Sesame Immunotherapy: A Systematic Review and Narrative Synthesis
In brief
Sesame oral immunotherapy desensitized 85% to 97% in small studies
Across nine studies, mostly small cohorts and case series, sesame oral immunotherapy was associated with desensitization in about 85% to 97% of participants. Most side effects were mild to moderate, but evidence for lasting unresponsiveness was limited; small samples, varied protocols and short follow-up leave long-term benefit and safety uncertain.
- Journal
- Clinical and translational allergy (Q1)
- Published
- 1 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Joanna Zielińska, Katarzyna Kunkiel, Anna Krupa-Łaska, Marek Kulus, Katarzyna Grzela
- PMID
- 42808451
- DOI
- 10.1002/clt2.70206
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 4 October 2026): Systematic review of sesame immunotherapy, not population epidemiology
Abstract
Sesame allergy is associated with severe allergic reactions, low rates of spontaneous resolution, and significant psychosocial burden. Current management relies on strict avoidance and emergency treatment. Allergen-specific immunotherapy, particularly oral immunotherapy (OIT), has emerged as a potential disease-modifying approach, but evidence for sesame allergy remains limited. A systematic search was conducted through August 2025. Eligible studies included participants of any age with confirmed sesame allergy treated with allergen immunotherapy. Primary outcomes were desensitization and sustained unresponsiveness assessed by oral food challenge. Secondary outcomes included adverse events, epinephrine use, quality of life, and mortality. Risk of bias was evaluated using Joanna Briggs Institute tools. Nine studies met the inclusion criteria, including one study identified through citation searching. The evidence consisted, primarily small cohort studies and case series. Single-allergen sesame OIT achieved high desensitization rates (approximately 85%-97%) across heterogeneous protocols and age groups. Sustained unresponsiveness was reported in a limited number of mainly pediatric cohorts. Most adverse events were mild to moderate; severe reactions requiring epinephrine were uncommon, and no deaths were reported. Adjunctive omalizumab improved tolerability in high-risk adults. Sesame OIT shows promising efficacy with an acceptable safety profile in specialized settings. However, evidence is limited by small sample sizes, heterogeneity, and short follow-up. Randomized controlled trials are needed to define optimal protocols and long-term outcomes. TRAIL REGISTRATION: The protocol for this systematic review was prospectively registered in PROSPERO (International Prospective Register of Systematic Reviews; Registration number: CRD420251087250).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.