February 2019

Counseling on common food allergies: is sesame now a concern?

According to a new study, the most common food allergens in the US are shellfish, milk, peanut, tree nut, fish, egg, wheat, soy, and sesame. However, only the first eight of these foods must be clearly identified on a food label.

Patients with confirmed or suspected sesame allergy may have heard that the FDA is considering adding sesame to the list of major allergens. If sesame is added to the list, food products containing sesame will be required to clearly note it as an ingredient on the food label. But for now, there’s no guarantee that sesame will be added to the list. Until sesame is classified as a major allergen, it can still be listed on food labels as simply “spice,” “flavoring agent,” or “tahini.” Tell patients with sesame allergy to continue avoiding foods with these questionable listed ingredients. Also, remind anyone with a confirmed severe food allergy to make sure they carry a rescue medication (epinephrine) with them at all times.

Food allergies should be taken seriously, but it’s important for patients to get tested for any suspected food allergy before eliminating foods from their diet. Many patients confuse food allergy with food intolerance. Since symptoms of food intolerance are generally less severe than those of food allergy, the steps to manage food intolerance is often less strict. Patients with food allergies must avoid all foods as well as certain drugs that contain the food allergens. But people with food intolerance are often able to eat small amounts of the food and may be able to take drugs containing the food trigger.

You should also encourage parents to expose children to allergens during infancy. This might be surprising, as previous expert advice has encouraged parents to AVOID possible allergens during infancy. However, the evidence now suggests that avoiding allergens during infancy might actually be contributing to an increased rate of food allergy. Introducing allergens during infancy, on the other hand, seems to help prevent the development of allergies.

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