Le sésame

Référence	Pays	Recrutement	Clinique positive	TC positifs
	Allemagne	1 adulte avec A* au sésame		arachide : non
	France	9 all. au sésame (dont 5 A)		arachide 2 / 9
	France	14 enfants all. au sésame(1 avec A)		arachide : 5 / 14
	Italie	1 enfant avec A au sésame		arachide : non
	France	2 enfants all. au sésame		arachide : aucun
	Israël	23 enfants all. au sésame (A chez 30%)	arachide 5 / 23
	Japon	16 enfants all. arachide	sésame 1 / 16
	USA	19 adultes all. noix de cajou	arachide 11 / 19 sésame 2 / 19
	USA	37 all. noix	arachide 17 / 37 sésame 1 / 37
* A = réaction anaphylactique

[1] - Stevens WJ, Ebo DG, Bridts CH, De Clerck LS. Anaphylaxis to Sesame (Sesamum Indicum) Seed and Sesame Oil. AAAAI 58th Annual Meeting, New York, 1-6 March, 2002, Poster n°650

A 42-year old man with house dust mite and pollen allergy was referred to our department because of several allergic reactions within minutes after consumption of sesame seed containing food such as bread and pancakes. Initially he suffered from urticaria but progressively more severe reactions with angio-oedema, bronchospasm, hypotension and shock had occurred. The last episode occurred in connection with consumption of meat and vegetables without sesame seeds but the food was backed in sesame oil (Chinese wok). Results are summarized in the table. After in vitro allergen-specific stimulation basophils become activated and express the membrane activation marker CD63. This up-regulated expression of CD63 on the plasma membrane can be detected by flow cytometry using monoclonal antibodies like anti-CD63-PE. Calculating the net percentage of basophils that express CD63 relative to buffer control allows assessing basophil activation. Sesame and its derivatives are widely employed in food industry and in the cosmetic and pharmaceutic industry as vehicles for parenteral and topical therapeutics because of their presumed low allergenicity. Anaphylaxis due to ingestion of sesame seed containing food has been increasingly reported. Reactions occurred in connection with a broad variety of foods in which the presence of sesame was not always apparent. Symptomatology included pruritus, erythematous rashes, urticaria, angioedema, nausea, vomiting, dyspnea and bronchospasm, hypotension and shock. Anaphylaxis from sesame oil is considered to be anecdotal. This case report confirms that anaphylaxis due to sesame oil can occur and that the basophil activation test can be a safe and reliable method for in vitro diagnosis of food allergy.

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[2] - Birnbaum J, Porri F, Castelain M, Vervloet D. Sesame seed oil anaphylaxis. J Allergy Clin Immunol 1997;99:S145

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[3] - Morisset M, Moneret-Vautrin DA, Kanny G, Guénard L, Beaudouin E, Flabbée J, et al. Thresholds of clinical reactivity to milk, egg, peanut and sesame in IgE-dependent allergies: evaluation by double-blind or single-blind placebo-controlled oral challenges. Clin Exp Allergy 2003;33:1046-1051

BACKGROUND: The prevalence of food anaphylaxis due to masked allergens has increased within the last 10 years. Contamination of manufactured products by food allergens is a key concern for food industries . OBJECTIVE: To determine quantities eliciting reactions in patients who have an IgE-dependent food allergy, thanks to standardized oral provocation tests. To evaluate the subsequent levels of sensitivity required for the detection tests of allergens for egg, peanut, milk and sesame . METHODS: Prick-in-prick tests, Cap system RAST, and single or double-blind placebo-controlled food challenges (SBPCFC or DBPCFC) were performed. The doses of natural food were gradually increased from 5 to 5000 mg for solid food and from 1 to 30 mL for peanut oil, sunflower oil, soy oil and sesame oil . RESULTS: Data from 125 positive oral challenges to egg, 103 to peanut, 59 to milk and 12 to sesame seeds were analysed. Haemodynamic modifications were observed in 2%, 3%, 1.7%, and 8% of the oral challenges (OCs) to egg, peanut, milk and sesame, respectively. Respiratory symptoms were observed in 12%, 20%, 10% and 42% of egg, peanut milk and sesame allergies, respectively. A cumulative reactive dose inferior or equal to 65 mg of solid food or 0.8 mL of milk characterized 16%, 18%, 5% and 8% of egg, peanut, milk and sesame allergies, respectively. 0.8% of egg allergies, 3.9% of peanut allergies, and 1.7% of milk allergies reacted to 10 mg or less of solid food or to 0.1 mL for milk. The lowest reactive threshold has been observed at less than 2 mg of egg; 5 mg of peanut, 0.1 mL of milk and 30 mg of sesame seed. Ten out of 29 OC with peanut oil, two out of two OC with soy oil and three out of six OC with sunflower oil were positive. Five out six OC with sesame oil were positive: 1 and 5 mL induced an anaphylactic shock . CONCLUSION: The risk of asthma and anaphylactic shock to sesame and peanut is confirmed. Minimal reactive quantities show that, in order to guarantee a 95% safety for patients who are allergic to egg, peanut and milk, and on the basis of consumption of 100 g of food, the detection tests should ensure a sensitivity of 10 p.p.m. for egg, 24 p.p.m. for peanut and 30 p.p.m. for milk proteins. Oil allergies being considered, the limit of sensitivity should fall to 5 p.p.m.

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[4] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[5] - Dezfoulian B, de la Brassinne M. Urticaire de contact par application d'un fond de teint contenant de l'huile de sésame. Alim'Inter 2002;7:252-257

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[6] - Piney D, Commun N, Kanny G. Les allergènes alimentaires à étiquetage obligatoire dans les 50 médicaments les plus vendus en pharmacie. Alim'Inter 2005;10:89-93

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[7] - Dalal I, Binson I, Reifen R, Amitai Z, Shohat T, Rahmani S, et al. Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. Allergy 2002;57:362-365

Objective:To determine the prevalence, importance, and the order of frequency of IgE-mediated food allergens among infants and young children in Israel. Study design and patients:In a cross-sectional study, the prevalence of IgE-mediated food allergy was investigated in 9070 infants and young children (0-2years) who were followed-up at 23 Family Health Centers (FHCs) in central Israel. Patients with suspected IgE-mediated food allergic reactions, were recruited for further evaluation (detailed questionnaire and skin-prick test (SPT)). Results:We identified 150 out of 9070 (1.7%) patients with suspected IgE-mediated food allergy. Among them, 102/150 (67%) [59 males, 43 females; mean age 10.3months] completed a detailed questionnaire and underwent SPT. Evaluation revealed 131 positive SPTs in 78/102 (76.5%) patients. Twenty-seven positive SPTs in 18 patients were considered clinically irrelevant based on previous consumption of the relevant foods without clinical symptoms. Thus, there were 104 relevant positive SPTs in 78 patients. The overall prevalence of clinically relevant IgE-mediated food allergic reactions among these patients is estimated to be 1.2% (104/9070). The most common food allergens were egg, cow's milk, and sesame. Anaphylaxis was the presenting symptom in 14/78 (18%) including six sesame-induced cases. A history of other atopic diseases was reported in 27 (35%) patients. In addition, 22 (28%) had a history of atopy in first-degree family members. Conclusions:We found sesame to be a major cause of IgE-mediated food allergy in Israel. In fact, it is second only to cow's milk as a cause of anaphylaxis. We recommend that testing for food allergens be tailored to each community based on local experience and should include sesame in appropriate populations.

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[8] - Dalal I, Binson I, Levine A, Somekh E, Ballin A, Reifen R. The pattern of sesame sensitivity among infants and children. Pediatr Allergy Immunol 2003;14:312-316

Recently, we found sesame to be a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. The purpose of this study was to describe the different patterns of sesame sensitivity. We have identified three subgroups among our patients (n = 32). Group I (n = 23, M/F; 14/9) consisted of cases with IgE-mediated sesame allergy. The mean age of the first allergic reaction was 11.7 months. Although the main clinical manifestation was urticaria/angiedema (n = 14, 60%), anaphylaxis was the presenting symptom in seven (30%) patients; all of them were younger than 1 year. Sixteen (70%) were found to be allergic to other foods, and other atopic diseases were identified in 18 (78%) patients. Three patients 'outgrew' their allergy within 1-2 years. Group II (n = 2) included cases in whom sesame allergy was ruled out based on a negative skin prick test (SPT) together with a negative open oral challenge. Group III (n = 7) consisted of patients that were found to be SPT positive for sesame as part of a screening for other food allergies. Although sesame products have become fashionable in westernized countries, early exposure may cause sesame to share eventually the same 'noteriety and fate' as peanut - a major cause of severe food allergic reactions.

