Allergen

Where It Hides

Alternate Names

Sesame, Other Seeds

• baked goods, e.g., breads, cookies, pastries, bagels, buns
• Bread crumbs, bread sticks, cereals, crackers, melba toast, muesli
• dips, pâtés, spreads, e.g., hummus, chutney
• dressings, gravies, marinades, salads, sauces, soups
• ethnic foods, e.g., flavored rice, noodles, shish kebabs, stews, stir fry
• flavor(ing)
• herbs, seasoning, spice
• margarine
• processed meats, sausages
• risotto (rice dish)
• sesame oil, sesame salt (gomasio)
• snack foods, e.g., bagel/pita chips, candy, granola bars, halvah, pretzels, rice cakes, sesame snap bars
• tahini
• tempeh
• vegetarian burgers
• cosmetics and soaps

• benne/benne seed/benniseed
• gingelly/gingelly oil

seeds

• sesamol/sesamolina
• sesamum indicum
• sim sim
• Tahina
• tahini
• Til
• vegetable oil

• sauces
• salad dressings
• gravies
• dips
• prepared meat products (sausages, hamburger patties)
• spice mixes

• natural flavoring
• spices

• animal food, specifically bird
• vegetable oil
• breads
• crackers
• sunflower seed spreads
• trail mixes (Enjoy Life trail mix does contain sunflower seeds)
• pay attention to the labels on other seed spreads (or nuts, if there are no allergies to nuts) as they may be made on the
• same equipment or in the same facility as sunflower seed spread
• Cosmetics/Soaps

Sources:
-ImmunoCAP
-Canadian Food Inspection Agency

But sesame? Probably not. So how did it land on Health Canada’s list of priority allergens?

In short, in the ‘80s and ‘90s sesame became more common in breads, the popularity of traditionally Middle Eastern foods such as hummus skyrocketed, and bagels, which are often coated with sesame seeds, became a mainstay in the mainstream North American diet.

At the same time, allergists began seeing more and more patients who had experienced serious reactions to the tiny seed – in some practices it even became more common than shellfish and fish allergies – and they suspected that its increased use in our diets was to blame.

Sesame allergy is also seen more commonly in kids who have peanut allergies, and peanut allergies are on the rise, so researchers believe that might be pushing the sesame allergy rates even higher. See: Sesame Seed Allergy Prevalence

But because sesame allergy has only recently come to the fore, some regulatory bodies have yet to catch up. In the United States, food manufacturers must clearly declare the top allergens on its product labels – but as yet, sesame has not yet made that list, so it can still be hidden as “tahini”, “spices” or “natural flavoring”. (It’s also used in cosmetics and pharmaceuticals.)

In Canada, sesame was added to the priority allergens list in 2000, and so must be named on product labels; it is also a priority allergen in Europe.

There’s even a medical report of allergic reaction to hemp seed. In this case, the diner ate hemp-seed covered catfish and ended up in the hospital with anaphylaxis.

Seeds can be quite insidious because not only are they a tasty source of protein, but their oils are used for cosmetics, lotions, bandages, and even insecticides.

Be especially careful with generic label descriptions like spices and vegetable oil. Seeds can lurk there and in marinades (source: Health Canada).

Be part of an investigative community. On the Allergic Living website, there’s been a feisty discussion about the use of sesame in bandage adhesives. While the Canadian Food Inspection Agency lists bandaids as a carrier of sesame, it does not require manufacturers to list this as an ingredient. Your sleuth skills need to be honed because sesame comes under many names. According to Health Canada, watch for the following.

