Eric Athas

The finding indicates that sesame allergy is more prevalent than previously known, although still far less common than peanut allergy. But sesame is not among the allergens that the Food and Drug Administration requires manufacturers to list on food labels.

“Sesame allergy is becoming a common allergy in the U.S.,” said Dr. Ruchi S. Gupta, a professor of pediatrics at Northwestern Medicine in Chicago and senior author of the study, which was published in the journal JAMA Network Open. “The impact on over a million people in the U.S. is significant.”

The study relied on online and phone survey responses from 40,453 adults and 38,408 children. People who have had at least one symptom of sesame allergy made up an estimated 0.23% of the population, Gupta and her colleagues found.

Those who have been diagnosed with the allergy but have never experienced a symptom accounted for an estimated 0.11% of the population.

“That’s about 1.1 million people in the U.S. who currently probably have a sesame allergy and therefore are avoiding sesame in their daily lives,” said Christopher M. Warren, an epidemiologist at the Northwestern Center for Food Allergy and Asthma Research and lead author of the study.

Exposure to a food allergen like sesame can lead to an anaphylactic reaction, including throat swelling and a drop in blood pressure. Severe reactions can be fatal.

Among people with a sesame allergy, 62% said they had a prescription for epinephrine, the injected medicine used to ease an allergic reaction. Of those with an epinephrine prescription, about one third said they had used the medication at some point.

Many people in the survey reported symptoms of sesame allergy but were never actually diagnosed, Gupta noted.

“If you eat a food and have a reaction, it is important to get it diagnosed, because you want to make sure it really is an allergy to that food before you spend your life avoiding that food,” she said.

Currently, the federal government requires manufacturers to tell consumers when a product was made using any of eight allergens: milk, eggs, fish, shellfish, peanuts, wheat, soybeans and tree nuts. Consumers can find those allergens printed in the ingredients list or in a special warning.

But sesame, which Gupta referred to as “the ninth most common allergen,” wasn’t part of the 2004 law that mandated the labeling. Consumers cannot know for certain whether food at the grocery store has sesame in it. Even if sesame were used as an ingredient, it might be described as “natural flavors” or “spices.”

Lisa G. Gable, chief executive of Food Allergy Research &amp; Education, a nonprofit organization in McLean, Virginia, hopes that this latest study convinces the FDA to make a change.

“It elevates, with great specificity, the data related to the impact of sesame on the lives of individuals who have to basically avoid that food,” Gable said.

The FDA is considering adding sesame — which is already regulated in the European Union, Canada and Australia — to the list. In 2018, the agency issued a request for information to “learn more about the prevalence and severity of sesame allergies in the U.S.”

“The FDA has received more than 4,800 comments from consumers, industry associations, medical professionals and academics,” a press officer for the FDA said. “We are carefully considering all of the comments received as we explore different options for possible agency actions and will provide updates as they become available.”

Certain food allergies already covered under the labeling law appear to be less common than sesame allergies. Allergies to macadamia nuts, a type of tree nut, were only found in 0.008% of children and adults in the United States, according to the study.

This article originally appeared in <a href="https://www.nytimes.com/2019/08/02/science/sesame-food-allergies.html" id="96222e60-f6ee-3090-a736-d2b879c90b50">The New York Times</a>.

Sesame Allergy More Common Than Once Thought, Study Finds

At least 1 million children and adults in the United States are allergic to sesame, an ingredient used in everything from hummus to snack bars, researchers reported Friday.

<h1>When you are shopping for someone who has a food allergy, a trip to the grocery store is like a police investigation. Each product must be scrutinized. Labels are examined, each ingredient studied.</h1>

My 5-year-old son, Alexander, is allergic to almonds and hazelnuts, so my wife and I spend a lot of time trying to decipher food labels. If you miss something, even one word, you risk an allergic reaction.

Although federal law requires manufacturers to include allergen warnings on prepackaged foods, it is not always clear which products contain allergens and which do not. The regulation does not cover all types of foods, nor instances in which trace amounts of allergens may be present.

