your own food in a sesame-free home is the first line of defense. Many foods can be made with seedless alternatives: you bake granola bars without seeds, make hummus with chickpeas, garlic and olive oil.

Learn to read labels. Every time. The labeling of sesame and other seeds is not required in the U.S., but you can still call a manufacturer if you suspect it might be in the ingredients. In Canada, sesame is one of the priority allergens and must be listed in store-bought food ingredients. Learn the alternate names for sesame (see below) and beware of generic items like “spices” or “vegetable oil” that can contain sesame seeds or their oils.

Try to stick to foods from countries with stricter labeling requirements. Since sesame is used extensively in baking and imported foods from Asia – where there are not strict allergen controls, you may want to avoid buying those items and make an alternative versions of them at home.

Read food allergy labels carefully every time. Ingredients do change. One popular spaghetti sauce recently began adding sesame oil after years of using another type.

Next: Eating Out Safely

Sesame’s reach became more sticky, more apparent, and more extensive. There was no take out sushi, Indian food or Chinese food. There was none of my preferred combo: sesame crackers with peanut butter atop. And, unexpectedly, there were no more of my favourite indulgences: Creme de la Mer skin cream and fancy Gel Express Aux Fleur Sisley face masks. Sesame, the oily seed, also lodged itself in unexpected places: adhesive bandages and pharmaceuticals.

When my son was diagnosed with a potentially life-threatening allergy as a 1-year-old, I was initially glad he didn’t have a peanut allergy. Who had heard of sesame? How bad could that be? Sesame had much less awareness (and the peanut allergy was yet to come). Who knew that — on top of the grinding worry — so much of the world would become denied to us?

Food writers try to describe the taste of sesame, but they always seem to fall short. Sesame is nutty, they say. But not really. It has a spectacular taste unto its own, one that adds spark and refinement to so many foods. Sesame harkens back to Ethiopia and is a central ingredient in many of the world’s great cuisines: Indian, Thai, Chinese, Middle Eastern.

My son’s first birthday invitation came when he was kindergarten. It was to McDonald’s. Of course, sesame’s reach is firmly embedded in that American icon: the McDonald’s hamburger bun. He did not go to the party.

We discovered the allergy on the last hour of a six-hour car ride from Calgary to Jasper. Our one-year-old was fussing, I gave him a Sesame Snap to suck on. You know how the story goes: his face became red and blotchy, then puffy, his eyes began to swell shut. When we checked in at the hotel, the receptionist took one look and said: “Do you need the number of the hospital?”

We called. We could come down and have him assessed, the nurse said lamely. We were tired. We thought we’d wait. It was only sesame, I thought. We waited, his swelling went down. Later, there was a visit to the allergist for skin testing. There would be no more sesame in our house, or peanuts or sunflower seeds.

The joy of sesame is lost. When my husband buys sushi with sesame in error, we wait until the kids are in bed. We eat it in stony silence. There’s little joy to be had from sesame any more. Not in the house, not in a bed, not with a cat, not with a mouse, move over green eggs and ham. There will be no sesame, Sam I am.

At the same time, there was no sesame, of course, there was sesame everywhere. At every friend’s lunch and in every restaurant, sesame was much more in evidence than I’d ever suspected. I would become familiar with the work of a young Spanish scientist, Estibalitz Orruno, at the University of Leeds. Under a grant from the Basque government, she undertook a doctoral degree studying sesame allergy.

And what a spectacular seed sesame was found to be: 42 to 54 per cent oil, 22 to 25 per cent protein, full of folic acid, niacin, calcium, phosphorus. The cost: cheap. In addition to taste, sesame also won’t go rancid. Orruno examined sesame’s proteins and sought to isolate ones that might cause the allergic reaction; she documented sesame’s world dominance in terms of use, and its fast rise as a source of allergic reactions.

The irony of the purpose of the proteins is not lost. Their role is to promote germination and continue the lineage. Yet at the same time, increasing numbers of people have life-threatening reactions to these very same proteins.

Little lingering seeds. There has been an evolution in the seven years since my son’s diagnosis. A pamphlet is now available from Health Canada – “Sesame Seeds: One of the nine most common food allergens,” and every bakery slaps on a “may contain” warning about sesame. Our bread maker does overtime.

We travel within Canada and to the United States, but foreign travel, to the exotic places where sesame is prevalent, is avoided for now. Instead we hope for scientific breakthroughs that will allow the wonderful world that sesame inhabits and represents to open to us again.

Janice Paskey is a writer and editor who lives in Calgary.

Five people were sent to hospital by ambulance. Since then, Allergic Living has been trying to find out whether these were cases of anaphylaxis and if so, what caused them. While the Public Health Agency of Canada has not issued a public report and the investigating allergist would not speak to the media, Alberta health authorities will say that only one of the reactions was definitely anaphylaxis. Two reactions have been attributed to anxiety, and the causes of another two remain unknown. The sixth person refused to participate in the follow-up investigation.

There are trace amounts of egg protein in the MMR shot, but that is not considered a culprit in this situation. Recent clinical trials suggest that, under a revised manufacturing process, there is not enough egg protein in the vaccine to cause an allergic reaction. With egg ruled out, health authorities have gone to lengths test the individuals involved, as well as the vaccine.

Health Canada requested that the lots of the vaccine, manufactured by Merck & Co., be quarantined. Alberta Health hired an expert to review the cases and perform an allergy challenge in a medical setting on those who had reacted to the MMR vaccine. One person reacted again, while officials concluded that anxiety, which can mimic anaphylaxis in acute cases, caused reactions in two other cases. The reasons for the original symptoms in the remaining two subjects could not be resolved.

