Non-Sesame Seed, Spice Allergies Can Trigger Severe Reactions

New data from the FARE (Food Allergy Research & Education) Patient Registry show non-sesame seed and herb/spice allergies can trigger severe reactions requiring epinephrine and biphasic responses at rates comparable to sesame allergy.¹

"When patients report allergic reactions to non-sesame seeds, herbs, or spices, we should be cognizant these allergens can cause more severe reactions, including those requiring one or more doses of epinephrine or biphasic reactions," said Carolyn H. Baloh, MD, from the division of allergy and clinical immunology at Brigham and Women's Hospital, Harvard Medical School.

FARE Registry Reaction Severity Findings: Non-Sesame Seed, Herb/Spice

Investigators extracted deidentified survey data on 2601 participants reporting a sesame (n = 1195), non-sesame seed (n = 968), and/or herb or spice (n = 616) allergy from the FARE registry.¹ Data collection spanned August 24, 2017, to July 1, 2025, and the overall cohort was 51% male and 56% Caucasian, though demographics diverged sharply by allergen group.¹ Epinephrine was administered for approximately one-third of reported reactions.¹

In the mutually exclusive analysis, epinephrine use was reported by 42% of participants with sesame allergy, 40% with non-sesame seed allergy, and 29% with herb/spice allergy (P =.05).¹ Use of ≥ 1 epinephrine doses was numerically greater among the non-sesame seed-only group, though the difference did not reach statistical significance.¹ Biphasic reactions occurred across all 3 groups and were most frequent among participants with only herb/spice allergy (40%), compared with 17% in the sesame-only group and 34% in the non-sesame seed-only group.¹

Diagnosis Timing and Cross-Reactivity in Seed Allergy

Diagnosis occurred before 18 years of age in approximately 80% of participants across all 3 groups.¹ Diagnosis before 1 year of age was significantly more common with sesame allergy (18%) than non-sesame seed (7%) or herb/spice allergy (2%) (P <.0001).¹ Most food allergy diagnoses were made by a healthcare provider, ranging from 89% for sesame to 78% for herbs/spices, with the remainder self-diagnosed.¹

Atopic comorbidities were frequently reported across allergen groups, including allergic rhinitis (46%), eczema (49%), and asthma (38%) among sesame-allergic participants.¹ Cross-reactivity among seed allergens remains a clinical challenge. Baloh said allergists should rely on a combination of clinical history, skin prick testing, specific IgE, and food challenges to guide management.¹

Baloh's group plans to use the registry to assess whether specific symptoms during food allergic reactions correlate with the causative allergen rather than patient age alone.¹ Baloh also noted that she wants to use the registry to learn more about the racial, socioeconomic, and geographic factors in food allergic reactions.

“It's worth keeping in mind that while the prevalence of these allergies is increasing, they're still relatively uncommon,” she said. “That said, these allergens can cause anaphylaxis, even anaphylaxis requiring multiple doses of epinephrine and biphasic reactions. It's always worth evaluating if a non-sesame seed or herb or spice is concerning for an allergic reaction. Allergists should really take a thorough history of all possible foods ingested at the time of a food reaction; they should consider the possibility of these hidden allergens.”

Watch part 1 of our interview with Baloh here: FARE Registry Reveals Disparities in Seed and Spice Allergies

Editor’s note: A reported disclosure for Baloh includes SANOFI-AVENTIS U.S. LLC.

References

1. Liu EY, Lopez S, Bufford JL, Laidlaw TM, Baloh CH. Seeds, Spices-Not Always so Nice: A Report on the FARE (Food Allergy Research & Education) Patient Registry. J Allergy Clin Immunol Pract. 2026. doi:10.1016/j.jaip.2026.06.042

2. Baloh C. FARE Registry Reveals Disparities in Seed and Spice Allergies. HCPLive Published July 28, 2026. Accessed July 29, 2026. https://www.hcplive.com/view/fare-registry-disparities-seed-spice-allergies