D3.302 - Sesame as an under-recognized allergen: storage protein sensitization underlying food-induced anaphylaxis in a young adult

INTRODUCTION:

Sesame is an increasingly important cause of food-induced anaphylaxis and is now classified as a priority allergen in several regions. Its allergenic profile includes stable storage proteins, particularly the 2S albumin Ses i 1, which is associated with systemic reactions. Because sesame is commonly incorporated into composite dishes and processed foods, its role as a trigger may not be readily suspected.

CASE PRESENTATION:

A 21-year-old woman with seasonal allergic rhinoconjunctivitis developed abdominal pain, dyspnea, wheezing, and subjective tongue swelling 30–60 minutes after ingestion of sushi, subsequently confirmed to contain sesame. No urticaria or cardiovascular involvement was reported. She presented to the emergency department and was hemodynamically stable at assessment. No cofactors were identified.

According to WAO/EAACI criteria, the presence of respiratory symptoms together with gastrointestinal manifestations following exposure to a probable food allergen is consistent with anaphylaxis.

OUTCOME:

Serum specific IgE to fish and Anisakis was negative. Multiplex molecular analysis demonstrated elevated IgE to sesame extract (10.47 kUA/L) and to Ses i 1 (2S albumin) (6.51 kUA/L). PR-10 proteins, profilin, nsLTP, cereal storage proteins, and fish allergens were negative. Additional sensitizations to other plant foods lacked clinical relevance.

Strict sesame avoidance was advised. The patient subsequently tolerated rice and other previously consumed foods without symptoms. No further reactions have occurred.

CONCLUSION:

This case underscores sesame as a clinically relevant and potentially under-recognized allergen in mixed dishes. Sensitization to the stable storage protein Ses i 1 provides a molecular basis for systemic involvement and supports risk stratification. Recognition of storage protein–mediated sesame allergy is essential for accurate diagnosis and appropriate prescription of an adrenaline autoinjector after food-related anaphylaxis.