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Sesame allergy


Is there a difference in using whole sesame seeds (hulled) vs ground seeds for oral challenges, as long as the total amount of ingested protein is equivalent? Another allergist recently commented to a colleague that she would not use whole sesame seeds (did not specify hulled or not) for an oral challenge (and instead use ground seeds) because there are "different proteins inside and outside of the seed". And so, one could ingest the seeds, and seem fine, but as they digest the seeds, start having reactions (which may wax and wane as the digestion continues) - and gives an example of one of her patients to whom that happened. I had not heard this and she has not provided any references. I cannot find anything in my lit search. Based on what I see of sesame seeds, if they are hulled (as they typically are in the US), the "inside" should be accessible to the immune system readily, and not matter if whole or ground.


I have asked Dr David Fleischer to offer his insights into this question and his reply is below.

"I also asked our food allergy dietitian, Carina Venter, about this, as we have recently switched to tahini over seeds. She said if you use whole seeds, the patient should chew them, which most do not do, as we would mix them in pudding or yogurt and have them swallow them. So you may want to grind them up a bit and then mix them in with something, or use tahini mixed with something.

There are no published data yet – there may be something published in the coming weeks-months about this in Annals, as a paper was accepted on this (I do not have any more details than it apparently was accepted)."

I hope this has been helpful
Andrew Murphy MD FAAAAI