Comparing Two Oral Immunotherapy Strategies for Sesame Allergy: Baked Goods with Sesame Paste versus Crushed Sesame Seeds.

INTRODUCTION: Sesame allergy is reported to be a major trigger of food-induced anaphylaxis and is associated with increased risk of accidental exposure. This study aimed to assess the efficacy and safety of a modified sesame desensitization protocol in children in real-world clinical practice. METHODS: Children with a positive skin prick test and a history consistent with an IgE-mediated allergy to sesame presenting at the Allergy Clinic of the Montreal Children's Hospital were recruited. After parents provided informed consent, an initial dose of sesame protein was introduced in the form of baked sesame paste (tahini) muffin or raw sesame seeds under physician supervision. An initial dose of 1/4 teaspoon (5 mg sesame protein) was given to the baked group, reaching a maintenance dose of two teaspoons of hummus (600 mg protein). In contrast, 75 mg of crushed sesame seeds (approximately 15 seeds) was given to the seeds group, reaching a maintenance dose of one tablespoon (3 g protein) of tahini. Once a maintenance dose was achieved, participants were asked to return to the clinic once a year for 5 years. RESULTS: The cohort consisted of 76 patients, in which 39 received baked sesame and 37 raw sesame. Considering the two desensitization strategies, using seeds significantly increased the odds of being at a higher reaction severity level by a factor of 7.1 (95% CI: 3.6-14.1) than baked goods with sesame paste. For both the baked goods and the seeds group, likelihood of severe reactions significantly decreased over time. CONCLUSION: A modified sesame desensitization protocol using baked sesame paste can be safely used for children with sesame allergy.