Carolyn H. Baloh, MD, from the division of allergy and clinical immunology at Brigham and Women's Hospital, Harvard Medical School.

Carolyn H. Baloh, MD

Non-Sesame Seed, Spice Allergies Can Trigger Severe Reactions

New data from the FARE (Food Allergy Research & Education) Patient Registry show non-sesame seed and herb/spice allergies can trigger 

and biphasic responses at rates comparable to sesame allergy.¹

"When patients report allergic reactions to non-sesame seeds, herbs, or spices, we should be cognizant these allergens can cause more severe reactions, including those requiring one or more doses of epinephrine or biphasic reactions," said Carolyn H. Baloh, MD, from the division of allergy and clinical immunology at Brigham and Women's Hospital, Harvard Medical School.

FARE Registry Reaction Severity Findings: Non-Sesame Seed, Herb/Spice

Investigators extracted deidentified survey data on 2601 participants reporting a sesame (n = 1195), non-sesame seed (n = 968), and/or herb or spice (n = 616) allergy from the FARE registry.¹ Data collection spanned August 24, 2017, to July 1, 2025, and the overall cohort was 51% male and 56% Caucasian, though demographics diverged sharply by allergen group.¹ Epinephrine was administered for approximately one-third of reported reactions.¹

In the mutually exclusive analysis, epinephrine use was reported by 42% of participants with sesame allergy, 40% with non-sesame seed allergy, and 29% with herb/spice allergy (

=.05).¹ Use of ≥ 1 epinephrine doses was numerically greater among the non-sesame seed-only group, though the difference did not reach statistical significance.¹ Biphasic reactions occurred across all 3 groups and were most frequent among participants with only herb/spice allergy (40%), compared with 17% in the sesame-only group and 34% in the non-sesame seed-only group.¹

Diagnosis Timing and Cross-Reactivity in Seed Allergy

Diagnosis occurred before 18 years of age in approximately 80% of participants across all 3 groups.¹ Diagnosis before 1 year of age was significantly more common with sesame allergy (18%) than non-sesame seed (7%) or herb/spice allergy (2%) (

 <.0001).¹ Most food allergy diagnoses were made by a healthcare provider, ranging from 89% for sesame to 78% for herbs/spices, with the remainder self-diagnosed.¹

Atopic comorbidities were frequently reported across allergen groups, including allergic rhinitis (46%), eczema (49%), and asthma (38%) among sesame-allergic participants.¹ Cross-reactivity among seed allergens remains a clinical challenge. Baloh said allergists should rely on a combination of clinical history, skin prick testing, specific IgE, and food challenges to guide management.¹

Baloh's group plans to use the registry to assess whether specific symptoms during food allergic reactions correlate with the causative allergen rather than patient age alone.¹ Baloh also noted that she wants to use the registry to learn more about the racial, socioeconomic, and geographic factors in food allergic reactions.

“It's worth keeping in mind that while the prevalence of these allergies is increasing, they're still relatively uncommon,” she said. “That said, these allergens can cause anaphylaxis, even anaphylaxis requiring multiple doses of epinephrine and biphasic reactions. It's always worth evaluating if a non-sesame seed or herb or spice is concerning for an allergic reaction. Allergists should really take a thorough history of all possible foods ingested at the time of a food reaction; they should consider the possibility of these hidden allergens.”

Watch part 1 of our interview with Baloh here: 

FARE Registry Reveals Disparities in Seed and Spice Allergies

Editor’s note: A reported disclosure for Baloh includes SANOFI-AVENTIS U.S. LLC.

Liu EY, Lopez S, Bufford JL, Laidlaw TM, Baloh CH. Seeds, Spices-Not Always so Nice: A Report on the FARE (Food Allergy Research & Education) Patient Registry. J Allergy Clin Immunol Pract. 2026. d

Baloh C. FARE Registry Reveals Disparities in Seed and Spice Allergies. HCPLive Published July 28, 2026. Accessed July 29, 2026. 

https://www.hcplive.com/view/fare-registry-disparities-seed-spice-allergies

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New FARE registry data show epinephrine use and biphasic reactions occur across sesame, seed, and herb/spice allergies, according to Carolyn H. Baloh, MD.

 FARE Registry Reveals Disparities in Seed and Spice Allergies

New data from the FARE (Food Allergy Research & Education) Patient Registry show 

 most often begin in childhood, occur at greater rates among Black, American Indian/Alaska Native, and Hispanic patients and those with lower household income, and can trigger reactions severe enough to require epinephrine.¹

Sesame allergy carries an estimated prevalence of 0.1% to 0.2%, but allergists increasingly encounter reactions to non-sesame seeds and spices as consumers turn to alternatives like sunflower seed butter.

