The Hidden Risks of Sesame Allergies

Hi, I’m Russell. I don’t have food allergies. I never gave them much thought, eating whatever I wanted.

Then I had my daughter.

After introducing solid foods at six months, I learned she was allergic to peanuts. Allergic reactions can be scary, including things like hives, swelling, and anaphylaxis, which can be fatal.

She got tested at the allergist: tree nuts and sesame were added to the list.

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The tree nuts she is allergic to are cashews and pistachios. Technically, they aren’t even nuts, but seeds! And peanuts are legumes! Although tree nuts are lumped into a single category, they are made up of cashews, pistachios, walnuts, almonds, hazelnuts, pecans, and others.

I knew peanuts and tree nuts were common, but sesame surprised me. It was time to learn about food allergies.

I read Dr. Ruchi Gupta’s recent book Food Without Fear. Here are some basics:

Food allergies are common. About 32 million Americans have at least one allergy. Different from an intolerance, they are medical diagnoses for foods that trigger a harmful immune response, sending someone to the ER on average every three minutes. One in 10 adults, and one in 13 children have food allergies.

Food allergies are on the rise in recent decades, and sesame is especially an allergen of growing concern. According to a 2019 study by Dr. Gupta, the top nine allergens in the US are shellfish (8.7 million with a convincing allergy*), milk (6.4), peanut (6.3), tree nut (4.0), egg (2.7), fin fish (2.7), wheat (2.4), soy (2.0) and sesame (0.8).

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The Center for Disease Control and Prevention estimated that food allergies increased by 50% in children between 1997 and 2011. Why? Still being debated. In addition to emotional costs, Dr. Gupta estimates that families with a child with food allergies can on average spend an extra $4,000 a year.

Since 2006, the FDA “requires that the label of a food that contains an ingredient that is or contains protein from a ‘major food allergen’ declare the presence of the allergen in the manner described by the law.”

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Why is this so important? Because accurate food labeling is not the standard. A Canadian study referenced in Dr. Gupta’s book found that 17% of accidental exposures came from unlabeled ingredients.

But advisory labeling policies can be better. For example, current precautionary allergen labeling (PAL), like “may contain [allergen],” is not regulated and is voluntarily placed on products. This leads consumers to interpret that one message is safer than another.

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In a survey, Dr. Gupta found that 56% of people think PAL is mandated by law, and 41% believe the language correlates to the quantity of allergen present, when in fact they don’t adhere to any standard.

There is no cure for food allergies. And since labeling regulations are limited and don’t account for a variety of potential risks hidden during manufacturing practices, the only prevention is being prepared and informed.

Michelle also has food allergies. We shared our experiences and talked about all the stresses that come with them, whether it is eating out or grocery shopping.

We discussed the complexities of food labeling, and the hidden ways sesame can end up in a product, like being in a generic ingredient such as “spices,” or from cross-contact on shared equipment.

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There are a few common hiding places for sesame in ingredients. It can be part of a vague “spices” blend, or in “natural flavors.” It can be masked by another name or ingredient (e.g., tahini). It can also sneak in during manufacturing (e.g., the product was made on the same line as another that had sesame).

We decided to run an experiment on the presently unregulated labeling practices of sesame. Our goal: explore data to shine some light on an aspect of life that may seem trivial to most, but stressful to many.

Our experiment focused on grocery shopping, since every choice could have potentially life-threatening consequences for my daughter. Just one of many mundane daily habits that can be anxiety-inducing for people with allergies.

We focused our research on crackers; a snacking staple that can often have sesame seeds. We (virtually) visited two massive grocery chains — Albertsons and Whole Foods — and picked the 100 most popular crackers from each place.

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Why Albertsons? It is one of the biggest chains in the US (including Safeway, Vons, Jewel-Osco, Acme, Shaw’s) and carries crackers most people are familiar with. Why Whole Foods? It is the biggest “natural” food store in the US, and carries items that more conventional stores do not.

Our mission: find how confident we can be when deciding to purchase each cracker. Does the product’s labeling practices make life easier or more stressful?

We compiled all the ingredients for the 200 crackers across 42 brands, and contacted them (via websites, emails, and phone calls) to get details about their approaches to labeling and manufacturing.

We split the results into two groups. 65% of crackers fall into the “confident” group. Confidence means we can clearly determine whether the product contains sesame or not based on the label.

One in five of these we simply avoid because sesame is an ingredient. For the rest, we feel it is safe to purchase, either because the brand runs a sesame-free facility, or we understand and trust their manufacturing or labeling practices.

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An example of a good response: “sesame has been identified as an allergen of growing concern, and as such, we want to provide the information our consumers need to evaluate our products. We voluntarily call out sesame as such on our product labels and we would always detail the presence of sesame even if it was found in our flavors or spices.”

But for 35% of crackers, we have “no confidence”. Even after contacting the manufacturers, we are unsure whether they contain sesame or not, so we avoid them. For many, this was because we received unclear or unconvincing responses to our inquiries.

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Two examples of bad responses: “We unfortunately cannot disclose the ingredients in our natural flavors as they are proprietary so they may or may not contain sesame,” and “We do not have the information you requested. Since sesame is not a top 8 allergen in the USA it is currently not treated as an allergen in our facilities.”

A handful of these were even more concerning: despite our best efforts, there was no accessible information on their label or websites, and we were unable to contact them or didn’t hear back.

After talking to dozens of brands, we were ultimately disappointed by the results. Because the regulations are limited for all allergens — and forthcoming for sesame — more than one third of crackers presented a considerable risk. And beyond the varied approaches to labeling and manufacturing, the biggest challenge we encountered was simply accessing this information.

However, some brands did show how allergen information can be done well. Take Simple Mills, which makes a product by product allergen list easily accessible on their site.

Until labeling laws improve, it’s no wonder some people just choose to avoid products altogether that aren’t explicitly made in allergen-free facilities.

So where do we go from here? Here are some things you can do, with various levels of involvement:

Although we’d like to share the data as a resource for others, we think this is a disservice to the community. Not only is it out of date as of publishing the story, but doctors always recommend to read the labels for yourself every time and contact brands regularly since manufacturing practices and facilities can change.

For comments or questions get in touch with the team at [email protected]. Special thanks to Dr. Gupta and her team for providing feedback on the story.

*According to the researchers at CFAAR, population estimates for a “convincing allergy” were based on symptom-reporting criteria for IgE-mediated food allergy, irrespective of whether or not it’s physician diagnosed.