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[9] - Cohen A, Goldberg M, Levy B, Leshno M, Katz Y. Sesame food allergy and sensitization in children: the natural history and long-term follow-up. Pediatr Allergy Immunol 2007;18:217-223

Sesame food allergy (SFA) in children is an increasingly recognized one in many countries. Our objective was to describe the course and natural history of SFA. Seventy-four patients sensitized to sesame were evaluated using clinical records, questionnaires, skin prick tests (SPT), in vitro specific immunoglobulin (sIg) E, and oral challenges (OC) and categorized into three groups: group A: patients who experienced allergic reaction after ingestion of sesame-containing food (n = 45); group B: patients evaluated for atopic dermatitis and found to be sesame SPT-positive (n = 11); group C: patients with sensitization to sesame allergen (n = 18). Group A patients were followed for an average of 6.7 yr. Analysis of our results revealed that 76% of patients in group A developed the allergy by the age of 2. The median age at onset of allergy in these patients was 1 yr. Immediate reaction to a minimal amount of sesame was characteristic. Skin was the most common site of involvement, followed by respiratory and gastrointestinal systems. Tolerance developed in only 20% of the patients. High sIgE (>0.15 IU) was demonstrated only in 75% of those in which it was examined. Sixteen patients performed oral sesame food challenge which was found positive in 88%. No correlation was found between the size of SPT and the level of in vitro sesame IgE antibodies, the outcome of OC results, and the development of tolerance to sesame. In conclusion, SFA tends to appear early in life, but unlike cow's milk and egg allergy, persists in 80% of the cases. Typical reactions combined with positive sesame SPT are reliable for diagnosis.

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[10] - Agne PSE. Allergie au sésame de l'enfant. Mémoire Capacité Allergologie - Paris V - novembre 2003

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[11] - Agne P, Bidat E. L'allergie au sésame de l'enfant: originalités. Communication: 10èmes Journées Parisiennes d'Allergie - Paris 9-11 janvier 2002

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[12] - Cohen A, Goldberg M, Levy B, Leshno M, Katz Y. Sesame food allergy and sensitization in children: the natural history and long-term follow-up. Pediatr Allergy Immunol 2007;18:217-223

Sesame food allergy (SFA) in children is an increasingly recognized one in many countries. Our objective was to describe the course and natural history of SFA. Seventy-four patients sensitized to sesame were evaluated using clinical records, questionnaires, skin prick tests (SPT), in vitro specific immunoglobulin (sIg) E, and oral challenges (OC) and categorized into three groups: group A: patients who experienced allergic reaction after ingestion of sesame-containing food (n = 45); group B: patients evaluated for atopic dermatitis and found to be sesame SPT-positive (n = 11); group C: patients with sensitization to sesame allergen (n = 18). Group A patients were followed for an average of 6.7 yr. Analysis of our results revealed that 76% of patients in group A developed the allergy by the age of 2. The median age at onset of allergy in these patients was 1 yr. Immediate reaction to a minimal amount of sesame was characteristic. Skin was the most common site of involvement, followed by respiratory and gastrointestinal systems. Tolerance developed in only 20% of the patients. High sIgE (>0.15 IU) was demonstrated only in 75% of those in which it was examined. Sixteen patients performed oral sesame food challenge which was found positive in 88%. No correlation was found between the size of SPT and the level of in vitro sesame IgE antibodies, the outcome of OC results, and the development of tolerance to sesame. In conclusion, SFA tends to appear early in life, but unlike cow's milk and egg allergy, persists in 80% of the cases. Typical reactions combined with positive sesame SPT are reliable for diagnosis.

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[13] - Agne PSE, Bidat E, Rancé F, Paty E. Sesame seed allergy in children. Eur Ann Allergy Clin Immunol 2004;36:300-305

BACKGROUND: Sesame seed allergy is becoming more common in childhood. The aim of this study is to define the clinical signs and the results of allergological work-up of this food allergy as well as the demographical data in children. Sesame seed allergy outcome is unknown. MATERIALS AND METHODS: 14 children were recruited from 3 allergy centers in France. The diagnosis of food allergy was based on a convincing clinical history and positive skin prick tests and/or an elevated sesame specific IgE. Food challenge test was done when results of history and allergological work-up were conflicting. A reintroduction test was done when a child seemed to outgrow his (or her) food allergy . RESULTS: The median age at the beginning of sesame seed allergy was 5 years (range from 5 months to 16 years old). All patients reacted immediately after sesame seed consumption and presented as a first manifestation: edema (9 cases, 48%), urticaria (5, 27%), and one of each of the following symptoms (vomiting, rhinitis, conjunctivitis, asthma and anaphylactic shock). One patient had recurrent anaphylactic shocks and another an anaphylactic shock after subsequent sesame seed exposure; these 2 patients were asthmatic. The median of the wheal size was 5 mm (range 3 to 15 mm). The commercial sesame seed extract was less sensitive than the native seed. The median of sesame seed IgE was 5.58 kUA/L (range 0.35 to 100 kUA/L). The follow up lasted from a few months to 6 years. Three patients outgrew their food allergy. All of these patients showed a previous drop of sesame seed IgE and skin prick-tests became negative . CONCLUSION: Sesame seed allergy is not very different than other food allergy. We reported the spontaneous outgrowing of sesame seed allergy without being able to define the predictive criteria for a good outcome.

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[14] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[15] - MacDougall CF, Cant AJ, Colver AF. How dangerous is food allergy in childhood ? The incidence of severe and fatal allergic reactions across the UK and Ireland. Arch Dis Child 2002;86:236-239

AIMS: To discover the incidence of fatal and severe allergic reactions to food in a large population of children. METHODS: A retrospective search for fatalities in children 0-15 years from 1990 to February 1998, primarily of death certification at offices of national statistics. A prospective survey of fatal and severe reactions from March 1998 to February 2000, primarily through the British Paediatric Surveillance Unit. MAIN OUTCOME MEASURES: were deaths and severe reactions. A case was deemed severe if one or more of the following criteria was met: cardiorespiratory arrest; need for inotropic support; fluid bolus >20 ml/kg; more than one dose of epinephrine; more than one dose of nebulised bronchodilator. A case was deemed near fatal if intubation was necessary. RESULTS: The UK under 16 population is 13 million. Over the past 10 years, eight children died (incidence of 0.006 deaths per 100 000 children 0-15 years per year). Milk caused four of the deaths. No child under 13 died from peanut allergy. Two children died despite receiving early epinephrine before admission to hospital; one child with a mild food allergic reaction died from epinephrine overdose. Over the past two years, there were six near fatal reactions (none caused by peanut) and 49 severe ones (10 caused by peanut), yielding incidences of 0.02 and 0.19 per 100 000 children 0-15 years per year respectively. Coexisting asthma is more strongly associated with a severe reaction than the severity of previous reactions. CONCLUSIONS: If 5% of the child population have food allergy, the risk that a food allergic child will die from a food allergic reaction is about 1 in 800 000 per year. The food allergic child with asthma may be at higher risk. Prescribing an epinephrine autoinjector requires a careful balance of advantages and disadvantages.

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[16] - Dosen AM, Ziegler JB, Kakayos A, Gold M. Australian National Surveillance of Anaphylaxis following food ingestion follow-up data from 2002-3. Allergy Clin Immunol Int 2005;17(Suppl. 1):65

Background Anaphylaxis is a life threatening, acute allergic reaction requiring prompt medical treatment.However, the incidence and mortality from anaphylaxis associated with food is not known.The Australian Paediatric Surveillance Unit study represents the first population based study of food anaphylaxis in Australian children. Aims The objectives of the study are to estimate the incidence of anaphylactic reactions to food in Australian children and their outcome; to describe clinical features of anaphylactic reactions to food and their management;to identify probable causative allergens;and to review current management of anaphylaxis in children. Method & Case Definition Anaphylaxis was defined as an immediate life-threatening, multisystem hypersensitivity response involving at least two of the following four systems: i. angioedoma, urticaria; ii.respiratory: airway obstruction; iii.gastrointestinal;iv.cardiovascular compromise. Cases have been notified if they were less than 15 years of age and had presented to a hospital or medical practitioner for medical treatment, with adrenaline being appropriate treatment. Children are excluded if their symptoms manifest as asthma or wheeze alone, or the allergic reaction is mild and requires no adrenaline treatment.Data was collected from questionnaires sent or emailed to paediatricians and adult allergists who notify cases via the APSU monthly surveillance.The prospective study commenced in July 2002 and ended in Dec 2003. Results There were 303 notifications, which is approx. 17 per month. The return rate on the questionnaires has been 175/303 (58%). Due to 13 invalid notifications there were 162 confirmed cases. Of the 162 cases, 44 (27%) were self limiting and did not need any active treatment. The incidence was 1.4 cases per 100.000. Male to female ratio was 1.6. Mean age is 4.5 years, range 3 months to 15 years. The commonest allergen reported was peanut at 51/175 (30%) then tree nuts at 35/175 (20%). Cashew was the main confirmed tree nut. Milk was the commonest allergen for children less than 2 years being 20% of cases. Five children were admitted to intensive care units and there were two reported deaths from these five. The first in a 15 year old girl known to have peanut allergy. This occurred after accidental exposure to peanut in salad dressing and in physical activity. The second in a 10 year old girl known to have nut allergy and was away from home.