 Until now, evidence on these triggers was limited mostly to case reports and single-center series.¹ The FARE registry, launched in 2017 and encompassing roughly 14,000 pediatric and adult participants, gave investigators the statistical power to characterize these under-recognized allergens nationally.¹

"This is the largest and most comprehensive analysis to date of patient-reported non-sesame seed and herb spice allergens, and allergies to these foods often present in childhood and are more prevalent among specific socioeconomic groups," said Carolyn H. Baloh, MD, from the Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School. "Our hope is this information will help guide providers in the evaluation and treatment of these often hidden or under-recognized food allergens."

Non-Sesame Seed and Herb/Spice Allergen Patterns in the FARE Cohort

Investigators extracted deidentified survey data on 2601 participants reporting a sesame (n = 1195), non-sesame seed (n = 968), and/or herb/spice (n = 616) allergy from the FARE registry between August 24, 2017, and July 1, 2025.¹ The overall cohort was 51% male and 56% Caucasian, though demographics diverged sharply by allergen group.¹ Participants reporting only sesame allergy were significantly more likely to identify as White than those reporting only herb/spice allergy (P <.0001).¹

Black or African American (23.3%) and American Indian/Alaska Native (16.4%) race were particularly common among the herb/spice group.¹ Hispanic or Latino ethnicity was reported by 38% of the herb/spice group, versus 18% of the sesame group and 29% of the non-sesame seed group (P<.0001).¹ Household income < $25,000 was reported by 27% of the herb/spice-only group compared with 8% of the sesame-only group and 14% of the non-sesame seed-only group (P <.0001).¹

Sunflower (28%; n = 515), mustard (19%; n = 343), and flaxseed (14%; n = 256) were the top non-sesame seed allergens, while garlic (6%; n = 111), black pepper (6%; n = 110), cinnamon (5%; n = 96), ginger (5%; n = 95), and curry (5%; n = 94) led the herb/spice list.¹ Diagnosis occurred before 18 years old in roughly 80% of participants across all 3 groups, though diagnosis before 1 years old was significantly more common with sesame allergy (18%) than non-sesame seed (7%) or herb/spice allergy (2%) (P <.0001).¹

Epinephrine Use and Reaction Severity Across Allergen Groups

Epinephrine was administered for approximately one-third of reported reactions regardless of the causative allergen, per registry-wide descriptive data.¹ In the mutually exclusive analysis, epinephrine use was reported by 42% of participants with only sesame allergy, 40% with only non-sesame seed allergy, and 29% with only herb/spice allergy (P =.05).¹ Use of ≥ 1 epinephrine dose was numerically greater among the non-sesame seed-only group, though the difference did not reach statistical significance.¹

Biphasic reactions occurred across all 3 groups and were most frequent among participants with only herb/spice allergy (40%), compared with 17% in the sesame-only group and 34% in the non-sesame seed-only group.¹ Atopic comorbidities were common across allergen groups, with allergic rhinitis (46%), eczema (49%), and asthma (38%) frequently reported among sesame-allergic participants.¹ Sesame and non-sesame seed allergies were reportedly outgrown in 24% of respondents, compared with 46% of respondents with herb/spice allergy.¹

Investigators noted the registry relies on participant-reported and self-diagnosed data and could not stratify outcomes by allergist-confirmed diagnosis in all cases, pointing to a need for confirmatory studies incorporating oral food challenge or component-resolved testing.¹

“Participants reporting an herb or spice allergy in our study were more likely to report a lower family income and to identify as Black or African American, American Indian, Alaska Native, or Hispanic," Baloh concluded. “This really emphasizes the importance of including a diverse participant population in clinical studies and trials and a need to improve clinical practice to provide equitable care for everyone.”

Patel A, Bahna SL. Hypersensitivities to sesame and other common edible seeds. Allergy. 441 2016 Oct;71(10):1405–13. doi:10.1111/all.12962 PubMed PMID: 27332789. 442 7.

Treffeisen ER, Mepyans C, Conroy ER, Baer HJ, Williams DN, Williams KA, et al. 443 Characterization and Incidence of Sunflower Seed Allergy in a Pediatric Allergy Clinic. J 444 Allergy Clin Immunol Pract. 2024 Nov;12(11):3081-3088.e6. doi:10.1016/j.jaip.2024.07.029 445 PubMed PMID: 39117271; PubMed Central PMCID: PMC11560651.

A FARE Patient Registry analysis finds herb and spice allergies disproportionately affect Black, Hispanic, and lower-income patients, Carolyn Baloh, MD, says.

Carolyn H. Baloh, MD

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