SESAME SEED ALLERGY RESOLUTION IN TODDLERHOOD WITH NON- IGE ALLERGY COMORBIDITIES; AN EXCEPTION OR RULE?

Abstract

<h3>Introduction</h3> Sesame seed (SS) allergy is increasingly common in pediatrics and affects approximately 17% of children with existing food allergies. More children with atopic dermatitis (AD) are being identified as sensitized and allergic. Counseling on avoidance and anaphylaxis preparedness remains active for many early years in childhood. The resolution rate of pediatric sesame allergies is only between 20-30%. <h3>Case Description</h3> A 17 month-old female patient presented with acute facial urticaria upon SS exposure, limited to the mouth and upper jaw. The reaction did not progress to vomiting or respiratory distress. In the clinic, the evaluated skin test (ST) size for the histamine positive control was 4mm, and sesame extract 5mm. The patient's history included non-IgE mediated cow's milk protein allergy induced colitis and food protein induced enterocolitis syndrome (FPIES) to salmon. Counseling was provided on avoidance to each of the above foods and treatment in case of SS induced anaphylaxis. The patient was re-evaluated at the age of 39 months and tested negative for SS extract (twice) and prick to prick test to raw SS. An oral challenge to SS is planned to confirm the resolution of the SS allergy. <h3>Discussion</h3> Isolated SS allergy in a patient with FPIES has resulted in early loss of sensitization and tolerance by the age of 39 months, 22 months after initial SS exposure. SS allergy, although generally long lasting, may have different phenotypes in children with co-morbid non-IgE allergy that would benefit from earlier allergy review and challenge to confirm resolution.