Baked Sesame Paste May Offer Safer Desensitization Option for Children

New research found that modified sesame desensitization using baked goods with sesame paste was safer than the conventional use of raw sesame seeds among children with sesame allergy.1

“The use of baked goods may be a preferred protocol for patients at increased baseline risk for severe allergic events or an alternative for those experiencing reactions while using the standard protocol of raw sesame protein,” wrote Roy Khalaf, MD, from McGill University, and colleagues.1

According to the American Academy of Allergy, Asthma, & Immunology, sesame is the 9th most common food allergy in the US.2Despite its prevalence, sesame is not listed as a major food allergy, and as a result, is not required to have mandatory labeling. Sesame is present in many foods and products, including oils, pastes, cosmetics, medications, and supplements.1

This real-world study sought to assess the efficacy and safety of a modified sesame desensitization protocol in children with sesame allergy.1 The study recruited 76 children who had a positive skin prick test and had visited the Allergy Clinic of the Montreal Children’s Hospital.1

Children were introduced to an initial dose of sesame protein in the form of either a baked sesame paste (tahini) muffin (n = 39) or raw sesame seeds (n = 37) under physician supervision. Those on paste muffins received 1/4 teaspoon of sesame protein, with a maintenance dose of 2 teaspoons of hummus with 600 mg protein). Children on raw sesame seeds received 75 mg of crushed sesame seeds, approximately 15 seeds, reaching a maintenance dose of 1 tablespoon (3 grams of protein) of tahini.

“The difference in protein concentration between the two groups should be acknowledged, particularly given that the baked goods group received lower doses than the sesame seeds group,” investigators wrote. 1“It is also worth mentioning that children in the seeds group were eventually transitioned to two teaspoons of hummus, which contains approximately 4 grams of protein according to product labeling.”

Once children achieved a maintenance dose, they were asked to return to the clinic once a year for 5 years. Follow-up phone calls with 33 patients showed that most reactions occurred within the first month of desensitization, with skin symptoms the most common, followed by gastrointestinal and airway-related symptoms. All patients experienced spontaneous resolution of symptoms within 24 hours.

“These findings reinforce the well-documented trend that the escalation phase carries the highest risk of allergic events,” investigators wrote.1 They added how this finding suggests that the early stage of therapy offers valuable safety evidence.

When comparing the 2 desensitization strategies, using seeds significantly increased the odds of being at a greater reaction severity level by a factor of 7.1 (95% confidence interval [CI], 3.6 – 14.1) compared to baked goods with sesame paste. However, with both baked goods and raw sesame seeds, the likelihood of severe reactions significantly decreased over time.1

Furthermore, older age and a history of asthma increased the risk of severe reactions, as seen with non-sesame OIT protocols.1

Investigators noted several limitations of the research, including the lack of randomization or blinding between study groups, inconsistent data on immunological tests such as sesame-specific IgE or component testing, the use of protocols determined by the treating allergist, and the absence of maintenance-phase outcome assessments between the 2 groups.

“This study compares for the first time different sesame OIT protocols in real world and reveals that the use of baked goods with sesame paste followed by hummus was associated with a decreased frequency and severity of allergic reactions when compared to the use of crushed raw sesame seeds and tahini,” investigators wrote.1 “Future studies assessing the long-term outcomes of this modified protocol will allow for implementation into standard clinical practice.”

References

1. Khalaf R, Mulé P, Kaouache M, et al. Comparing Two Oral Immunotherapy Strategies for Sesame Allergy: Baked Goods with Sesame Paste Versus Crushed Sesame Seeds. Int Arch Allergy Immunol. Published online October 16, 2025. doi:10.1159/000549025

2. Sesame Now the 9th Most Common Food Allergy in U.S. Aaaai.org. Published 2019. https://www.aaaai.org/about/news/news/sesame