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[17] - Wüthrich B. Lethal or life-threatening allergic reactions to food. J Investig Allergol Clin Immunol 2000;10:59-65

Fatal or life-threatening anaphylactic reactions to food occur in infants, children and adults. Atopic individuals with bronchial asthma and prior allergic reactions to the same food are at a particularly high risk, whereby even the mere inhalation of the allergenic food can be fatal. Not only peanuts, seafood and milk can induce severe, potentially lethal anaphylaxis, but indeed a wide spectrum of foods, according to the different patterns of food sensitivity in different countries. Foods with "hidden" allergens and meals at restaurants are particularly dangerous for patients with food allergies. Similarly, schools, public places and restaurants are the major places of risk. However, the main factor contributing to a fatal outcome is the fact that the victims did not carry their emergency kit with adrenaline (epinephrine) with them. In cases of death where food anaphylaxis is suspected, it is important for forensic reasons to preserve uneaten portions of the food in order to identify (hidden) allergens. It is also important to determine postmortem specific serum IgE, tryptase and histamine levels to document the anaphylaxis. There is a need to raise awareness of the diagnosis and treatment of anaphylaxis among doctors, those called upon to administer emergency medical care, and the public, and also to provide increased support for those with potentially fatal food allergies through the help of patients' organizations, and national and international medical societies. The food industry should ensure a policy of comprehensive labelling of ingredients so that even the smallest amount of potentially lethal foodstuffs can be clearly identified. Finally, the pharmaceutical industry should be persuaded to reintroduce an adrenaline inhaler onto the market.

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[18] - Moneret-Vautrin DA, Kanny G. L'anaphylaxie alimentaire: nouvelle enquête multicentrique française. Bull Acad Natl Med 1995;179:161-172

The frequency of food-induced anaphylactic shocks (FIAS) has been investigated beside 46 emergency departments, 29 departments of Dermatology, and 19 departments of Intern Medicine or Pneumology. 794 A.S have been reported. FIAS represent 10.2% of the etiologies. More than a third of them are relapsing anaphylaxis. Food allergy had been previously identified in 23.4% of cases. The allergen was present as a hidden allergen or inadvertently consumed in 30.8% of FIAS. 9.9% of the patients were asthmatic. An enhancing factor was heightened in 25.9% of cases: alcohol, exercise, simultaneous intake of aspirin, beta-blockers, conversion enzyme inhibitors. Other factors predisposing to food anaphylaxis were a cross-reactivity shared by pollens and fruit, latex and exotic fruit, house dust mites and snails, or mastocytosis. More than 15 allergens were detected: egg (11.6%), fish (10.4%), crustaceans (10.4%), milk (6.5%), fruit-latex group (6.5%), peanut and other legumes (soy, peas, lentils, guar gum...), celery, garlic, etc... The food allergen still remained unknown in 25% of cases. However, the rate of efficiency of the diagnosis reached 94% in the Allergy Units. In addition 10.2% of A.S were considered idiopathic, raising the hypothesis of allergy to masked food allergens. Compared to a previous study from the 1982's, this survey shows a striking increased prevalence of FIAS. The frequency of recurrent anaphylaxis, occurring in one-third of cases, is also highlighted and makes plausible once more the role of masked food allergens. The insist upon the need of a thorough allergologic investigation in all the cases of A.S. An informative labelling about the presence or absence of food proteins which are mostly allergenic should be recommended. The need of a thorough allergologic investigation is supported not only by the incidence of FIAS but also by the incidence of idiopathic anaphylaxis: 10.2%.

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[19] - Moneret-Vautrin DA, Kanny G, Parisot L. Accidents graves par allergie alimentaire en France: fréquence, caractéristiques cliniques et étiologiques. Première enquête du réseau d'allergovigilance, avril-mai 2001. Rev Fr Allergol Immunol Clin 2001;41:696-700

La première enquête menée par le réseau d'allergovigilance concerne les réactions anaphylactiques sévères, survenue pendant un mois (avril ou mai 2001). Les 100 premières réponses ont été analysées et correspondent à 74 allergologues généralistes, 15 pédiatres, huit pneumologues et trois dermatologues. Cent soixante-trois réactions sévères ont été recensées : oedème laryngé (51,5 %), choc anaphylactique (39,9 %), asthme aigu (8,6 %). Ces réactions surviennent chez des enfants de moins de 15 ans dans 46,6 % des cas et chez des adultes dans 53,4 % des cas. Les allergènes les plus fréquents sont : l'arachide et les noix diverses (27,6 %), les aliments croisant avec le latex (11 %), les oeufs (8,6 %), le poisson (6,7 %), les crustacés (5,5 %), le lait (4,3 %), le sésame (4,3 %), le blé (3,6 %), les légumineuses (3,6 %), les coquillages (3 %), la moutarde (1,8 %), le céleri (1,8 %), les additifs (carmin de cochenille, alpha-amylase et sulfites : 1,8 %). La fréquence des réactions sévères en France peut être évaluée entre 15 000 et 30 000 par an. L'asthme aigu grave est rarement rapporté, principalement par les allergologues pneumologues : sa fréquence est probablement sous-estimée. Le rôle prépondérant des fruits à coque dans la genèse des réactions graves est confirmé. Cette enquête souligne la fréquence des réactions allergiques aux fruits croisant avec le latex et au sésame. La fréquence des allergènes incriminés peut varier avec la saison. C'est pourquoi la même enquête sera reconduite en janvier 2002.

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[20] - Kolopp-Sarda MN, Moneret-Vautrin DA, Gobert B, Kanny G, Brodschii M, Bene MC, et al. Specific humoral immune response in 12 cases of food sensitization to sesame seeds. Clin Exp Allergy 1997;27:1285-1291

BACKGROUND: Hypersensitivity to sesame seeds is becoming increasingly frequent, probably owing to the larger use of this compound in international food . OBJECTIVES: This study investigated serum responses of 12 sesame sensitized patients (seven with food allergy, five with food sensitization), to a sesame protein extract, and attempted at identifying sesame major antigens . METHODS: Sesame protein extracts were prepared from black, white and brown sesame seeds. Electrophoretic analysis showed similar protein patterns in the three extracts, and proper preservation of the proteins integrity. The brown sesame extract was used to set-up an ELISA assay and measure serum levels of antisesame IgG, IgA, IgM and IgE in 12 samples from sesame-sensitized individuals and six controls. It also allowed to perform western blot analyses in order to investigate the molecular weight of sesame proteins recognized by IgG, IgA and IgE . RESULTS: Nineteen protein bands were observed upon polyacrylamide gel electrophoresis of the sesame protein extracts. Using this whole extract in ELISA, significant antisesame IgG, IgA and IgE-responses were observed in the serum of sensitized individuals, different from the lower signals obtained with control samples. Western blot analysis demonstrated highly polymorphic IgG and IgA responses and a more restricted IgE response pattern, suggesting that two proteins, respectively, 14 kDa and 25 kDa are mostly involved in sesame IgE-dependent hypersensitivity, the 25 kDa band presenting several characteristics of a major allergen . CONCLUSIONS: This study reports novel information on the possible involvement of a 25 kDa sesame protein in IgE-dependent hypersensitivity to sesame seeds.

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[21] - Frémont S, Zitouni N, Kanny G, Veneri V, Metche M, Moneret-Vautrin DA, et al. Allergenicity of some isoforms of white sesame proteins. Clin Exp Allergy 2002;32:1211-1215

Background Allergy to sesame seeds is often associated with particularly severe reactions, with a high risk of anaphylaxis. The increase in reports of allergic reactions to sesame is probably due to the growing use of sesame seeds or sesame oil in food. Objective To determine the molecular weights of the proteins in three variety of sesame seeds and to study the isoelectric points and the allergenicity of white sesame proteins. Methods Extracts of white, brown and black sesame seeds were prepared. The white sesame extract, mostly used in bakery, was run on SDS-PAGE and two dimensional electrophoresis. Six sera from patients sensitized or symptomatic to sesame seed were used for Western blotting. Results The protein patterns of the white, brown and black sesame extracts showed major quantitative differences. The white extract had the higher protein concentration and contained 15 proteins of 12-79 kDa, some of them having several acidic isoelectric points. The lowest isoelectric point was 4.9 and the highest was 6.4, giving 35 isoforms. Ten of the 15 proteins (12-57.5 kDa) were recognized by specific IgE. The 12-13 kDa and 22-33 kDa proteins could correspond to the main allergens. Conclusion White sesame seeds contain at least 10 allergenic proteins with acidic isoelectric points. In accordance with previous results, two of them seem to contain the major allergens.

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[22] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[23] - Zuberbier T, Edenharter G, Worm M, Ehlers I, Reimann S, Hantke T, et al. Prevalence of adverse reactions to food in Germany – a population study. Allergy 2004;59:338-345

OBJECTIVE: A population study was performed to identify the prevalence of all kinds of adverse reactions to food . METHODS: In a representative cross-sectional survey performed in 1999 and 2000 in Berlin, 13 300 inhabitants of all ages were addressed by questionnaire. This questionnaire was answered by 4093 persons. All respondents mentioning any sign of food intolerance or the existence of allergic diseases (n = 2298) were followed up by telephone and, in case food intolerance could not be ruled out by patient history, were invited to attend to the clinic for personal investigation including double-blind, placebo-controlled food challenge tests (DBPCFC) . RESULTS: The self-reported lifetime prevalence of any adverse reaction to food in the Berlin population (mean age 41 years) was 34.9%. Eight hundred and fourteen individuals were personally investigated according to the guidelines. The point prevalence of adverse reactions to food confirmed by DBPCFC tests in the Berlin population as a mean of all age groups was 3.6% (95% confidence interval [3.0-4.2%]) and 3.7% in the adult population (18-79 years, 95% confidence interval [3.1-4.4.%]). Two and a half percent were IgE-mediated and 1.1% non-IgE-mediated, females were more frequently affected (60.6%). Based on a statistical comparison with available data of adults from the nationwide German Health Survey from 1998, adverse reactions to food in the adult population of Germany (age 18-79) were calculated with 2.6% [2.1-3.2%]) . CONCLUSIONS: The study gives for the first time information about the point prevalence of both immunological and nonimmunological adverse reactions to food and underlines the relevance of this issue in public health. The data also show that an individualized stepwise approach including provocation tests is mandatory to confirm the diagnosis.