This has created a confusing and risky marketplace for my family and millions of others — roughly 8 percent of children have a food allergy. I set out to better understand allergen labeling and the problems consumers face. Here’s what I learned.

— Warnings for Certain Allergens

Congress passed the Food Allergen Labeling and Consumer Protection Act in 2004, a rule book for manufacturers. Companies must place special warnings on prepackaged foods if they were made using certain allergens: milk, eggs, fish, shellfish, peanuts, wheat, soybeans and tree nuts.

If I grab a box of cookies from the store shelf, I might find a special warning printed near the ingredients list — “contains almonds” — because almonds are part of the tree nut family. If I don’t see one, I can be assured that the product wasn’t made using almonds.

— But Some Allergens Aren’t on the Label

Sesame is the ninth-most-prevalent food allergy among adults in the United States. But the food was left off the list of major food allergens in the labeling law passed by Congress.

Manufacturers do not have to print a “contains sesame” message. It may even be hidden under “natural flavors” or “spices” on the ingredients label.

“I can’t even trust what’s written on the label anymore,” said Madeline L. Whitney, 18, a freshman at the University of Notre Dame who is allergic to sesame.

One morning this past October, Whitney ate a protein bar before a statistics exam. She checked the label, which noted “natural flavors” on the list of ingredients — but not sesame.

When Whitney sat down to take the exam, she started experiencing signs of an anaphylactic reaction. She readied her EpiPen.

“All of a sudden, my tongue is just totally swollen and my throat is closing,” Whitney said. The reaction was so severe that she had to be injected with two doses of epinephrine before recovering at the university’s health clinic.

Stories like Whitney’s are driving a push by advocacy groups to mandate sesame labeling.

The Food and Drug Administration is considering whether to add sesame to the list of major allergens.

“Sesame should be included as one of the top allergens that needs to be disclosed on labels,” said Lisa G. Gable, chief executive of Food Allergy Research &amp; Education, a nonprofit organization based in McLean, Virginia.

Sesame labeling is already mandated in Canada, the European Union and Australia.

— Trace Amounts Are Difficult to Track

Here is where it gets even more complicated. Even if my box of cookies does not include one of the mandated warning labels, the cookies may still contain an allergen.

Let’s say, back at the manufacturer, my cookies were put on the same conveyor belt used for almond cookies. Small bits of almond might have made it into my seemingly almond-free cookies.

This is called cross contact. And there is no surefire way I can know it happened — the federal government does not require manufacturers to include labeling for possible cross contact of allergens.

As a result, food manufacturers developed their own unregulated labeling practices to alert consumers to potential cross contact. Here’s a sampling from a recent trip to the grocery store:

— Cookies: “May contain peanuts and tree nuts.”

— Chocolate bar: “Manufactured on the same equipment that processes almonds.”

— Bread: “Made in a bakery that may also use tree nuts.”

These short descriptions, often called “precautionary allergen labeling,” may alert consumers to some risks, but because the labels are unregulated, their meanings differ from company to company.

A 2017 study, published in The Journal of Allergy and Clinical Immunology: In Practice showed that consumers made “risk assessments” based on the words used in this kind of labeling.

“We’re making consumers decide, based on the wording of that precautionary allergen label, what seems safe for themselves or their child, and I think that’s a huge issue,” said Dr. Ruchi S. Gupta, a professor of pediatrics at Northwestern Medicine in Chicago and an author of the study.

— Cross Contact May Cause a Reaction

My child has not had a reaction from cross contact in prepackaged food, fortunately. But other children certainly have.

“The whole world of food labeling is almost like a foreign language,” said Allison A. Ososkie of Vienna, Virginia.

Her 2-year-old son, Lincoln, is allergic to egg, milk, peanuts, tree nuts, soy and shellfish. This past spring, he had an anaphylactic reaction to crackers that might have been processed on equipment with milk products.

Anna M. Francis, an acupuncturist in Wheat Ridge, Colorado, has a 6-year-old daughter, Penelope, who is allergic to egg, dairy, cashew, pistachio, cherry and blackberry. In 2015, Francis thought the snack bar she was giving her daughter was safe. She even called the company to ask about its equipment-cleaning process.