Other Names for Sesame Seeds

Benne/benne seed/benniseed
Gingelly/gingelly oil
Seeds
Sesamol/sesamolina
Sesamum indicum
Sim sim
Tahina
Tahini
Til
Vegetable oil

Possible Sources of Sesame

Aqua Libra (herbal drink)
Baked goods: breads, cookies, pastries, bagels, buns
Bread crumbs, bread sticks, cereals, crackers, melba toast, muesli
Dips, pâtés, spreads, e.g., hummus, chutney
Dressings, gravies, marinades, salads, sauces, soups
Ethnic foods, e.g., flavoured rice, noodles, shish kebabs, stews, stir fry
Flavour(ing)
Herbs, seasoning, spice
Margarine
Processed meats, sausages
Risotto (rice dish)
Sesame oil, sesame salt (gomasio)
Snack foods: bagel/pita chips, candy, granola bars, halvah, pretzels, rice cakes, sesame snap bars
Tahini
Tempeh
Vegetarian burgers

It’s good to understand the foreign names for seeds. From the Epicentre Website:

Other Sesame Seed Names
Bene Seeds, Beniseed, Benne, Gingelly, Gingili, Gingilli, Semsem, Simsim, Teel, Til
French: sesame
German: Sesam
Italian: sesamo
Spanish: ajonjoli, sesamo
Arabic: tahina, tahine, tahini
Chinese: chi mah, hak chi mah (black sesame)
Indian: gingelly (oil)
Japanese: goma, kuro goma (black sesame)
Malay: bene, bijan

Health Canada also developed criteria with which it can assess new potential priority allergens in the future. “That is important because that now says there’s a standard to follow,” says Marilyn Allen, a food allergy consultant to Health Canada and Anaphylaxis Canada.

The criteria say that when evaluating a potential priority allergen, Health Canada will examine the severity of reactions to a food, the data available on the prevalence of allergic reactions to it, as well as the level of exposure to the food in Canada. Staff will also research what other countries are including on their priority allergen lists.

The addition of mustard to the allergy list is a good example of the process. That allergy isn’t particularly widespread, but reactions that have occurred have been severe, and mustard is used in many products in Canada and is easily hidden behind words like “spice,” Allen says

The move to include mustard on the priority list will help people with mustard allergy and their families identify what foods are safe to eat. “It will make our lives easier in terms of labeling,” says Julie Mototsune. She’s had to avoid everything from soups to potato chips to prepared meats because of her 7-year-old’s mustard allergy.

Health Canada expects the regulations to become final by the end of 2010, at which point food manufacturers will have an 18-month implementation period.

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

A recent Canadian population survey estimates that .23 per cent of Canadian children have a “probable” allergy to sesame, considerably less than the 1.68 per cent who have a probable allergy to peanuts and the 1.59 per cent to tree nuts.

Yet scientists say sesame allergy is on the rise, and at a far faster rate than other allergens. Sesame seed allergy is most commonly seen in children, but often carries on into adulthood as well, or can develop in adulthood.

People can also be allergic to many other seeds, including sunflower seed, mustard seed, rapeseed, flaxseed and poppy seed, although these allergies are much less common.

Mustard Seed Allergy

Canada is in the process of adding mustard seed to its list of priority allergens because, even though few people have the allergy, those who do tend to have severe reactions.

Mustard is already included on the European Union’s priority allergen list, but neither sesame nor mustard is currently included among the top allergens in the United States.

Allergies to seeds can be severe, and can cause anaphylaxis, the life-threatening allergic reaction that can affect multiple systems in the body, including the cardiovascular system, the respiratory tract, the skin and the gastrointestinal tract.

Symptoms can include tingling in the mouth, swelling around the face and throat, itchiness, difficulty breathing, abdominal cramping, vomiting and diarrhea, and even a sudden drop in blood pressure, loss of consciousness, or cardiac arrest, which can be fatal. As a result, it is critical that people with serious sesame, mustard or other seed allergies carry an auto-injector (an EpiPen or Twinject) with them at all times.

Why More?

There are several theories about why seed allergies, and especially sesame allergies, appear to be on the rise in North America. Scientists believe that the increased prevalence of sesame in our diets is at least partly to blame, with foods such as bagels, hummus, halva and other traditionally Middle Eastern and Asian foods, which used to be specialty items, having become mainstream favourites. (In countries such as Israel, where sesame has been a very common food for decades, sesame allergy is very common – even more so than tree nut or peanut.)

Sesame is also commonly added to rice cakes, granola bars, veggie burgers, sauces, soups, salad dressings, margarine and many other foods. Bakeries, as well as Middle Eastern and Asian restaurants are considered especially high-risk for people with sesame allergies.