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[24] - Derby CJ, Gowland MH, Hourihane JO’B. Sesame allergy in Britain: A questionnaire survey of members of the Anaphylaxis Campaign. Pediatr Allergy Immunol 2005;16:171-175

Sesame is a major allergen in countries where it is a common food. It was noted that an increasing number of members of the UK charity, the anaphylaxis campaign, were reporting allergy to sesame. This study, sought to examine features of sesame allergy among members of the Anaphylaxis Campaign (which supports those at potentially life-threatening risk from allergies) focusing on clinical symptoms and features of the foods implicated. A physician-designed questionnaire was sent by post to 400 members of the Anaphylaxis Campaign who reported avoidance of sesame. Two hundred and eighty replies were received (70%). Twenty-three replies (7%) were excluded and 96 replies (24%) came from subjects who avoided sesame but had never reacted to it. One hundred and fifty people (54%) reported 288 reactions to sesame. 89% of reactive subjects reported other atopic diseases and notably 84% were also nut/peanut allergic. One in six (17%) had suffered potentially life-threatening symptoms, with 65% of severe reactions happening on first known exposure. The age of first reaction ranged from 6 months to 65 yr. The majority of reactions reported (91%) involved foods or dishes which had sesame as a deliberate ingredient, rather than sesame as an accidental contaminant. Respondents represented a well-informed and highly selected group of people at risk from potentially life-threatening allergies. Sesame should be identified clearly as an ingredient and separately from nuts and peanuts when it may be an allergen contaminant. People at potential risk need clear allergy diagnosis and informed guidance to enable them to avoid this key allergen more easily

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[25] - Dalal I, Binson I, Levine A, Somekh E, Ballin A, Reifen R. The pattern of sesame sensitivity among infants and children. Pediatr Allergy Immunol 2003;14:312-316

Recently, we found sesame to be a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. The purpose of this study was to describe the different patterns of sesame sensitivity. We have identified three subgroups among our patients (n = 32). Group I (n = 23, M/F; 14/9) consisted of cases with IgE-mediated sesame allergy. The mean age of the first allergic reaction was 11.7 months. Although the main clinical manifestation was urticaria/angiedema (n = 14, 60%), anaphylaxis was the presenting symptom in seven (30%) patients; all of them were younger than 1 year. Sixteen (70%) were found to be allergic to other foods, and other atopic diseases were identified in 18 (78%) patients. Three patients 'outgrew' their allergy within 1-2 years. Group II (n = 2) included cases in whom sesame allergy was ruled out based on a negative skin prick test (SPT) together with a negative open oral challenge. Group III (n = 7) consisted of patients that were found to be SPT positive for sesame as part of a screening for other food allergies. Although sesame products have become fashionable in westernized countries, early exposure may cause sesame to share eventually the same 'noteriety and fate' as peanut - a major cause of severe food allergic reactions.

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[26] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[27] - Dechamps B, Leduc V, Guérin L. Choc anaphylactique sévère au sésame avec prick-tests et RAST négatifs. Alim'Inter 2006;11:27-28

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[28] - Cohen A, Goldberg M, Levy B, Leshno M, Katz Y. Sesame food allergy and sensitization in children: the natural history and long-term follow-up. Pediatr Allergy Immunol 2007;18:217-223

Sesame food allergy (SFA) in children is an increasingly recognized one in many countries. Our objective was to describe the course and natural history of SFA. Seventy-four patients sensitized to sesame were evaluated using clinical records, questionnaires, skin prick tests (SPT), in vitro specific immunoglobulin (sIg) E, and oral challenges (OC) and categorized into three groups: group A: patients who experienced allergic reaction after ingestion of sesame-containing food (n = 45); group B: patients evaluated for atopic dermatitis and found to be sesame SPT-positive (n = 11); group C: patients with sensitization to sesame allergen (n = 18). Group A patients were followed for an average of 6.7 yr. Analysis of our results revealed that 76% of patients in group A developed the allergy by the age of 2. The median age at onset of allergy in these patients was 1 yr. Immediate reaction to a minimal amount of sesame was characteristic. Skin was the most common site of involvement, followed by respiratory and gastrointestinal systems. Tolerance developed in only 20% of the patients. High sIgE (>0.15 IU) was demonstrated only in 75% of those in which it was examined. Sixteen patients performed oral sesame food challenge which was found positive in 88%. No correlation was found between the size of SPT and the level of in vitro sesame IgE antibodies, the outcome of OC results, and the development of tolerance to sesame. In conclusion, SFA tends to appear early in life, but unlike cow's milk and egg allergy, persists in 80% of the cases. Typical reactions combined with positive sesame SPT are reliable for diagnosis.

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[29] - Kolopp-Sarda MN, Moneret-Vautrin DA, Gobert B, Kanny G, Brodschii M, Bene MC, et al. Specific humoral immune response in 12 cases of food sensitization to sesame seeds. Clin Exp Allergy 1997;27:1285-1291

BACKGROUND: Hypersensitivity to sesame seeds is becoming increasingly frequent, probably owing to the larger use of this compound in international food . OBJECTIVES: This study investigated serum responses of 12 sesame sensitized patients (seven with food allergy, five with food sensitization), to a sesame protein extract, and attempted at identifying sesame major antigens . METHODS: Sesame protein extracts were prepared from black, white and brown sesame seeds. Electrophoretic analysis showed similar protein patterns in the three extracts, and proper preservation of the proteins integrity. The brown sesame extract was used to set-up an ELISA assay and measure serum levels of antisesame IgG, IgA, IgM and IgE in 12 samples from sesame-sensitized individuals and six controls. It also allowed to perform western blot analyses in order to investigate the molecular weight of sesame proteins recognized by IgG, IgA and IgE . RESULTS: Nineteen protein bands were observed upon polyacrylamide gel electrophoresis of the sesame protein extracts. Using this whole extract in ELISA, significant antisesame IgG, IgA and IgE-responses were observed in the serum of sensitized individuals, different from the lower signals obtained with control samples. Western blot analysis demonstrated highly polymorphic IgG and IgA responses and a more restricted IgE response pattern, suggesting that two proteins, respectively, 14 kDa and 25 kDa are mostly involved in sesame IgE-dependent hypersensitivity, the 25 kDa band presenting several characteristics of a major allergen . CONCLUSIONS: This study reports novel information on the possible involvement of a 25 kDa sesame protein in IgE-dependent hypersensitivity to sesame seeds.

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[30] - Kanny G, De Hauteclocque C, Moneret-Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996;51:952-957

Sesame seed and sesame seed oil have been thought of as rare causes of food allergy, representing less than 1% of all food allergy cases. We now report nine cases of IgE-dependent allergy to sesame seed and/or sesame seed oil, six of which were diagnosed in 1995 alone. Our skin test results draw attention to the poor quality of a commercial sesame seed extract and the good sensitivity of skin prick tests made with a freshly prepared sesame seed flour extract. The diagnosis of this food allergy was established by double-blind oral provocation tests, with doses of sesame seed flour ranging from 100 mg to 10 g. Allergy to sesame seed oil was also demonstrated in some cases. The sensitivity of the Pharmacia Phadebas CAP System for the detection of sesame seed-specific IgE was only mediocre. We draw attention to the important use of sesame seed in modern cooking, a fact which may explain the growing frequency of this allergy. We underline the particular risk with sesame seed oil. Sesame seed should also be considered a cause of allergic reactions to drug products and cosmetics.

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[31] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[32] - Leduc V, Tzen JTC, Guérin L, Moneret-Vautrin DA, Kanny G. Sesame seeds allergy : how to select raw material and identify the relevant allergens. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°110

Background: Sesame seed ( Sesamum indicum) allergy is a food allergy of growing importance and its diagnosis is often difficult due to the poor quality of commercial SPT extracts. The study of sesame allergens and the selection of raw materials are of the most importance in the production of adequate prick-test solutions. Methods: Thirteen patients with sesame food allergy were selected by positive skin prick tests to three varieties of sesame seeds, labial tests or DBPCFC. Sesame seed raw materials (white and brown) were compared. Allergens were studied by IEF, SDS-PAGE and 2D-PAGE followed by immunoblotting. Purified storage proteins (11S globulin subunits (IA, IB, IIA, IIB), 2S albumin and oil bodies proteins), obtained from JTC Tzen2, were tested for their recognition by IgE contained in pooled sera. Results: By IEF/immunoblotting, brown sesame showed a higher diversity of allergens compared to white sesame. By SDS-PAGE/immunoblotting , 11S IA subunit showed a strong IgE binding band at 32 kDa in reducing conditions corresponding to a molecule of 52 kDa when non reducing conditions were used. 2S albumin was recognized by IgE in non reduced form only, with a molecular mass of 15.5 kDa. A 17.5 kDa allergen, so-called oleosin, is detected in oil bodies. A 47 kDa monomer, which could be a 7S globulin, is also strongly recognized in brown and white sesame seed extracts in non reduced and reduced forms. Although a birch pollen cross- reactive profilin, recognized by three birch sensitized patients, was identified in brown sesame exclusively, this allergen was not recognized by sesame allergic patients. 2D-PAGE followed by immunoblotting allowed to identify location of sesame allergens. Conclusions: Specific and precise identification of three sesame allergens has been performed. The identification of sesame seed allergens and the selection of raw materials has allowed the production of a reliable skin prick test solution which, in preliminary results, gives comparable results to the native sesame seed.

