The role of diagnostic tests and oral food challenge results to predict sesame allergy.

Ocak M., Sahiner Ü. M., Soyer O., Sekerel B. E.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, vol.128, no.1, 2022 (SCI-Expanded) identifier identifier identifier


Background: The presence of sesame allergy and its importance are increasing. Objective: To determine the results of sesame and tahini oral food challenges (OFCs) and whether sesame-spe-cific immunoglobulin E and skin prick tests (SPTs) accurately predicted sesame allergy in children. Methods: Patients with suspected sesame allergy between June 1, 2018, and June 1, 2020, were examined. Results: Of 92 patients (n = 65, 70.7% of the patients were boys) with a median age of 2 years (interquartile range, 1.2-3.8 years), 64 were reactive to tahini. Of 64 patients, 41 had a positive OFC result and 23 had a consistent his-tory. Of 54 sesame OFCs, 10 patients had a positive outcome. Of 44 with a negative outcome of sesame OFC, 4 experienced allergic reactions with tahini at home and 22 patients had a positive result for tahini OFC. In multi-variate logistic regression analysis, clinical reactivity of sesame (either a consistent history or a positive OFC) was positively associated with sesame SPT (odds ratio, 2.120; 95% confidence interval, 1.136-3.957; P = .01) and tahini SPT (odds ratio, 1.661; 95% confidence interval, 1.143-2.413; P = .008). Nevertheless, sesame-specific immuno-globulin E did not predict clinical reactivity. Tahini OFC outcomes were well predicted for both sesame and tahini SPTs (area under the curves of 0.937 and 0.896, respectively, P < .001 for both). A sesame SPT wheal size of 5.25 mm had 90.6% sensitivity, 82.1% specificity, and 5.1 positive likelihood ratio. For tahini SPT, the 6-mm threshold had 100% sensitivity, 82.1% specificity, and 5.6 positive likelihood ratio. Conclusion: In the OFC, tahini emerged as a more optimal diagnostic tool to avoid false negatives. Furthermore, both high sesame and tahini SPT levels individually can help predict the diagnosis of sesame allergy. (c) 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.