“My daughter had a bite and had an anaphylactic reaction,” Francis said. She wants the government’s regulation to include labeling for possible cross contact of allergens.

— Sometimes the Labels Are Just Wrong

There is something else consumers with food allergies have to worry about: incorrect packaging. Sometimes, during the manufacturing process, food made using one of the eight major allergens is not properly labeled.

In 2018, about one-third of FDA recalls involved prepackaged foods that were erroneously labeled, according to data compiled by the agency.

— It Doesn’t Get Better at the Bakery or Deli

Remember my box of cookies? Let’s say I put it back on the shelf and head over to the store’s bakery for freshly prepared treats instead. Sadly, foods produced in a bakery or deli and “placed in a wrapper or container in response to a consumer’s order” are not covered under federal labeling requirements. The label on my box of cookies, packaged by a bakery worker, will not have any federally regulated allergen labels on it.

— Manufacturers Say Safety Is the Priority

The labeling on the side of my box of cookies — whether it says “contains almonds,” “may contain almonds” or nothing at all — is determined by the food manufacturer.

So what goes into making the food that ends up on a shelf? And what kind of consideration is given to people with food allergies?

At Nestlé's U.S. operation, the key is applying “allergen management” across the expansive and complex operation, said David C. Clifford, director of food safety at Nestlé USA. He described the company’s approach as “objective, science-based, risk-based.”

“It’s a very serious responsibility that we have to feed the public, and the responsibilities around these systems extend horizontally across the organization,” said Clifford, who added that his team conducted allergen training throughout the company.

The Hershey Co. also runs a training program for employees, it said in a statement. The training “includes video interviews with allergic children and their families who face the challenges of allergen management on a personal level every day of their lives.”

Tips for Finding Safe Food

Given everything we know about food allergen labeling, here is some advice.

— Skip Food With Precautionary Labels

When you’re scanning the shelves, if you spot precautionary labels beginning with “may contain” or “processed in the same facility as,” don’t buy the products if the labels refer to your allergy, said Dr. Scott H. Sicherer, chief of pediatric allergy and immunology at the Icahn School of Medicine at Mount Sinai in New York.

“You shouldn’t make risk decisions based on what precautionary words are used on the label,” Sicherer said. “But rather, to be 100 perfect safe, just avoid products that have the precautionary label, if that’s a food that you’re avoiding.”

— Reach Out to Food Manufacturers

Instead of guessing what a label might mean, a few parents I spoke to take a proactive approach: calling companies to get answers, even if it is time-consuming.

“Maybe once a month I’m calling and trying to track something down,” said Julie V. Lunn, a bookkeeper and entrepreneur in Havre de Grace, Maryland, whose 3-year-old daughter, Alafair, is allergic to a variety of foods.

— Find Products From Allergen-Free Sites

One way to simplify things is to seek out products made in allergen-free plants.

Enjoy Life Foods has one such plant, said Joel D. Warady, general manager of the company. He said employees were forbidden from bringing peanuts to work, and they must wear company-issued shoes that don’t leave the factory, in Jefferson, Indiana.

MadeGood Foods, based in Vaughan, Ontario, swabs hands and tables to test for allergens, said Janice A. Harada, the company’s marketing manager.

Manufacturers like these cater to the allergy community, using branding to make it clear their foods are free of allergens.

And that box of cookies I’ve been looking for? If its label says “made in a dedicated allergen-free facility,” it should be safe to give to my son.

This article originally appeared in <a id="d7c6ad85-8de3-43a5-bf36-400046d05169" href="https://www.nytimes.com/2019/01/28/health/food-allergies-children-labeling.html">The New York Times</a>.

My 5-year-old son, Alexander, is allergic to almonds and hazelnuts, so my wife and I spend a lot of time trying to decipher food labels. If you miss something, even one word, you risk an allergic reaction.

Shopping like an allergy detective

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Pulse Kenya is the most followed news and entertainment platform in Kenya. It informs and engages young Kenyans around the clock and provides updates by the hour.

Eric Athas

Articles written by the author

Sesame Allergy More Common Than Once Thought, Study Finds

Shopping like an allergy detective