Rapid allergic reaction may include anaphylaxis, a potentially life-threatening condition requiring treatment with epinephrine.

Commercially prepared sesame extracts lack these lipophilic proteins, and so can be the reason for false negative skin prick test results even though the oleosins can be responsible for a range of allergic reactions, including anaphylactic shock.

[4] Strong predictors for adult-persistence are anaphylaxis, high sesame-specific serum immunoglobulin E (IgE) and robust response to the skin prick test.

[6] Food allergies in general usually have an onset of symptoms in the range of minutes to hours for an IgE-mediated response, which may include anaphylaxis.

[17] Symptoms may include rash, hives, itching of mouth, lips, tongue, throat, eyes, skin, or other areas, swelling of lips, tongue, eyelids, or the whole face, difficulty swallowing, runny or congested nose, hoarse voice, wheezing, shortness of breath, diarrhea, abdominal pain, lightheadedness, fainting, nausea, or vomiting.

[1] Non-IgE-mediated responses occur hours to days after consuming the allergenic food, and are not as severe as IgE-mediated symptoms.

[1] Potentially life-threatening, the anaphylactic onset of an allergic reaction is characterized by respiratory distress, as indicated by wheezing, breathing difficulty, and cyanosis, and also circulatory impairment that can include a weak pulse, pale skin, and fainting.

This can occur when IgE antibodies are released[23] and areas of the body not in direct contact with the food allergen show severe symptoms.

[1][17][24] Untreated, the overall response can lead to vasodilation, which can be a low blood pressure situation called anaphylactic shock.

One theory holds that proteins which resist digestion in the stomach, therefore reaching the small intestine relatively intact, are more likely to be allergenic.

These mediators on release cause several systemic effects, such as vasodilation, mucous secretion, nerve stimulation, and smooth-muscle contraction.

[11][38] Allergic reactions to oleosins from sesame, hazelnut and peanut oils have been confirmed, ranging from contact dermatitis to anaphylactic shock.

[11][39] Standardized sesame extracts used for allergy diagnosis do not contain oleosins, so the results of skin prick tests can present a false negative whereas using freshly ground seeds elicits a true positive.

[5][41] Skin prick tests sometimes give false negatives due to the lack of oleosin proteins in standardized sesame extracts.

[21] Confirmation is by double-blind, placebo-controlled food challenges, which remains the diagnostic gold standard for sesame allergy.

[13] Reviews of food allergens in general stated that introducing solid foods to infants at ages 4–6 months may result in the lowest subsequent allergy risks for eczema, allergic rhinitis and more severe reactions, with the best evidence for peanuts and chicken eggs.

[7][42] As of March 2022, one clinical trial attempted to determine whether introducing sesame to the diets of infants early or delaying until older would affect the risk of subsequent allergy, but there were too few confirmed subsequent sesame allergy subjects in the test or control groups to conduct a statistical analysis.

[4] Strong predictors for adult-persistence are anaphylaxis, high sesame-specific serum IgE and robust response to the skin prick test.

The Culinary Institute of America, a premier school for chef training, offers courses in allergen-free cooking and a separate teaching kitchen.

Laws and regulations passed in the United States and by the European Union recommend labeling but do not mandate declaration of the presence of trace amounts in the final product as a consequence of unintentional cross-contamination.

[62] In 2005, the European Union required listing for those eight major allergens plus molluscs, celery, mustard, lupin, sesame and sulfites.