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[33] - Frémont S, Zitouni N, Kanny G, Veneri V, Metche M, Moneret-Vautrin DA, et al. Allergenicity of some isoforms of white sesame proteins. Clin Exp Allergy 2002;32:1211-1215

Background Allergy to sesame seeds is often associated with particularly severe reactions, with a high risk of anaphylaxis. The increase in reports of allergic reactions to sesame is probably due to the growing use of sesame seeds or sesame oil in food. Objective To determine the molecular weights of the proteins in three variety of sesame seeds and to study the isoelectric points and the allergenicity of white sesame proteins. Methods Extracts of white, brown and black sesame seeds were prepared. The white sesame extract, mostly used in bakery, was run on SDS-PAGE and two dimensional electrophoresis. Six sera from patients sensitized or symptomatic to sesame seed were used for Western blotting. Results The protein patterns of the white, brown and black sesame extracts showed major quantitative differences. The white extract had the higher protein concentration and contained 15 proteins of 12-79 kDa, some of them having several acidic isoelectric points. The lowest isoelectric point was 4.9 and the highest was 6.4, giving 35 isoforms. Ten of the 15 proteins (12-57.5 kDa) were recognized by specific IgE. The 12-13 kDa and 22-33 kDa proteins could correspond to the main allergens. Conclusion White sesame seeds contain at least 10 allergenic proteins with acidic isoelectric points. In accordance with previous results, two of them seem to contain the major allergens.

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[34] - Leduc V, Tzen JTC, Guérin L, Moneret-Vautrin DA, Kanny G. Sesame seeds allergy : how to select raw material and identify the relevant allergens. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°110

Background: Sesame seed ( Sesamum indicum) allergy is a food allergy of growing importance and its diagnosis is often difficult due to the poor quality of commercial SPT extracts. The study of sesame allergens and the selection of raw materials are of the most importance in the production of adequate prick-test solutions. Methods: Thirteen patients with sesame food allergy were selected by positive skin prick tests to three varieties of sesame seeds, labial tests or DBPCFC. Sesame seed raw materials (white and brown) were compared. Allergens were studied by IEF, SDS-PAGE and 2D-PAGE followed by immunoblotting. Purified storage proteins (11S globulin subunits (IA, IB, IIA, IIB), 2S albumin and oil bodies proteins), obtained from JTC Tzen2, were tested for their recognition by IgE contained in pooled sera. Results: By IEF/immunoblotting, brown sesame showed a higher diversity of allergens compared to white sesame. By SDS-PAGE/immunoblotting , 11S IA subunit showed a strong IgE binding band at 32 kDa in reducing conditions corresponding to a molecule of 52 kDa when non reducing conditions were used. 2S albumin was recognized by IgE in non reduced form only, with a molecular mass of 15.5 kDa. A 17.5 kDa allergen, so-called oleosin, is detected in oil bodies. A 47 kDa monomer, which could be a 7S globulin, is also strongly recognized in brown and white sesame seed extracts in non reduced and reduced forms. Although a birch pollen cross- reactive profilin, recognized by three birch sensitized patients, was identified in brown sesame exclusively, this allergen was not recognized by sesame allergic patients. 2D-PAGE followed by immunoblotting allowed to identify location of sesame allergens. Conclusions: Specific and precise identification of three sesame allergens has been performed. The identification of sesame seed allergens and the selection of raw materials has allowed the production of a reliable skin prick test solution which, in preliminary results, gives comparable results to the native sesame seed.

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[35] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[36] - Pastorello EA, Varin E, Farioli L, Pravettoni V, Ortolani C, Trambaioli C, et al. The major allergen of sesame seeds (Sesamum indicum) is a 2S albumin. J Chromatogr B Biomed Appl 2001;756:85-93

BACKGROUND: Allergic reactions induced by ingestion of foods containing sesame seeds are a well recognized cause of severe food-induced anaphylaxis. OBJECTIVE: This study aimed to identify and characterize the clinically most important major allergen of sesame seeds. METHODS: Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and IgE immunoblotting were performed on sera of 10 patients selected for severe and documented allergic reaction after eating food containing sesame. The major allergen was purified by gel filtration and characterized by isoelectric point (pI), glycosylation and amino acid sequencing. RESULTS: All the patients had positive IgE antibodies and skin prick tests (SPTs) to sesame. The major, clinically most important allergen was a protein with molecular mass of about 9000. It was not glycosylated, the amino acid sequence showed it was a 2S albumin with a pI of 7.3; the small and the large subunits, forming the whole protein, showed pI values of 6.5 and 6.0.

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[37] - Beyer K, Bardina L, Grishina G, Sampson HA. Identification of sesame seed allergens by 2-dimensional proteomics and Edman sequencing: Seed storage proteins as common food allergens. J Allergy Clin Immunol 2002;110:154-159

BACKGROUND: Sesame seed allergy is becoming increasingly prevalent, probably because of its use in international fast-food and bakery products. Despite this fact, few studies have focused on the identification of its major allergenic proteins . OBJECTIVE: The aim of this study was to identify allergenic proteins of sesame seeds (Sesamum indicum) . METHODS: Extracted sesame seed proteins were separated by means of SDS-PAGE and 2-dimensional (2-D) PAGE. Immunolabeling was performed with individual patient sera from 20 patients with sesame seed allergy. Selected proteins were further analyzed by means of Edman sequencing . RESULTS: IgE-binding proteins were identified at 78, 52, 45, 34, 32, 29, 25, 20, 9, and 7 kd. Analyzing internal sequences, the protein at 45 kd, which was recognized by 75% of the patients, was found to be a 7S vicilin-type globulin, a seed storage protein of sesame and named Ses i 3. The protein at 7 kd was found to be a 2S albumin, another seed storage protein of sesame and named Ses i 2. Seed storage proteins are known food allergens in peanut, walnut, Brazil nut, and soybean. Interestingly, one known IgE-binding epitope of the peanut allergen Ara h 1 has 80% homology with the corresponding area of Ses i 3. The different amino acids were previously shown not to be critical for IgE binding in Ara h 1. In addition, the proteins at 78 and 34 kd were found to be homologous to the embryonic abundant protein and the seed maturation protein of soybeans, respectively . CONCLUSION: The identification of 4 sesame seed allergens is the first step toward generating recombinant allergens for use in future immunotherapeutic approaches. In addition, the detection of conserved IgE binding epitopes in common food allergens might be a useful tool for predicting cross-reactivity to certain foods.

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[38] - Tai SS, Wu LS, Chen EC, Tzen JT. Molecular cloning of 11S globulin and 2S albumin, the two major seed storage proteins in sesame. J Agric Food Chem 1999;47:4932-4938

Insoluble 11S globulin and soluble 2S albumin, conventionally termed alpha-globulin and beta-globulin, are the two major storage proteins and constitute 80-90% of total seed proteins in sesame. Two full-length cDNA clones were sequenced and deduced to encode sesame 11S globulin and 2S albumin precursors, respectively. Deduced amino acid composition reveals that 2S albumin, but not 11S globulin, is a sulfur-rich protein. Three abundant polypeptides of 50-60 kDa were resolved on SDS-PAGE when seed-purified 11S globulin was prepared in nonreducing conditions. Immunological analysis suggests that these three polypeptides are encoded by homologous genes. Immunodetection on the overexpressed protein of the 11S globulin clone in Escherichia coli indicates that this clone encodes the precursor protein of one of the three purified 11S globulin

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[39] - Moreno FJ, Maldonado BM, Wellner N, Mills EN. Thermostability and in vitro digestibility of a purified major allergen 2S albumin (Ses i 1) from white sesame seeds (Sesamum indicum L.). Biochim Biophys Acta 2005;1752:142-153

A major 2S albumin allergen, Ses i 1, from white sesame seeds was purified to homogeneity, characterized and identified using proteomic techniques. Ses i 1 exhibited a molecular weight of 12062 Da, although an extensive C-terminal clipping of the small subunit was observed. In addition, the N-terminal glutamine of the small subunit had been converted to pyroglutamate and a variant of the large subunit which had lost the N-terminal glutamine was also detected. The protein was thermo-stable up to 90 degrees C at neutral and acid pH, retaining its monomeric state and showing minimal alterations, which were reversible on cooling, in a predominantly alpha-helical secondary structure, as shown by circular dichroism and Fourier transform-infrared spectroscopy. Ses i 1 was also highly resistant to digestion using a physiologically relevant in vitro gastrointestinal model system. After 2 h of gastric digestion, the allergen remained completely intact and only the small subunit was cleaved during 2 h of subsequent duodenal digestion, leaving a major IgE epitope region of this protein intact. Neither prior heating of the Ses i 1 nor the presence of the physiological surfactant phosphatidylcholine affected the pattern of proteolysis. These findings are consistent with those found for the 2S albumin allergen from Brazil nut, Ber e 1, and suggest that Ses i 1 may preserve its structure from the degradation in the gastrointestinal tract, a property thought to be crucial for both a protein to sensitise the mucosal immune system and provoke an allergic reaction in a sensitised individual.

