Determination of Sesame Allergen Threshold Doses
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Keren Golobov, BScNutr RD, Tamar Yichie, BScNutr RD, Michael B. Levy, MD FAAAAI, Michael R Goldberg, MD PhD, Liat Nachshon, MD, Arnon Elizur, MD, Yitzhak Katz, MD FAAAAI

Sesame food allergy (SFA) already represents a major food health issue in Israel, and with the growing popularity of the "Mediterranean diet," it is an emerging concern in the US. Data on the lowest observed adverse effect level (LOAEL) and the no-observed adverse effect level (NOAEL) to sesame, is lacking, with broad implications on precautionary allergen labeling (PAL) practices.


A retrospective analysis of oral food challenge (OFC) results of patients with a clinical history of SFA and a positive skin prick test (≥ 3 mm wheal) and/or patients enrolled in a sesame oral immunotherapy (OIT) program was performed.  A physician-supervised OFC was started at a dose of 0.3 mg of sesame protein followed by subsequent dose escalations that continued until a clinical reaction occurred.  


OFC were performed in 53 patients aged 7 months to 21.3 years (median 7.36 years).  Thirty-four subjects (63%) were male.  Seven out of 53 patients (13.2%) reacted at 15.7 mg or less, four of whom were left censored. 23/53 (43.4%) reacted at 60 mg protein or less.  The LOAEL value for sesame was 3 mg (n=1) and its NOAEL was 0.3 mg protein (n=49).


Data from this single center and the largest to date cohort of SFA patients suggests allergen threshold levels similar to those reported for peanuts.  This information is essential for the establishment of clinical and PAL guidelines.