Maren Koharski, a nurse at Walter Reed National Military Medical Center, was on her way home from a kids party when she shared a snack of hummus and pretzels with her 18-month-old son, Oliver. He began playing with his lip, and soon there was a big welt. Within 10 minutes his face was splotchy and the red marks had spread to his hands and face. Ten minutes after that, his lips were swollen and he was having trouble breathing.
Koharski raced to the nearest emergency room, where Oliver was treated with epinephrine for an severe allergic reaction.
The culprit? Sesame seeds in the hummus. Oliver, now almost 4, has had three trips to the ER since then — one from a pita chip whose ingredient label did not reveal that it contained sesame, another after eating a piece of bread with a sesame seed on it, and another accidental exposure.
“Knock on wood, we haven’t had any exposure in over a year,” said Koharski, who lives in Ashburn, Va. “Mostly because we now know the rules.”
Her rules include reading food ingredients carefully, calling companies to double-check food labels and watching over everything her son eats.
Her sesame surveillance may become easier if Congress mandates the labeling of sesame.
In Canada, the European Union, Australia and New Zealand, sesame seeds and products derived from them are required to be listed on food labels.
A 2014 petition filed by the Center for Science in the Public Interest asked the Food and Drug Administration to require labels on foods that contain sesame or have cross contact during manufacturing. In June of this year, Sens. Chris Murphy (D-Conn.), Richard Blumenthal (D-Conn.) and Edward J. Markey (D-Mass.) took up the issue, calling on the FDA to require sesame labeling because of the severe health risk to those with allergies.
In a letter to the FDA, the senators noted that when Congress passed the Food Allergen Labeling and Consumer Protection Act in 2004, the measure included milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soy, and was intended to cover 90 percent of all allergies.
Now, “allergists consider sesame to be an emerging allergy concern, affecting an estimated 300,000 to 500,000 people in the United States,” in part because of the growing popularity of Middle Eastern foods such as hummus, they wrote, adding that if the law “were enacted today, sesame would be included on the list.”
Robert Wood, chief of the Division of Allergy and Immunology at Johns Hopkins Children’s Center, said that sesame allergy has seemed to increase in the past 15 to 20 years.
“There is a fairly broad consensus among those of us who see people with sesame allergy that sesame allergy is comparable [to] and as prevalent as [allergies to] some of the individual tree nuts,” said Wayne Shreffler, director of the Food Allergy Center at Massachusetts General Hospital. Tree nuts include walnut, almond, hazelnut, cashew, pistachio and Brazil nuts.
Shreffler said the difficulty of detecting sesame in foods is “not trivial” because the ingredient is often categorized on labels as “natural flavoring” or “spices.”
Most notable is tahini, which contains sesame pulverized into a powder or paste. Wood said it was rare 20 years ago to see a young child have a reaction after eating hummus, but every week now he sees children less than 15 months old with severe reactions after eating hummus. Hummus, a chickpea spread, often contains tahini, and the sesame component of this ingredient usually is not noted on the food’s label.
A 2012 study from the Sackler School of Medicine in Tel Aviv indicates that reports about sesame allergy have grown significantly worldwide over the past 20 years, possibly due to an increase in people experiencing it or to greater awareness of the problem. The authors say that although only one death from sesame has been reported, a significant number of people had allergic reactions severe enough to be life-threatening.
Caroline Stone’s son Bradley, 7, has developed a host of allergies — to peanuts, coconut, tree nuts, kiwis — since he was 1
Stone, who lives in Boston, said Bradley has had six anaphylactic reactions because of his food allergies, and in her effort to keep him safe she has found it most difficult to figure out where sesame may be lurking. Like Koharski, she has taken to calling manufacturers to get a full ingredient list when she’s nervous about a food.
“It would make the world of difference if Congress passes this,” Stone said. “I feel [now] like every meal is a roll of the dice.”
Shreffler says people worried that they might have a sesame allergy should consult an allergist about testing, even though these exams have a high rate of false positives. “There are lots of overdiagnoses [because of the false positives] that lead to unnecessary avoidances. . . . Getting the diagnosis right is worthwhile,” Shreffler said.
He does not advise pregnant or breast-feeding women to avoid sesame as a way of protecting an unborn child, and he said there is no need for a healthy child with no family history of food allergies to avoid sesame products. Shreffler also noted new research — on peanut allergies — that found avoidance of peanuts during pregnancy, lactation and infancy was associated with greater risk of a child’s developing an allergy.
“It is tempting to generalize from peanut, and there already are data for other allergens [milk, egg] suggesting that delayed introduction might be deleterious,” Shreffler said. “For example, researchers at Murdoch Children’s Hospital in Melbourne found that delayed introduction of egg (after 1 year) was associated with a five-fold increased risk of egg allergy.”
Shreffler said the investigators in the peanut study are conducting a similar trial that is evaluating additional foods, including sesame, cow’s milk, wheat, eggs and fish, seeking to determine how to best prevent allergies in children.
Berger is a freelance journalist who writes frequently about health issues.