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[40] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[41] - Beyer K, Grishina G, Bardina L, Sampson HA. Identification of 2 new sesame seed allergens: Ses i 6 and Ses i 7. J Allergy Clin Immunol 2007;119:1554-1559

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[42] - Wallowitz ML, Chen RJ, Tzen JT, Teuber SS. Ses i 6, the sesame 11S globulin, can activate basophils and shows cross-reactivity with walnut in vitro. Clin Exp Allergy 2007;37:929-938

Background Sesame allergy is increasingly being reported, and multi-sensitization to peanut and tree nuts has been described. The clinical relevance and cross-reactivity of many sesame proteins, such as Ses i 6, are unknown. Objective The aims of this study were to perform a preliminary examination of the cross-reactivity of Ses i 6 in vitro, examine the ability of Ses i 6 to activate basophils in a modified basophil activation test (mBAT), and assess whether such an assay may help to distinguish between potentially relevant and irrelevant IgE reactivity towards 11S globulin proteins. Methods Inhibition immunoblotting and chicken anti-rJug r 4 antibodies were used to determine the cross-reactivity of rSes i 6. Basophils from atopic donors were stripped of resident IgE before passive sensitization with food-allergic sera and challenged with protein extracts or recombinant protein. Basophil activation was measured using two activation markers, CD203c and CD63, via flow cytometry. Results IgE immunoblotting showed cross-reactivity between rJug r 4 and rSes i 6 using sera from two human donors and chicken IgY. Additionally, rSes i 6 activated basophils passively sensitized with sesame-allergic sera. Cross-reactive serum from a sesame-allergic but walnut-tolerant donor was not able to activate basophils when challenged by walnut extract despite IgE reactivity to walnut determined by immunoblotting. Conclusions The sesame 11S globulin shows partial immunological cross-reactivity with walnut, and although it is classified as a minor allergen, activated basophils sensitized with serum from seven out of eleven sesame-allergic donors. Additionally, the mBAT may help distinguish between clinically relevant and irrelevant in vitro IgE cross-reactivity of seed storage proteins in nuts and seeds and thus warrants use in further studies.

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[43] - Beyer K, Grishina G, Bardina L, Sampson HA. Identification of a New Sesame Seed Allergen - Ses i 7, an 11 S Globulin belonging to the Seed Storage Proteins. J Allergy Clin Immunol 2007;119(1 suppl):S117

RATIONALE: Seed storage proteins have been identified as common allergens in peanut, tree nut and seed allergy. We recently identified three seed storage proteins in sesame seed, a 2S albumin (Ses i 2), a 7S globulin (Ses i 3) and an 11S globulin (Ses i 6) as allergens. The purpose of this study was to show whether a second 11S globulin in sesame seed that has only 36% identity with Ses i 6 also has allergenic potential. METHODS: RNA isolated from sesame seeds was used to construct a cDNA library. Using known sequence data from the 11S globulin, oligonucleotide primers were synthesized and used to screen the library. Full-length cDNA clones were isolated, sequenced, expressed and screened with individual patient sera from 24 patients who experienced systemic allergic reactions to sesame. RESULTS: Screening the constructed sesame cDNA library with oligonucleotides based on the known sequence of a sesame 11S globulin the protein expressed by the cDNA was isolated. Using Western blot analysis, 10 out of the 24 patients with sesame seed allergy showed IgE-binding to the expressed recombinant protein. Therefore, this 11S globulin was named Ses i 7 by the allergen nomenclature sub-committee. CONCLUSION: A new sesame seed allergen, Ses i 7, belonging to the class of seed storage proteins has been identified. The identification of new food allergens is the first step towards the use of these recombinant allergens in future diagnostic and therapeutic approaches.

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[44] - Dalal I, Binson I, Levine A, Somekh E, Ballin A, Reifen R. The pattern of sesame sensitivity among infants and children. Pediatr Allergy Immunol 2003;14:312-316

Recently, we found sesame to be a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. The purpose of this study was to describe the different patterns of sesame sensitivity. We have identified three subgroups among our patients (n = 32). Group I (n = 23, M/F; 14/9) consisted of cases with IgE-mediated sesame allergy. The mean age of the first allergic reaction was 11.7 months. Although the main clinical manifestation was urticaria/angiedema (n = 14, 60%), anaphylaxis was the presenting symptom in seven (30%) patients; all of them were younger than 1 year. Sixteen (70%) were found to be allergic to other foods, and other atopic diseases were identified in 18 (78%) patients. Three patients 'outgrew' their allergy within 1-2 years. Group II (n = 2) included cases in whom sesame allergy was ruled out based on a negative skin prick test (SPT) together with a negative open oral challenge. Group III (n = 7) consisted of patients that were found to be SPT positive for sesame as part of a screening for other food allergies. Although sesame products have become fashionable in westernized countries, early exposure may cause sesame to share eventually the same 'noteriety and fate' as peanut - a major cause of severe food allergic reactions.

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[45] - Kanny G, De Hauteclocque C, Moneret-Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996;51:952-957

Sesame seed and sesame seed oil have been thought of as rare causes of food allergy, representing less than 1% of all food allergy cases. We now report nine cases of IgE-dependent allergy to sesame seed and/or sesame seed oil, six of which were diagnosed in 1995 alone. Our skin test results draw attention to the poor quality of a commercial sesame seed extract and the good sensitivity of skin prick tests made with a freshly prepared sesame seed flour extract. The diagnosis of this food allergy was established by double-blind oral provocation tests, with doses of sesame seed flour ranging from 100 mg to 10 g. Allergy to sesame seed oil was also demonstrated in some cases. The sensitivity of the Pharmacia Phadebas CAP System for the detection of sesame seed-specific IgE was only mediocre. We draw attention to the important use of sesame seed in modern cooking, a fact which may explain the growing frequency of this allergy. We underline the particular risk with sesame seed oil. Sesame seed should also be considered a cause of allergic reactions to drug products and cosmetics.

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[46] - Woltsche-Kahr I, Aberer W. Recurrent anaphylactic reactions following hidden ingestion of sesame seed. 8th International Symposium on Problems of Food Allergy, Venice 2001, March 11-13

Sesame (Sesamum indicum) is commonly used for the production of whole seeds, extracted oil or seed paste. Sesame and it's related products are widely employed in the food industry, but furthermore in the pharmaceutic and cosmetic industry as vehicles for parenteral and local therapeutics because of their presumed low antigenicity. IgE-mediated allergies, including anaphylaxis and extrinsic asthma, and non-lgE-mediated reactions have been reported following sesame ingestion. A non-atopic 36 year old Caucasian baker presented with systemic urticaria, facial erythema, dizziness and loss of consciousness five minutes after eating a piece of apple pie. Intensive questioning revealed that the patient had experienced 10 anaphylactic reactions of different degrees since 1992 following ingestion of whole meal bread, hamburgers, pastries and a "Mexican meal". As a baker he knew that pastries not sold and containing sesame are milled and "recycled" and therefore may cause adverse reactions as hidden allergens. Specific IgE using the RAST (CAP, Pharmacia-Uppsala, Sweden) was also negative. Skin Prick testing with crushed sesame seed diluted in physiological sodium chloride was positive: 18x16 mm wheal with pseudopods.

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[47] - Dechamps B, Leduc V, Guérin L. Choc anaphylactique sévère au sésame avec prick-tests et RAST négatifs. Alim'Inter 2006;11:27-28

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[48] - Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of sesame seed-induced anaphylaxis. Allergy 1999;54:526-527

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[49] - Rancé F, Juchet A, Rittié JL, Brémont F, Dutau G. Sensibilisations et allergies au sésame: étude clinique et biologique de 4 observations. Ann Pediatr (Paris) 1997;44:353-356

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[50] - Stevens WJ, Ebo DG, Bridts CH, De Clerck LS. Anaphylaxis to Sesame (Sesamum Indicum) Seed and Sesame Oil. AAAAI 58th Annual Meeting, New York, 1-6 March, 2002, Poster n°650

A 42-year old man with house dust mite and pollen allergy was referred to our department because of several allergic reactions within minutes after consumption of sesame seed containing food such as bread and pancakes. Initially he suffered from urticaria but progressively more severe reactions with angio-oedema, bronchospasm, hypotension and shock had occurred. The last episode occurred in connection with consumption of meat and vegetables without sesame seeds but the food was backed in sesame oil (Chinese wok). Results are summarized in the table. After in vitro allergen-specific stimulation basophils become activated and express the membrane activation marker CD63. This up-regulated expression of CD63 on the plasma membrane can be detected by flow cytometry using monoclonal antibodies like anti-CD63-PE. Calculating the net percentage of basophils that express CD63 relative to buffer control allows assessing basophil activation. Sesame and its derivatives are widely employed in food industry and in the cosmetic and pharmaceutic industry as vehicles for parenteral and topical therapeutics because of their presumed low allergenicity. Anaphylaxis due to ingestion of sesame seed containing food has been increasingly reported. Reactions occurred in connection with a broad variety of foods in which the presence of sesame was not always apparent. Symptomatology included pruritus, erythematous rashes, urticaria, angioedema, nausea, vomiting, dyspnea and bronchospasm, hypotension and shock. Anaphylaxis from sesame oil is considered to be anecdotal. This case report confirms that anaphylaxis due to sesame oil can occur and that the basophil activation test can be a safe and reliable method for in vitro diagnosis of food allergy.

