Sesame Becomes the Ninth Major Allergen in the U.S.

New Law Requires Declaration of Sesame on Food Labels by 2023:

From hummus to baked goods to sushi, sesame is a prevalent and versatile ingredient found in foods around the world. Yet for individuals with a sesame allergy, consumption can be dangerous, with reactions ranging from mild to severe.

It is estimated that more than 1 million Americans have a sesame allergy. Yet, until recently, sesame was not considered to be one of the major food allergens in the United States. Therefore, labeling of sesame on packaged food products has not been required, making it challenging for those who have the allergy to identify foods made with sesame. The Food Allergy Safety, Treatment, Education and Research Act signed into law by President Biden on April 23 named sesame as the ninth major food allergen in the U.S., requiring it to be declared on food labels beginning January 1, 2023.

Allergen Legislation:

The Food Allergen Labeling and Consumer Protection Act of 2004 recognized what became known as the “Top 8” major allergens: milk, wheat, soybean, eggs, fish, shellfish, peanuts and tree nuts. These allergens were believed to account for 90% of the food allergies in the United States. The law required disclosure on most packaged foods sold in the U.S., regardless of whether they were made in this country or imported.

Some foods and beverages are not covered by this legislation: meat, poultry and egg products, as they are regulated by the U.S. Department of Agriculture; alcoholic beverages, which are regulated by the Alcohol and Tobacco Tax and Trade Bureau; raw agricultural commodities such as fresh fruits and vegetables; and most foods sold without a label, such as in a restaurant.

Prior to the introduction of the FASTER Act in the U.S., labeling of sesame in food has been required in various parts of the world; Australia, New Zealand, Canada, EU, Iceland, Liechtenstein, North Macedonia, Norway, Switzerland, Taiwan, Turkey, Ukraine and GSO (Saudi Arabia, UAE, Kuwait, Bahrain, Oman, Qatar and Yemen) all require sesame labeling.

For years, consumers, advocacy groups and legislators have advocated for sesame to be added to the list of major allergens. In November 2020, the U.S. Food and Drug Administration published guidance for food manufacturers to voluntarily disclose sesame in their products. However, there still was no mandatory compliance or uniform oversight by the FDA. To change this, the FASTER Act of 2021 was introduced.

The FASTER Act will make it safer for those with a sesame allergy by requiring declaration of sesame on food labels. Additionally, it requires the U.S. Department of Health and Human Services to report on research opportunities for prevention, treatment and potential cures for food allergies. The FASTER Act also develops a scientific framework for adding additional allergens to the top nine in the future, if warranted.

While there is no clear data to indicate the introduction of a 10th major allergen in the U.S. anytime soon, some advocates are calling for clear labeling of substances such as corn, gluten, mustard and celery. In other regions of the world, labeling for these ingredients is sometimes required. More research is needed to identify the prevalence and severity of allergies to these ingredients in the U.S.

Sesame in Foods:

According to Food Allergy Research & Education, sesame can be referred to by many names as an ingredient on a label, making it difficult for consumers to identify it in a product. Sesame may appear as benne, benne seed, benniseed, gingelly, gingelly oil, gomasio (sesame salt), halvah, sesame flour, sesame oil, sesame paste, sesame salt, sesame seed, sesamol, sesamum indicum, sesemolina, sim sim, tahini, tahina, tehina or til. It also may be hidden as “natural flavor” or “spices” in an ingredient statement.

Oils, such as peanut oil, that are derived from major allergens are often highly refined. This process removes the allergenic protein that causes an allergic reaction, making it safe for most people with that allergy. Sesame oil, however, typically is not highly refined, so the allergen is still present, making it unsafe for people who are allergic to sesame. Cold-pressed, expelled or extruded oils (sometimes referred to as gourmet oils) from any of the major allergens still contain the allergenic protein and should be avoided by people with that particular allergy.

Sesame in Non-Food Items:

In addition to food, sesame can be found in items including cosmetics, medications, nutritional supplements, perfumes and pet foods. Typically, sesame is labelled with the scientific name Sesamum indicum on these items. People with a sesame allergy may experience a reaction from contact with these items. Except for dietary supplements, non-food items do not have the same labeling requirements and are not covered under FALCPA or the FASTER Act.

Prevalence, Severity and Treatment of Sesame Allergies:

While the exact number of people with a sesame allergy is unknown, a cross-sectional study published in 2019 surveyed 51,819 U.S. households from October 1, 2015, through September 31, 2016, and estimated that more than 1.5 million children and adults — 0.49% of the U.S. population — may have a sesame allergy. However, further analysis indicated that only 0.23% met the criteria for a “convincing” IgE-mediated allergy based on self-reported symptoms, and 0.11% never experienced a reaction, despite being diagnosed with a sesame allergy by a physician.

Most respondents reported having more than one food allergy, particularly peanuts. In fact, more than 75% of those with a likely sesame allergy also reported an allergy to one or more of the other top eight allergens.

One theory for the rise in food allergies, particularly sesame in the U.S., points to the growth of global flavors such as tahini, hummus and spice blends. People who may not have previously consumed sesame may have been unaware of the allergy. As sesame becomes more ubiquitous in dishes across America, an increase in the number of reported allergies to it seems likely.

Allergic reactions to sesame can range from mild (hives) to severe (anaphylaxis or multiple organ system involvement). More than 37% of survey respondents reported having a severe reaction and more than 20% reported wheezing, fainting, dizziness or low blood pressure.

According to the individuals surveyed, hives were experienced more frequently with a sesame allergy. Gastrointestinal symptoms such as stomach pain, cramps, diarrhea, nausea or vomiting occurred less oftenin people with a sesame allergy compared to those who were allergic to one of the top eight allergens.

Treatment for sesame allergic reactions vary based on the severity of the reaction. In the same 2019 study, about one-third of participants reported use of an epinephrine autoinjector, a device that administers medicine to treat severe allergic reactions, at some point in their lifetime; nearly half reported antihistamine use; less than one-tenth reported use of an asthma inhaler, with slightly more reporting use of corticosteroids.

This study suggests a sesame allergy can be severe and identifies an opportunity for improved research, awareness, treatment and management of sesame allergy for people and the food and nutrition industry, as well as government regulation.

Putting It into Practice for Registered Dietitian Nutritionists (RDNs):

To provide proper nutrition care and guidance, registered dietitian nutritionists should educate themselves on food allergens and allergies, as well as their potential impact on a patient’s or client’s lifestyle. Advise patients or clients who suspect they have a sesame allergy to seek a medical diagnosis. Oral food challenges are the gold standard for a food allergy diagnosis, but other evidence-based methods may be used, along with a comprehensive medical history. Self-diagnosed allergies and intolerances can lead to unnecessary dietary restrictions and inadequate nutrition.

For patients or clients with a known sesame allergy:

• Recommend they always carry an epinephrine auto-injection device in case of anaphylaxis.
• Clarify that compliance for the FASTER Act does not begin until January 1, 2023. In the interim, urge them to continue reading food labels, looking for other ingredient names for sesame and avoid ingesting foods with sesame or coming into contact with non-food items that may contain sesame.

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