LAUSR

To the Editor, Common forms of sesame, namely seeds, oil, or paste (tahini), have differences in protein content and the available allergenic protein may differ (i.e., absorbed less from whole seeds compared to paste). Sesameallergic patients likely have varying thresholds of sensitivity that could result in reactions to some, but not all, forms of sesame. In a Turkish study, 26 of 44 patients (59%) with a negative oral food challenge (OFC) to sesame seed reacted to a similar dose of sesame protein in the form of tahini during an OFC (n = 22) or after consumption of tahini at home (n = 4).1 An Israeli retrospective chart review demonstrated that 78% of sesameallergic patients passed an OFC to approximately 60 intact sesame seeds (n = 51).2 These studies suggest that a substantial number of sesameallergic patients may be able to tolerate some forms of sesame (i.e., scattered seeds), but not others (i.e., tahini). Evidencebased guidance on how to advise sesameallergic patients on ingesting various forms is lacking. As a first step to understand whether there are various sesame allergy phenotypes, we sought to describe the number of patients who reported an allergic reaction to seeds, oil, and/or tahini, the reaction characteristics, and the advice provided by their allergist regarding dietary avoidance. An IRBapproved retrospective chart review was performed in pediatric patients presenting to an outpatient allergy referral clinic. A data exploration tool was used to identify charts for patients aged <18 years with an outpatient allergy encounter from 1/1/2018 to 1/31/2020 and ICD10 code Z91.018 (“Allergy to tree nuts or seeds”). Inclusion criteria for data collection were: age <18 years at time of encounter, physician diagnosis of sesame allergy, and at least one documented allergic reaction to a sesamecontaining food. Demographics, clinical and laboratory findings, and recommendations were recorded. Factors associated with allergic reaction to different forms of sesame were analyzed using Fisher's exact and Mann– Whitney tests. A result was considered statistically significant at the p < .05 level of significance. All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). A total of 3394 charts matching the coding criteria were identified, 297 were randomly selected for chart review, and 66 met inclusion criteria of which 59% were male, 77% were diagnosed with sesame allergy by age 2, and 94% had other food allergies (Table 1).