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[51] - Beyer K, Bardina L, Grishina G, Sampson HA. Identification of sesame seed allergens by 2-dimensional proteomics and Edman sequencing: Seed storage proteins as common food allergens. J Allergy Clin Immunol 2002;110:154-159

BACKGROUND: Sesame seed allergy is becoming increasingly prevalent, probably because of its use in international fast-food and bakery products. Despite this fact, few studies have focused on the identification of its major allergenic proteins . OBJECTIVE: The aim of this study was to identify allergenic proteins of sesame seeds (Sesamum indicum) . METHODS: Extracted sesame seed proteins were separated by means of SDS-PAGE and 2-dimensional (2-D) PAGE. Immunolabeling was performed with individual patient sera from 20 patients with sesame seed allergy. Selected proteins were further analyzed by means of Edman sequencing . RESULTS: IgE-binding proteins were identified at 78, 52, 45, 34, 32, 29, 25, 20, 9, and 7 kd. Analyzing internal sequences, the protein at 45 kd, which was recognized by 75% of the patients, was found to be a 7S vicilin-type globulin, a seed storage protein of sesame and named Ses i 3. The protein at 7 kd was found to be a 2S albumin, another seed storage protein of sesame and named Ses i 2. Seed storage proteins are known food allergens in peanut, walnut, Brazil nut, and soybean. Interestingly, one known IgE-binding epitope of the peanut allergen Ara h 1 has 80% homology with the corresponding area of Ses i 3. The different amino acids were previously shown not to be critical for IgE binding in Ara h 1. In addition, the proteins at 78 and 34 kd were found to be homologous to the embryonic abundant protein and the seed maturation protein of soybeans, respectively . CONCLUSION: The identification of 4 sesame seed allergens is the first step toward generating recombinant allergens for use in future immunotherapeutic approaches. In addition, the detection of conserved IgE binding epitopes in common food allergens might be a useful tool for predicting cross-reactivity to certain foods.

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[52] - Beyer K, Grishina G, Bardina L, Sampson HA. Identification of 2 new sesame seed allergens: Ses i 6 and Ses i 7. J Allergy Clin Immunol 2007;119:1554-1559

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[53] - Leduc V, Moneret-Vautrin DA, Tzen JTC, Morisset M, Guérin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61:349-356

BACKGROUND: The prevalence of sesame allergy is increasing in European countries. Cases of severe allergy lack any evidence of specific immunoglobulin (Ig)Es by prick tests and CAPSystem-FEIA. The reasons for this negativity are unknown . METHODS: In 32 patients displaying immediate symptoms such as anaphylactic shock, asthma, urticaria, angioedema, sesame allergy was diagnosed by double-blind placebo-controlled food challenge (DBPCFC) or convincing clinical history. However, 10 patients had negative prick tests and CapSystem-FEIA. The specificity of IgEs was further investigated by enzyme-linked immunosorbent assay (ELISA), isoelectrofocalisation (IEF)-blotting, and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) blotting using total sesame extracts and purified fraction of oil bodies. Monospecific rabbit antibodies directed to two oleosin isoforms (15 and 17 kDa) were used . RESULTS: By ELISA, white sesame seed extract allowed the detection of higher levels of IgE than brown sesame extract. In all sera, numerous bands binding IgEs were detected by IEF or SDS-PAGE. In reducing conditions, two bands (15-17 kDa), could be separated from 2S albumin. Oleosins, present in oil bodies fractions, were recognized by IgEs from all sera . CONCLUSION: Oleosins are major allergens of sesame seeds and may be relevant to severe anaphylaxis. Falsely negative prick tests could be due to the lack of oleosins in presently available extracts, or to the fact that epitopes might be buried in the inner molecule. Detection tests currently used to identify sesame allergens based on sesame vicillins or other storage proteins could be insufficient for the detection of sesame seed contamination. Oleosins have been named Ses i 4 (17 kDa) and Ses i 5 (15 kDa), in accordance with the IUIS Nomenclature Committee.

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[54] - Woltsche-Kahr I, Aberer W. Recurrent anaphylactic reactions following hidden ingestion of sesame seed. 8th International Symposium on Problems of Food Allergy, Venice 2001, March 11-13

Sesame (Sesamum indicum) is commonly used for the production of whole seeds, extracted oil or seed paste. Sesame and it's related products are widely employed in the food industry, but furthermore in the pharmaceutic and cosmetic industry as vehicles for parenteral and local therapeutics because of their presumed low antigenicity. IgE-mediated allergies, including anaphylaxis and extrinsic asthma, and non-lgE-mediated reactions have been reported following sesame ingestion. A non-atopic 36 year old Caucasian baker presented with systemic urticaria, facial erythema, dizziness and loss of consciousness five minutes after eating a piece of apple pie. Intensive questioning revealed that the patient had experienced 10 anaphylactic reactions of different degrees since 1992 following ingestion of whole meal bread, hamburgers, pastries and a "Mexican meal". As a baker he knew that pastries not sold and containing sesame are milled and "recycled" and therefore may cause adverse reactions as hidden allergens. Specific IgE using the RAST (CAP, Pharmacia-Uppsala, Sweden) was also negative. Skin Prick testing with crushed sesame seed diluted in physiological sodium chloride was positive: 18x16 mm wheal with pseudopods.

↩

[55] - Kanny G, De Hauteclocque C, Moneret-Vautrin DA. Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996;51:952-957

Sesame seed and sesame seed oil have been thought of as rare causes of food allergy, representing less than 1% of all food allergy cases. We now report nine cases of IgE-dependent allergy to sesame seed and/or sesame seed oil, six of which were diagnosed in 1995 alone. Our skin test results draw attention to the poor quality of a commercial sesame seed extract and the good sensitivity of skin prick tests made with a freshly prepared sesame seed flour extract. The diagnosis of this food allergy was established by double-blind oral provocation tests, with doses of sesame seed flour ranging from 100 mg to 10 g. Allergy to sesame seed oil was also demonstrated in some cases. The sensitivity of the Pharmacia Phadebas CAP System for the detection of sesame seed-specific IgE was only mediocre. We draw attention to the important use of sesame seed in modern cooking, a fact which may explain the growing frequency of this allergy. We underline the particular risk with sesame seed oil. Sesame seed should also be considered a cause of allergic reactions to drug products and cosmetics.

↩

[56] - Agne PSE, Bidat E, Rancé F, Paty E. Sesame seed allergy in children. Eur Ann Allergy Clin Immunol 2004;36:300-305

BACKGROUND: Sesame seed allergy is becoming more common in childhood. The aim of this study is to define the clinical signs and the results of allergological work-up of this food allergy as well as the demographical data in children. Sesame seed allergy outcome is unknown. MATERIALS AND METHODS: 14 children were recruited from 3 allergy centers in France. The diagnosis of food allergy was based on a convincing clinical history and positive skin prick tests and/or an elevated sesame specific IgE. Food challenge test was done when results of history and allergological work-up were conflicting. A reintroduction test was done when a child seemed to outgrow his (or her) food allergy . RESULTS: The median age at the beginning of sesame seed allergy was 5 years (range from 5 months to 16 years old). All patients reacted immediately after sesame seed consumption and presented as a first manifestation: edema (9 cases, 48%), urticaria (5, 27%), and one of each of the following symptoms (vomiting, rhinitis, conjunctivitis, asthma and anaphylactic shock). One patient had recurrent anaphylactic shocks and another an anaphylactic shock after subsequent sesame seed exposure; these 2 patients were asthmatic. The median of the wheal size was 5 mm (range 3 to 15 mm). The commercial sesame seed extract was less sensitive than the native seed. The median of sesame seed IgE was 5.58 kUA/L (range 0.35 to 100 kUA/L). The follow up lasted from a few months to 6 years. Three patients outgrew their food allergy. All of these patients showed a previous drop of sesame seed IgE and skin prick-tests became negative . CONCLUSION: Sesame seed allergy is not very different than other food allergy. We reported the spontaneous outgrowing of sesame seed allergy without being able to define the predictive criteria for a good outcome.

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[57] - Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of sesame seed-induced anaphylaxis. Allergy 1999;54:526-527

↩

[58] - Rancé F, Juchet A, Rittié JL, Brémont F, Dutau G. Sensibilisations et allergies au sésame: étude clinique et biologique de 4 observations. Ann Pediatr (Paris) 1997;44:353-356

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[59] - Dalal I, Binson I, Levine A, Somekh E, Ballin A, Reifen R. The pattern of sesame sensitivity among infants and children. Pediatr Allergy Immunol 2003;14:312-316

Recently, we found sesame to be a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. The purpose of this study was to describe the different patterns of sesame sensitivity. We have identified three subgroups among our patients (n = 32). Group I (n = 23, M/F; 14/9) consisted of cases with IgE-mediated sesame allergy. The mean age of the first allergic reaction was 11.7 months. Although the main clinical manifestation was urticaria/angiedema (n = 14, 60%), anaphylaxis was the presenting symptom in seven (30%) patients; all of them were younger than 1 year. Sixteen (70%) were found to be allergic to other foods, and other atopic diseases were identified in 18 (78%) patients. Three patients 'outgrew' their allergy within 1-2 years. Group II (n = 2) included cases in whom sesame allergy was ruled out based on a negative skin prick test (SPT) together with a negative open oral challenge. Group III (n = 7) consisted of patients that were found to be SPT positive for sesame as part of a screening for other food allergies. Although sesame products have become fashionable in westernized countries, early exposure may cause sesame to share eventually the same 'noteriety and fate' as peanut - a major cause of severe food allergic reactions.