Sesame seeds are also used in many cosmetics, soaps, hair-care products, and in some medications, sunscreens, ointments and pet foods, so it is relatively difficult to avoid.

See: Where Seeds Hide

Cross-Reactivity

People who are allergic to sesame also may react to poppy seeds, kiwi fruit, hazelnuts and rye grain, as the proteins in these foods are thought to be similar. A recent study has also shown a possible link between peanut allergy and sesame allergy, so the growing prevalence in peanut allergy may actually be playing a role in sesame’s increasing allergy presence.

However, while many peanut-allergic people may test positive for sesame on a skin test, they may still be able to eat it the seeds safely, so it’s important that they discuss the issue with their allergist.

Moreover, people who are allergic to one type of seed may not be allergic to others, or to the cross-reacting foods, so patients should work closely with their physicians to arrive at an accurate diagnosis.

Who Knew?

While allergies such as peanuts, tree nuts, wheat and milk are relatively familiar to the general public, fewer people have heard of sesame allergy. This is a concern for allergy practitioners and those living with sesame allergies since others may be less understanding or vigilant around a sesame allergy as opposed to a peanut allergy.

In one study of allergic parents in Boston, only one in five had understood the allergenic potential of sesame before their children tested positive.

Sesame at the Store

Since sesame is included on the priority allergens list in Canada and Europe,, this means those producing products containing sesame face stricter regulations when it comes to product labeling. As yet, sesame is not considered a priority allergen in the United States.

So in the U.S., it is not mandatory for food manufacturers to declare sesame on labels, and the seed may be hidden in ingredients such as “spices”, “natural flavor” and “tahini”. As a result, people with sesame allergies are encouraged to read product labels very carefully, and to contact food manufacturers when any ingredients are non-specific or unclear.

If you have an allergy to sesame, do not eat any food that may contain sesame, even in trace amounts.

Beware Sesame Oil

People who are allergic to sesame should also carefully avoid sesame oil. Unlike other oils such as corn and peanut oils, which are refined to the point where there is little or no allergenic protein left, sesame oil is made by cold-pressing sesame seeds and is not refined, so retains most of its allergenicity.

But the patients coming through Ham Pong’s offices in Ottawa and Vancouver were telling a very different story. Not only were more of them reacting to sesame, but those reactions tended to be severe; in fact, more of his patients were experiencing full-blown anaphylaxis from eating sesame products than from shellfish.

A more formal survey of more than 2,000 patients confirmed the allergist’s suspicions – but many of his colleagues were still not convinced. “I presented a study at an allergy meeting, and one of the allergists didn’t believe that sesame was a problem. So he asked parents for a show of hands of how many of their children had sesame allergy, and he was very surprised “at how many hands went up,” recounts Ham Pong. “It took him aback because there was no published literature on its prevalence at the time.”

Since then, there has been a significant amount of scientific literature to show that sesame is yet another one of those especially problematic foods, to the point where the European Union and Canada have added it to their priority allergen lists, which include peanuts, tree nuts, dairy, wheat, eggs, fish, shellfish and soy. The United States is investigating whether to follow suit.

But sesame isn’t the only new culprit to gain priority status in Canada; nor is it the only emerging allergen on the radar of North American scientists. The fact is, our diets are constantly in flux – often because particular foods are found to have special disease-fighting properties and become trendy, or because people from around the world bring their culinary influences with them when they arrive on North American shores.

In turn, those foods – from sushi to hummus to curry – get woven into our ever more colorful mainstream diet. Those constantly changing grocery lists, however, mean that our society’s allergies are bound to see shift as well.

“Until kiwi became popular because of the high levels of vitamin C, you didn’t see a lot of kiwi allergy – but now you see a fair amount because it’s a very allergenic fruit,” says Ham Pong. “But if there wasn’t much of it in the diet, it wouldn’t really be an issue. So what makes a food a problem in society is how allergenic the food is, and how much that food is adopted as part of the daily diet.”

