Sesame recently was added to allergens that must be listed on the ingredient labels of most packaged foods sold in the United States.
The Food Allergy Safety, Treatment, Education and Research (FASTER) Act requires food manufacturers to modify labeling of packaged foods containing sesame by Jan. 1, 2023. The FASTER Act was signed into law by President Joe Biden, with bipartisan support in the House and Senate. The AAP also supported labeling of sesame. Ingestion by those who are allergic can result in severe reactions, including anaphylaxis.
Allergen avoidance is the cornerstone of food allergy management and requires clear, accurate ingredient labels so that consumers can determine if foods are allergy-safe.
The Food Allergen Labeling and Consumer Protection Act of 2004 required all packaged foods (except meat, poultry, certain egg products and alcoholic beverages) sold in the United States to list the name of eight allergenic foods or food groups in plain English on the ingredient label. The allergen must be embedded in the ingredient list or in a “contains” statement. The eight foods are cow’s milk, eggs, fish (e.g., bass, flounder, cod), crustacean shellfish (e.g., crab, lobster, shrimp), peanuts, tree nuts (e.g., almonds, walnuts, pecans), wheat and soybeans. Both U.S.-made and imported packaged foods are subject to the regulation.
Though many more foods have been identified as triggers for food allergy, these eight foods account for 90% of all documented food allergies in the U.S.
Data suggest that sesame allergy prevalence has been rising. Sesame now is a relatively common food allergen, affecting an estimated 1.5 million children and adults in the U.S. (Sicherer SH, et al. J Allergy Clin Immunol. 2010;125:1322-1326; Warren CM, et al. JAMA Netw Open. 2019;2:e199144).
The median age of sesame allergy onset is 3.5 years, with one in four individuals developing the allergy as an adult. Sesame allergy is rarely outgrown (an estimated 20% to 30% of infants outgrow their allergy during childhood), and more than 80% of those allergic to sesame report having allergies to multiple foods. More than one in three children and adults with sesame allergy have reported experiencing severe allergic reactions.
Sesame appears in many different foods, such as baked goods, sauces/dressings and hummus, as well as in a variety of cuisines (e.g., Asian and Middle Eastern). Identifying sesame-free foods can be challenging. Some manufacturers do not list sesame directly as an ingredient but instead include it on the ingredient label under the words “natural flavors” or “natural spices.” They also may use words that are not easily recognized by consumers such as “tahini.”
Sesame will be the ninth allergen that is required to be listed in plain-language labeling in the U.S., which will help families identify safe foods when shopping. Labeling laws in Europe, Canada, Japan, the U.K., New Zealand and Australia already recognize sesame as a major allergen and require it to be clearly labeled.
The FASTER Act also prioritizes food allergy research. The secretary of Health and Human Services is required to issue a report on the prevalence of food allergies and severity of allergic reactions; identification of food allergy biomarkers; prevention of food allergies; development of therapeutics; and recommendations to expand, enhance or improve federal food allergy activities.
Only one treatment for life-threatening food allergy has been approved by the Food and Drug Administration, and it only helps individuals with peanut allergy. More research in these priority areas will support developments to enhance the lives of children with food allergies.
Dr. Wang is chair and Dr. Bird is a member of the AAP Section on Allergy and Immunology Executive Committee.
