Comparison of Diagnostic Tests with Oral Food Challenge in a Clinical Trial for Adult Patients with Sesame Anaphylaxis
Sesame food allergy (SFA); especially anaphylaxis, is a life-threatening condition. The accurate diagnosis of SFA is done by skin prick test (SPT), skin prick to prick (SPP) or specific IgE (sIgE) and is confirmed by oral food challenge (OFC). Since there are few studies evaluating and comparing the utility of these methods for diagnosis of sesame anaphylaxis in adult patients, we aimed to compare OFC with diagnostic tests, including SPT, SPP, and sesames IgE; using ImmunoCAP considering the sensitivity and specificity issues in patients with sesame anaphylaxis. Twenty patients with sesame anaphylaxis were diagnosed based on OFC. Then SPT, SPP, and sIgE were evaluated. Sixteen patients had positive OFC; while 4 patients had negative results. Out of 16 OFC+ patients, 7 patients were SPT+, 15 patients were SPP+, and 2 patients had detectable sIgE. A positive SPT indicated 44% sensitivity and 50% specificity. A positive SPP showed 87.5% sensitivity and 75% specificity. A positive ImmunoCAP test demonstrated 12.5% sensitivity and 75% specificity. The AUC of SPP was significant for the diagnosis of sesame anaphylaxis (p=0.038). In conclusion, when the OFC is not possible, the SPP test with natural sesame seed may be applicable in patients with a convincing history instead of the artificial or commercial extracts of sesame used for SPT. Positive SPP is a good alternative diagnostic method for patients with sesame anaphylaxis. Also, the poor sensitivity of SPT and sIgE may indicate the poor discriminative capability of these tests.
2. Dalal I, Goldberg M, Katz Y. Sesame seed food allergy. Curr Allergy Asthma Rep 2012;12(4):339-45.
3. Fazlollahi M, Pourpak Z, Yeganeh M, Kardor G, Kazemnejad A, Movahedi M, et al. Sesame seed allergy&58; Clinical manifestations and laboratory investigations. Tehran University Medical Journal. 2007;65(8):85-90.
4. Nabavi M, Lavavpour M, Arshi S, Bemanian MH, Esmaeilzadeh H, Molatefi R, et al. Characteristics, Etiology and Treatment of Pediatric and Adult Anaphylaxis in Iran. Iran J Allergy Asthma Immunol 2017;16(6):480-7.
5. Cohen A, Goldberg M, Levy B, Leshno M, Katz Y. Sesame food allergy and sensitization in children: the natural history and long‐term follow‐up. Pediatr Allergy Immunol 2007;18(3):217-23.
6. Maruyama N, Nakagawa T, Ito K, Cabanos C, Borres MP, Movérare R, et al. Measurement of specific IgE antibodies to Ses i 1 improves the diagnosis of sesame allergy. Clin ExpAllergy 2016;46(1):163-71.
7. Rekabi M, Arshi S, Bemanian MH, Rekabi V, Rajabi A, Fallahpour M, et al. Evaluation of a new protocol for wheat desensitization in patients with wheat-induced anaphylaxis. Immunotherapy 2017;9(8):637-45.
8. Permaul P, Stutius LM, Sheehan WJ, Rangsithienchai P, Walter JE, Twarog FJ, et al., editors. Sesame allergy: role of specific IgE and skin prick testing in predicting food challenge results. Allergy Asthma Proc 2009; 30(6):643-8.
9. Kanny G, De Hauteclocque C, Moneret‐Vautrin D. Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996;51(12):952-7.
10. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson Jr NF, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. JAllergy Clin Immunol 2006;117(2):391-7.
11. Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977;309(8009):466-9.
12. Dano D, Remington B, Astier C, Baumert J, Kruizinga A, Bihain B, et al. Sesame allergy threshold dose distribution. Food Chem Toxicol 2015;83:48-53.
13. Della-Torre E, Pignatti P, Yacoub M-R, Sabbadini M-G, Colombo G. In vivo tests with “Tahini” sauce: new allergenic source to evaluate IgE-mediated hypersensitivity to sesame. Ann Allergy Asthma Immunol 2013;110(3):209-10.
14. Derby C, Gowland M, Hourihane JOB. Sesame allergy in Britain: a questionnaire survey of members of the Anaphylaxis Campaign. PediatrAllergyImmunol 2005;16(2):171-5.
15. Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol 2012;129(5):1187-97.
16. Li PH, Gunawardana N, Thomas I, Ue KL, Siew L, Watts TJ, et al. Sesame allergy in adults: Investigation and outcomes of oral food challenges. AnnAllergyAsthma Immunol 2017;119(3):285-7.
17. Peters RL, Allen KJ, Dharmage SC, Tang ML, Koplin JJ, Ponsonby A-L, et al. Skin prick test responses and allergen-specific IgE levels as predictors of peanut, egg, and sesame allergy in infants. J Allergy Clin Immunol 2013;132(4):874-80.
18. Raap U, Wieczorek D, Schenck F, Kapp A, Wedi B. The basophil activation test is a helpful diagnostic tool in anaphylaxis to sesame with false‐negative specific IgE and negative skin test. Allergy 2011;66(11):1497-9.
19. Babaie D, Nabavi M, Arshi S, Mesdaghi M, Chavoshzadeh Z, Bemanian MH, et al. Cow’s Milk Desensitization in Anaphylactic Patients: A New Personalized-dose Method. Iran J Allergy Asthma Immunol 2017;16(1):45-52.
20. Appel MY, Nachshon L, Elizur A, Levy MB, Katz Y, Goldberg MR. Evaluation of the basophil activation test and skin prick testing for the diagnosis of sesame food allergy. Clin Exp Allergy 2018;48(8):1025-34.
21. Adatia A, Clarke AE, Yanishevsky Y, Ben-Shoshan M. Sesame allergy: current perspectives. J Asthma Allergy 2017;10:141-51.
22. Zavalkoff S, Kagan R, Joseph L, St-Pierre Y, Clarke A. The value of sesame-specific IgE levels in predicting sesame allergy. JAllergyClin Immunol 2008;121(6):1508-10.
23. Barbarroja-Escudero J, Sanchez-Gonzalez M-J, Antolin-Amerigo D, Rodriguez-Rodriguez M, Pineda F, Alvarez-Mon M. Diagnosis of IgE-mediated hypersensitivity to sesame seeds supplemented with lipid body proteins. Allergol Int 2015;64(4):396-8.
24. Leduc V, Moneret-Vautrin D, Tzen J, Morisset M, Guerin L, Kanny G. Identification of oleosins as major allergens in sesame seed allergic patients. Allergy 2006;61(3):349-56.