Open Sesame

That’s likely what happened with sesame, says Dr. Robert Wood, director of pediatric allergy and immunology at the Johns Hopkins University School of Medicine in Baltimore. The seed became more common in breads, the popularity of traditional Middle Eastern foods such as hummus skyrocketed, and bagels, which are often coated with sesame seeds, became a mainstay in the mainstream North American diet.

And unlike some oils such as peanut and corn whose proteins are almost entirely removed during the refining process, Wood adds that sesame is a raw oil, and as a result can be just as allergenic as the seeds themselves.

“In our practice, it has become much more common, and appears to be the fourth or fifth most common allergen we deal with,” says Wood. In addition to pointing the finger at the increased prevalence of sesame in our diets, Wood says that one of the most notorious allergens on the list may also be adding to the problem.

“We see sesame allergy more commonly in children who also have a peanut allergy, and we suspect that there are some similarities in the allergens in sesame and peanuts,” he explains. “So there may be some of the sesame allergy that’s actually being driven by the increase in peanut allergy.”

But because the prevalence of sesame allergy is relatively new, regulatory bodies have yet to catch up. In the United States, food manufacturers must clearly declare the top allergens on its product labels – but as yet, sesame has not yet made that list, so it can still be hidden as “tahini”, “spices” or “natural flavouring”. (It’s also used in cosmetics and pharmaceuticals.)

In Canada, sesame was added to the priority allergens list in 2000, and mustard is in the process of being added as well, but the country has yet to enact new regulations that require manufacturers to label all priority allergens in clear language.

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.

Reading labels is a way of life when you or a member of your family has an allergy to sesame. Before eating anything in a package, be sure to read the label carefully. Look for hidden sources of sesame or other seeds that may be troublesome to you and alternate names shown for them.

Also be on the lookout for precautionary statements. These are statements that indicate an allergen may be in the food, due to cross contamination during processing. Examples of precautionary statements include: “May contain sesame” and “Manufactured in a facility that contains sesame.”

Allergists generally advise people with  sesame or other seed allergies to avoid all products that contain precautionary statements about their allergens. If you are ever uncertain about whether a food product is safe for you, call the manufacturer to confirm. When in doubt, don’t eat it.

In Canada, new regulations have been proposed that would require food manufacturers list priority allergens in plain language on packaging, rather than using alternate names (ie: tahini, for sesame). Ingredients of ingredients that are priority allergens would also have to be listed. For example, manufacturers couldn’t simply list “flavouring” if the source of the flavouring is a priority allergen, such as mustard.

More on Canada’s New Food Allergen Regulations.

In the United States, the Food Allergen Labeling and Consumer Protection Act went into effect in 2006. FALCPA requires manufacturers to use plain language when listing priority allergens, and to declare all allergens either in the ingredient list, or in a “Contains:” statement at the end of the list.

The allergens included in this regulation are milk, eggs, fish, shellfish, tree nuts, wheat peanuts and soybeans. These regulations do not include sesame and mustard, unlike the proposed Canadian regulations.

Separate legislation requires companies to declare sulphites if they are present at more than 10 parts per million, or if they had a technical or functional effect in the food.

Both Canada and the United States are studying ways to regulate the precautionary statements used on packaged food labels.

In Canada, 0.9 per cent of people have the allergy and in the United States that figure is 0.1 per cent.

For other seeds, such as mustard, the prevalence isn’t known. However, what is clear is that food allergy, including allergies to seeds, is on the rise in North America and other developed countries. In Canada, an estimated 7.5 per cent of people have food allergies, representing more than 2.5 million people. In the United States it’s estimated that 12 million Americans (or just under 4 per cent of the population) have food allergies.

A major study in the United States recently found that cases of peanut allergy in children more than tripled in a decade, and that more than 3 million Americans now have a peanut or nut allergy.

Here are the rates of some of the major allergens in Canada and the U.S.

CANADA

Source: Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) study. Published in the Journal of Allergy and Clinical Immunology, June 2010.

UNITED STATES

Peanut, Tree Nut or both:
Children -  2.1 %
Adults – 1.3 %

Source: US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. Published in the Journal of Allergy and Clinical Immunology, June 2010.
Source: AAAAI