Outcomes of sesame oral food challenges using different forms of sesame: Pediatric multicenter review.

Background: Some sesame-allergic individuals appear to tolerate whole sesame seeds while reacting to concentrated sesame products (tahini). It is unclear whether various forms of sesame may influence the outcome of sesame oral food challenge (OFC). Objective: We sought to describe the outcomes of sesame OFCs using different forms of sesame (whole seed, crushed seed, tahini), discover the threshold dose during OFCs, and examine how these forms affect cumulative dose ingested and anaphylaxis rate. Methods: A retrospective review of children with sesame allergy assessed at allergy clinics at 4 centers across Australia. Their OFCs were performed between January 1, 2007, and December 31, 2021, with different forms of sesame. Results: A total of 307 sesame OFCs were analyzed, and 104 patients (34%) experienced reactions. Overall, 28 (9.12%) of 307 participants had anaphylaxis during sesame OFC. A higher level of reactivity in children challenged with whole sesame was found compared to children challenged with crushed sesame or tahini. However, patients who received the latter had a lower median skin prick test result and were affected by referral and selection bias. The anaphylaxis rate was higher in patients who received tahini for OFC, and there was a trend toward significantly lower threshold and cumulative doses in children who developed anaphylaxis within the tahini and crushed sesame groups. Conclusion: Different forms of sesame may affect sesame OFC results. Whole sesame seeds may not be a suitable form of sesame for OFC, and tahini is recommended. Rates of anaphylaxis in sesame OFC are high compared to other common allergens.