Meanwhile, the Public Health Agency of Canada investigated whether the suspected allergic reactions were caused by a factor other than the administering of the shots. For example, was there an interruption in the refrigeration of the vaccine as it was transported? For its part, Merck looked at its manufacturing process for the vaccines in question. Both found nothing wrong.

In short, health authorities are stumped. “The reactions appear to be related to the individual hosts, all of whom had a history of allergies and a history of at least one dose of a measles-containing vaccine in the past,” noted one health region.

The authorities are now considering the antibiotic called neomycin, found in the vaccine, as well as gelatin, used as a stabilizer, as possible causes. Dr. Mark Greenwald, a Toronto allergist, is surprised that gelatin hasn’t come under more scrutiny, since it’s derived from animal (pig) protein, and sensitivity to gelatin has been raised in studies elsewhere.

In 2002, the Centers for Disease Control and Prevention in Atlanta began to look at allergic reactions to gelatin after Japanese researchers found some sensitization in earlier Diphtheria Tetanus Pertussis vaccines. The U.S. researchers found that, among those with allergic reactions to the MMR vaccine, one-quarter had IgE antibody sensitivity (a marker of allergy) to gelatin.

Still reactions are rare. In Canada, millions of MMR shots have been given since 1988, with only been 21 reports of anaphylaxis.

With the vaccine program up and running again, Alberta Health suggests that anyone with known severe allergies to neomycin or gelatin discuss them with a physician prior to being immunized. Will that prevent any further reactions? At this point, no one can say for sure.

From the Fall 2008 issue of Allergic Living magazine.
To order that issue or to subscribe, click here.

Today, Sean Randall, a 43-year-old artist, thinks it’s in a drawer somewhere. I always ask him if he has life insurance since Sean has allergies and asthma, the combination considered the most high risk for life-threatening reactions. A severe asthmatic as a child, he spent time in the oxygen tents, and now takes the controller drug Advair daily.

He has been coping in his own way for years. As a student in boarding school in Winnipeg, he never ate toast because the knives had been in peanut butter as well as jam jars.

“You manage,” he says. “You learn breakfast is cereal, you learn self-discipline.” Sean once ate a peanut by accident in a restaurant with low lighting, and had an anaphylactic reaction. He added to his strategies: “be more vigilant when eating in darkly lit restaurants.”

Rather than carrying an auto-injector, he figures a call to 911 will save him in a crisis. “It’s less of a decision and more of laziness. If you don’t use something for 20 years, it doesn’t seem necessary.”

Largely, he relies on avoidance: no peanuts are allowed in their house in Regina, and he doesn’t go to restaurants, such as Thai eateries, that use peanuts in the kitchen. He also avoids bake sales and has learned “the hard way” which chocolate bars will set off a reaction.

Still, my sister and I hope to wear him down yet, and finally get that prescription refilled.

Reprinted from Allergic Living magazine.

Related Reading:  The Allergy Deniers

The amount of food the average child comes in contact with at the modern school is several times what his 30- or 40-something parent encountered as a pupil. Today’s staples include the pizza-at-school fundraisers, rich and fatty cafeteria food, and school vending machines brimming with oversized beverages and chocolate bars.

Add to the mix the modern child’s obsession with computers, the hours of instant and text messaging time, and results are a shocker: kids across Canada and the United States are more overweight now than at any other time in history.

Between 1978 and 2004, government statistics show that the proportion of overweight Canadian kids aged 6 to 11 doubled to 26 per cent, while the rate of teenagers who were too heavy also doubled – to a whopping 29 per cent. The rate of obese teens tripled to 9 per cent.

Due to weight issues, the federal government stated that, for the first time, this generation of children might not live as long as their parents. In the United States, over the past three decades there has been a doubling of obesity rates for preschoolers and teens, and a tripling for the 6-to-11-year-old group.

“Kids are drinking more sugary drinks, and you have exercise being designed out of their lives,” says Dr. Brian McCrindle, a cardiologist at The Hospital for Sick Children in Toronto, professor of pediatrics and author of Get a Healthy Weight for Your Child. “Because of safety concerns, they don’t play outside, and you see a proliferation of sedentary pursuits, video and computer.”

As children have grown ever heavier, the concurrent trend, of course, is the skyrocketing of food allergy. A study from Mount Sinai’s School of Medicine in New York, published in 2004, confirmed what allergists knew anecdotally; the incidence of food allergy in the U.S. had doubled, and those statistics are mirrored in Canada. Six to 8 per cent of Canadian school children now have food allergies, which can cause dangerous, even life-threatening reactions. Provinces and states are considering and, in a few cases, passing anaphylaxis-readiness laws in the schools.

But as those bring restrictions on what is appropriate for the lunchbox, simultaneously, the weight issue has grabbed the attention of educators and the media. The result: the pendulum is beginning to swing toward better nutrition in some schools. This means a new focus on fruits and vegetables, which happens to dovetail neatly with concerns about allergens in the class, since those foods are not the top allergenic sources, and they won’t lead to accidental exposures.

The Institute of Medicine, a scientific advisory group based in Washington, produced a report in April, 2007 calling for a dramatic new approach to food in the classroom: no food as rewards; no food for celebrations. Then it ranked foods into tiers. Tier 1 is acceptable: fruits, vegetables, real juice, low-fat dairy, and nothing with trans fat.

These are the only snack foods to be allowed for elementary school children and fundraising efforts, while higher-fat and sugary Tier 2 food could be available for after-school activity for teens. No snack, though, should be more than 200 calories.

Next: Banning the cafeteria fryer