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[60] - Ito K, Takaoka Y, Futamura M, Sakamoto T, Urisu A, Tanaka A. Poor Cross-reactivity to Nut Allergens in Patients with Peanut, Cashew and Walnut Allergies. J Allergy Clin Immunol 2008;121:S243

RATIONALE: The frequency of generally severe and sometimes lifethreatening allergies to peanuts and other tree nuts is increasing among Japanese children, as it is in Europe and the United States. Cross-reactivity among nuts has been suggested, yet most patients seem to be allergic only to one or a few types of nuts. METHODS: We recruited 27 patients (male: female, 21: 6; mean age, 5.3 years) with a convincing clinical history of immediate-type allergic reactions to peanuts (n = 16), cashews (n = 5) and walnuts (n = 7, one also to peanuts). We measured specific IgE antibodies to peanuts, soy beans, cashews, pistachios, walnuts, pecans, almonds, hazelnuts, Brazil nuts, macadamia nuts and sesame seeds using ImmunoCAP . Clinical reactivity to other nuts was determined from a detailed questionnaire or an oral challenge test. RESULTS: Levels of IgE antibodies closely correlated between peanuts and soy beans (r=0.801), cashews and pistachios (r=0.979), and walnuts and pecans (r = 0.971). One patient each with a peanut allergy claimed an allergic reaction to almonds, walnuts and sesame seeds. Clinical crossreactions between peanuts and soy were not evident in any of the patients. Among patients with a walnut allergy, one each claimed a reaction to peanuts, pine nuts and hazelnuts, and none had ever consumed pecans. None of the patients with a cashew allergy was allergic to any other nuts, but they had never consumed pistachios. CONCLUSIONS: Clinical and serological cross-reactivity among nut allergies seems less prevalent than previously considered.

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[61] - Robotham JM, Wang F, Seamon V, Teuber SS, Sathe SK, Sampson HA, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol 2005;115:1284-1290

BACKGROUND: Cashew nut allergy is the second most commonly reported tree nut allergy in the United States. We have previously cloned and characterized major cashew allergens belonging to the vicilin and legumin families of seed storage proteins . OBJECTIVE: Here we set out to describe a third major cashew allergen, a 2S albumin . METHODS: The recombinant cashew 2S albumin was amplified from a cDNA library by means of PCR, sequenced, and expressed in Escherichia coli. Immunoblotting was used to screen for reactivity with patients' sera, and inhibition immunoblotting was used to identify the corresponding native cashew nut proteins. The mass of affinity-purified native allergen was determined by means of matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectroscopy. Patients' sera were used to probe solid-phase 2S albumin peptides to identify linear epitopes . RESULTS: The cloned allergen, designated Ana o 3, was identified as 2S albumin. MALDI-TOF mass spectroscopy of native Ana o 3 yielded a molecular mass of 12,598 d. Immunoblot analysis showed 21 (81%) of 26 sera from patients with cashew allergy were reactive. Three native Ana o 3 large-subunit isoforms with molecular weights ranging from approximately 6 to 10 kd were identified. Probing of overlapping synthetic Ana o 3 peptides with patients' sera identified 16 reactive peptides, 4 of which gave strong signals and one of which positionally overlaps linear epitopes in mustard and walnut allergenic 2S albumins. The overlapping cashew and walnut epitopes also share considerable homology . CONCLUSIONS: We conclude that this 2S albumin protein is a major allergen in cashew nut and demonstrates a possible basis for cross-reactivity with walnut 2S albumin.

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[62] - Wallowitz M, Peterson WR, Uratsu S, Comstock SS, Dandekar AM, Teuber SS. Jug r 4, a Legumin Group Food Allergen from Walnut (Juglans regia Cv. Chandler). J Agric Food Chem 2006;54:8369-8375

Allergy to walnut is the most frequently reported tree nut allergy in the United States. Walnut 2S albumin, a vicilin-like protein, and a lipid transfer protein allergen have previously been described. Our objective was to clone and express a cDNA encoding a legumin group protein, assess IgE-binding with sera from walnut allergic patients, and investigate cross-reactivity with selected nuts. Primers were used to obtain the cDNA by 5' and 3' rapid amplification of cDNA ends from walnut mRNA. The cDNA was subcloned into the pMAL-c2X vector and the recombinant fusion protein, named rJug r 4, was expressed in Escherichia coli. The obtained cDNA encoded a precursor protein with a predicted molecular weight of 58.1 kD, which showed significant sequence homology to hazelnut and cashew legumin allergens. Serum IgE from 21 of 37 (57%) patients bound the rJug r 4 fusion protein. In vitro cross-reactivity was demonstrated with hazelnut, cashew, and peanut protein extracts.

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[63] - Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of sesame seed-induced anaphylaxis. Allergy 1999;54:526-527

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[64] - Vocks E, Borga A, Szliska C, Seifert HU, Seifert B, Burow G, et al. Common allergenic structures in hazelnut, rye grain, sesame seeds, kiwi, and poppy seeds. Allergy 1993;48:168-172

Allergy to kiwi, poppy seeds, and/or sesame seeds often occurs in patients with a simultaneous sensitization to nuts and flour. Previously cross reactions have been verified by RAST inhibition. In this study the nature of this cross-reactivity is further characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), followed by immunoblotting to nitrocellulose. The degree of cross-reactivity among kiwi, sesame seeds, poppy seeds, hazelnuts, and rye grain was found to be very high in the patients studied. The existence of both cross-reacting and unique components was observed; however, the cross-reacting and unique components could be different for different patients.

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[65] - Agne PSE, Bidat E, Rancé F, Paty E. Sesame seed allergy in children. Eur Ann Allergy Clin Immunol 2004;36:300-305

BACKGROUND: Sesame seed allergy is becoming more common in childhood. The aim of this study is to define the clinical signs and the results of allergological work-up of this food allergy as well as the demographical data in children. Sesame seed allergy outcome is unknown. MATERIALS AND METHODS: 14 children were recruited from 3 allergy centers in France. The diagnosis of food allergy was based on a convincing clinical history and positive skin prick tests and/or an elevated sesame specific IgE. Food challenge test was done when results of history and allergological work-up were conflicting. A reintroduction test was done when a child seemed to outgrow his (or her) food allergy . RESULTS: The median age at the beginning of sesame seed allergy was 5 years (range from 5 months to 16 years old). All patients reacted immediately after sesame seed consumption and presented as a first manifestation: edema (9 cases, 48%), urticaria (5, 27%), and one of each of the following symptoms (vomiting, rhinitis, conjunctivitis, asthma and anaphylactic shock). One patient had recurrent anaphylactic shocks and another an anaphylactic shock after subsequent sesame seed exposure; these 2 patients were asthmatic. The median of the wheal size was 5 mm (range 3 to 15 mm). The commercial sesame seed extract was less sensitive than the native seed. The median of sesame seed IgE was 5.58 kUA/L (range 0.35 to 100 kUA/L). The follow up lasted from a few months to 6 years. Three patients outgrew their food allergy. All of these patients showed a previous drop of sesame seed IgE and skin prick-tests became negative . CONCLUSION: Sesame seed allergy is not very different than other food allergy. We reported the spontaneous outgrowing of sesame seed allergy without being able to define the predictive criteria for a good outcome.

↩

[66] - Dalal I, Binson I, Levine A, Somekh E, Ballin A, Reifen R. The pattern of sesame sensitivity among infants and children. Pediatr Allergy Immunol 2003;14:312-316

Recently, we found sesame to be a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. The purpose of this study was to describe the different patterns of sesame sensitivity. We have identified three subgroups among our patients (n = 32). Group I (n = 23, M/F; 14/9) consisted of cases with IgE-mediated sesame allergy. The mean age of the first allergic reaction was 11.7 months. Although the main clinical manifestation was urticaria/angiedema (n = 14, 60%), anaphylaxis was the presenting symptom in seven (30%) patients; all of them were younger than 1 year. Sixteen (70%) were found to be allergic to other foods, and other atopic diseases were identified in 18 (78%) patients. Three patients 'outgrew' their allergy within 1-2 years. Group II (n = 2) included cases in whom sesame allergy was ruled out based on a negative skin prick test (SPT) together with a negative open oral challenge. Group III (n = 7) consisted of patients that were found to be SPT positive for sesame as part of a screening for other food allergies. Although sesame products have become fashionable in westernized countries, early exposure may cause sesame to share eventually the same 'noteriety and fate' as peanut - a major cause of severe food allergic reactions.

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Les allergènes du sésame

Sésame et pollinose

Sésame et arachide

Sésame et fruits à coque

Sésame et graines diverses

Rubriques

Dans la même rubrique

Le sarrasin

La châtaigne