Tahini May Be the Preferred Form for Pediatric Sesame Oral Food Challenges

In a recent study, outcomes of 307 pediatric sesame oral food challenges (OFC) varied by sesame form, with tahini associated with higher anaphylaxis rates and lower reaction thresholds than whole seeds.1 The findings suggest that tahini may be the more appropriate sesame form for OFCs.

“Although using tahini for sesame OFCs is recommended, given the potentially higher risk of anaphylaxis, caution is advised,” wrote study investigator Aimee Huynh, MBBS, from the department of immunology at Sydney Children’s Hospital in Australia, and colleagues.

During food challenges, some patients with sesame allergy appear to tolerate whole sesame seeds but react to more concentrated sesame products, such as tahini. For instance, one study found that 49% of patients with a negative sesame seed OFC reacted to a similar dose of tahini during OFC or at home.2 Investigators therefore sought to determine whether different sesame forms, including whole seed, crushed seed, and tahini, affect OFC outcomes, such as reaction thresholds, cumulative dose tolerated, and anaphylaxis rates.1

To explore this, the team conducted a retrospective review of children with sesame allergy assessed at pediatric allergy clinics across 4 centers across Australia: Sydney Children’s Hospital, Royal Children’s Hospital, Epworth Allergy Specialists Richmond Hospital, and Queensland Children’s Hospital. OFCs using different sesame forms were performed between 2007 and 2021.1

An OFC was considered positive if a patient experienced skin changes, angioedema, oropharyngeal symptoms, gastrointestinal symptoms, multiorgan involvement, or anaphylaxis. The threshold dose was defined as the final dose administered before the onset of a reaction.

The review included 307 OFCs, of which 104 patients (34%) resulted in a reaction. Anaphylaxis occurred in 28 OFCS (9.12%), involving 307 participants.1

Of the total challenges, 53 involved whole sesame (47.2% male; mean age 5 years, mean skin prick test [SPT], 4.5 mm),163 involved crushed sesame (65.6% male, mean age, 6 years; mean SPT, 3.50 mm), and 91 involved tahini (48.2% males, mean age, 8 years; mean SPT, 3.00 mm). The most common referral reason for whole and crushed sesame OFCs was a SPT wheal ≥ 3 mm and a history of sesame reaction. In contrast, the most common referral reason for tahini OFCs was a SPT wheal ≥ 3 mm with no prior history of sesame ingestion.1

The study found higher reactivity in children who received whole sesame during OFCs compared with those who received crushed sesame or tahini. However, patients challenged with crushed sesame or tahini had lower median SPT values, a finding limited by referral and selection bias.1

The tahini group had the lowest median SPT and the highest cumulative dose tolerated compared with the whole sesame and crushed sesame groups, although these differences were not statistically significant. Within-group analyses showed no significant difference in median SPT between positive and negative challenges among children receiving tahini (4.28 mm vs 2.82 mm; P = .108). By contrast, significant differences in median SPT were observed between positive and negative OFCs in both the whole sesame group (5.86 mm vs 3.91 mm; P < .001) and the crushed sesame group (4.01 mm vs 3.19 mm; P = .03).1

Patients receiving tahini during OFCs experience a greater rate of anaphylaxis than those receiving whole or crushed sesame, though this difference was not statistically significant (P =.829). Investigators also observed a trend toward lower threshold and cumulative doses among children who developed anaphylaxis after receiving tahini or crushed sesame.1

“We believe that there was less influence of referral bias in the whole and crushed sesame groups,” investigators wrote. “This finding suggests that using intact sesame seeds for OFC in children may lead to falsely elevated threshold results—or indeed falsely negative challenge results—so we recommend using either tahini or crushed sesame instead. In addition, OFC with sesame seeds may be falsely reassuring that patients can tolerate all forms of sesame. The higher rate of anaphylaxis in [the tahini group] than in the other two groups, despite the issues associated with referral and selection bias, support this hypothesis.”1

References

1. Huynh A, Alhucema P, Mehr S, et al. Outcomes of sesame oral food challenges using different forms of sesame: Pediatric multicenter review. J Allergy Clin Immunol Glob. 2025;5(1):100604. Published 2025 Nov 13. doi:10.1016/j.jacig.2025.100604

2. Ocak M, Sahiner UM, Soyer O, Sekerel BE. The role of diagnostic tests and oral food challenge results to predict sesame allergy. Ann Allergy Asthma Immunol. 2022;128(1):46-52.e1. doi:10.1016/j.anai.2021.09.005