Sesame-induced anaphylaxis in pediatric patients from the cross-Canada anaphylaxis registry

Ann Allergy Asthma Immunol. 2022 Sep;129(3):342-346. doi: 10.1016/j.anai.2022.06.005. Epub 2022 Jun 10.


Background: Sesame can cause severe allergic reactions and is a priority allergen in Canada.

Objective: To assess clinical characteristics and management of pediatric sesame-induced anaphylaxis and identify factors associated with epinephrine treatment.

Methods: Between 2011 and 2021, children with sesame-induced anaphylaxis presenting to 7 emergency departments (ED) in 4 Canadian provinces and 1 regional emergency medical service were enrolled in the Cross-Canada Anaphylaxis Registry. Standardized recruitment forms provided data on symptoms, severity, triggers, and management. Multivariate logistic regression evaluated associations with epinephrine treatment pre-ED and multiple epinephrine dosages.

Results: Of all food-induced anaphylactic reactions (n = 3279 children), sesame accounted for 4.0% (n = 130 children), of which 61.5% were boys, and the average (SD) age was 5.0 (4.9) years. Hummus containing sesame paste triggered 58.8% of reactions. In the pre-ED setting, 32.3% received epinephrine, and it was more likely to be used in boys (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.08-1.50) and those with a known food allergy (aOR, 1.36; 95% CI, 1.11-1.68]). In the ED, 47.7% of cases received epinephrine, with older children more likely to receive multiple epinephrine doses (aOR, 1.00; 95% CI, 1.00-1.02).

Conclusion: In Canada, hummus is the major trigger of sesame-induced anaphylaxis. Knowledge translation focused on prompt epinephrine use and product-labeling policies are required to limit sesame reactions in communities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Allergens / therapeutic use
  • Anaphylaxis* / drug therapy
  • Anaphylaxis* / epidemiology
  • Anaphylaxis* / etiology
  • Canada / epidemiology
  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Epinephrine / therapeutic use
  • Female
  • Food Hypersensitivity* / complications
  • Food Hypersensitivity* / drug therapy
  • Food Hypersensitivity* / epidemiology
  • Humans
  • Male
  • Registries
  • Sesamum* / adverse effects


  • Allergens
  • Epinephrine