Sesame allergy and introducing sesame

Sesame: the newest major allergen

In the US, sesame became the 9th major food allergen through the FASTER Act, a federal law signed in 2021. Since January 1, 2023, packaged foods and dietary supplements that contain sesame must say so on the label (FDA). It joins milk, egg, fish, shellfish, tree nuts, peanut, wheat and soy.

FARE estimates that about 0.23% of people in the US are allergic to sesame, and says several reports suggest sesame allergy has become more common worldwide over the past 20 years. Reactions can range from mild hives to anaphylaxis, and the NHS lists sesame among the foods that can cause anaphylaxis.

In the UK, sesame is one of the 14 allergens that food businesses must tell you about.

When to introduce sesame

Sesame can go in with your baby’s other first foods, from around 6 months. The NHS lists seeds, particularly sesame, among the foods that can trigger allergy and can be introduced from around 6 months, one at a time. The AAP lists sesame with egg, peanut and the other allergens to offer once your baby has managed a few lower-risk first foods.

The evidence for sesame is less clear than for peanut and egg. In the EAT trial, starting sesame early (from 3 months) showed no clear effect on sesame allergy either way. The 2021 US and Canadian allergy consensus says there’s no proof that early sesame prevents allergy, but some observational studies suggest harm from delaying it on purpose, and there’s no sign that starting around 6 months does any harm. So the advice is simple: don’t hold it back.

Talk to your doctor first if your baby has severe eczema, an egg allergy, or has already reacted to a food. Ask how and when to introduce sesame and the other allergens, not about putting them off.

Safe forms of sesame

• Tahini (sesame paste), thinned with a little water, breast milk or formula until runny, then stirred into porridge, mashed vegetables or puréed fruit. Once wheat has gone well, you can spread it very thinly on soft toast strips. See tahini.
• Hummus, smooth and homemade with no added salt, thinned and offered on a pre-loaded spoon or as a dip for soft-cooked vegetables. Shop-bought hummus often has added salt: see hummus for what to look for. Hummus is also made from chickpeas, and the NHS lists beans, lentils and peas as possible allergens too, so it’s easier to tell what caused a reaction if tahini has gone well on its own first.
• Finely ground sesame seeds stirred into food. The NHS says to serve seeds finely ground.

Never give whole sesame seeds sprinkled on food, or spoonfuls of thick tahini. The CDC lists whole or chopped seeds, and chunks or spoonfuls of seed butters, as choking hazards.

Offer the first taste on a day your baby is well, at home, when you can watch them for a couple of hours afterward. Start with a small amount, and if there’s no reaction, build up over the next few servings. Then keep sesame in your baby’s diet: the AAP gives about 2 teaspoons of tahini as a regular portion. See keeping allergens in the diet.

Signs of a reaction

Reactions usually start within minutes of eating, but can take up to 2 hours (NHS).

Mild to moderate: hives or a red, itchy rash, especially around the mouth; mild puffiness of the face or around the eyes; vomiting once, tummy pain or diarrhea; sneezing or a runny nose. If it’s only one of these, stop offering sesame, stay with your baby and watch them closely for the next couple of hours, and call your pediatrician before you try it again. If signs show up in more than one part of the body at once, treat it as severe (below).

Severe (anaphylaxis): trouble breathing, wheezing, or a cough that won’t stop; swelling of the tongue or throat, lips or mouth that suddenly swell, a hoarse cry, drooling or trouble swallowing; turning pale or floppy, or very sleepy or unresponsive; or signs in more than one part of the body at once, such as hives with repeated vomiting.

If your baby has an epinephrine (adrenaline) auto-injector, use it right away, then call for an ambulance. Call 911.Call 999.Call your local emergency number (such as 112 in Europe or 000 in Australia). If you don’t have an auto-injector, call straight away. Keep your baby lying down, never standing or walking (on their side if they’re vomiting, head and shoulders a little raised if breathing is hard), and go to hospital even if they seem better. See signs of anaphylaxis.

Reading labels for sesame

If your child has been diagnosed with sesame allergy, your doctor will tell you what to avoid. Labels are your main tool.

On US packaged foods, sesame can appear in three ways (FDA):

• in the ingredient list by name, such as “sesame seeds”
• in a “Contains” statement next to the ingredients, such as “Contains: wheat, sesame”
• in brackets after an ingredient, such as “tahini paste (sesame)” or “spices (sesame)”

Things to watch for:

• Read the label every time. The FDA says some manufacturers changed their recipes after the law took effect, so foods that didn’t contain sesame before may now have small amounts.

• Unpackaged foods like bagels in a bin or pastries on a bakery tray may not be labeled. Ask staff (FDA).

• Other names. FARE lists names that mean sesame, including tahini (tahina, tehina), benne, gingelly, til, sim sim, sesame oil, halvah and gomasio.

• Sesame oil. FARE says that, unlike some highly refined oils, sesame oil is not highly refined and should be avoided with sesame allergy.

• Where sesame often turns up. FARE lists bagels, bread, buns and breadsticks, crackers, bread crumbs, granola and muesli, hummus, falafel, dips and dressings, some veggie burgers, sushi and many Asian dishes.

• “May contain” labels warn that traces may have got in by accident. They aren’t required by law in either country (FDA, GOV.UK), so a food without one isn’t a guarantee. Ask your allergist how to treat them.

If you’re not sure whether a food contains sesame, contact the manufacturer (FDA).

Where US and UK advice differs

• Which allergens are labeled. The US labels 9 major allergens, including sesame. The UK labels 14, including sesame seeds, and adds celery, mustard, lupin, molluscs, sulphites and cereals with gluten.
• How it looks on the label. On UK prepacked food, allergens must be emphasized in the ingredients list, for example in bold. UK food that is packed on the premises where it’s sold, like a café sandwich, must also have a full ingredients list with allergens emphasized. For loose food, the business must tell you, verbally or in writing (GOV.UK). US rules apply to packaged foods; for unpackaged foods, ask (FDA).
• Who should check first. The NHS asks you to talk to your GP or health visitor before introducing allergens if your baby has eczema or a food allergy, or there’s a family history of food allergies, eczema, asthma or hay fever. US guidance singles out severe eczema and egg or other food allergy.

For the other allergens, see how to introduce allergens and the safe first form of each one.