From Ms M. S. Perkins
SIR,—Johanna Hignett's (Nestlé UK) response to my letter (PJ, November 27, 1999, p861) requires comment. If her main points for justifying the marketing of sesame seed sticks for infants from one year of age are that anaphylaxis to sesame is rare, and sensitisation occurs very early in life, she is wrong.
As someone employed by Nestlé as an expert on allergies, Ms Hignett should know that anaphylaxis to sesame is no longer rare in the UK.1 Indeed, clinicians who are experts in the field of allergy are now including sesame in the list of foods commonly causing anaphylaxis. Professor John O. Warner's abstract (Food Intolerance Conference, Ministry of Agriculture, Fisheries and Food, November 5, 1997) is just one example and Dr Pamela Ewan's "ABC of allergies: Anaphylaxis" (BMJ 1998;316; 1443) is another.
Ms Hignett states: "One key point is the age at which infants are sensitised to a particular allergen. This process of sensitisation to allergens appears to occur very early, before birth or in the first few months of life". She also states: "Nestlé Sesame Sticks is part of the new junior range that is targeted at toddlers from one year of age". So parents are led to believe that the toddlers targeted, should not be at risk.2
However, it is not exclusively during the first few months of life that children become sensitised to a particular allergen. Sensitisation to sesame can occur at any age and individuals with no history of allergy can be affected. Indeed, my first near-fatal anaphylaxis to sesame occurred within weeks of becoming sensitised. I was in my early 50s, with no history of allergic symptoms.3,4
Ms Hignett's lengthy statement about the product being distinctively labelled as containing sesame seeds had the effect of weakening the main thrust of the issue. It is blatantly obvious that Sesame Sticks contain sesame. That is not the issue. What is not obvious from the labelling is that sesame seeds can cause severe allergies in children. Moreover, once an individual is sensitised to sesame, initial reactions become significantly more pronounced and lead to anaphylaxis. These highly allergenic seeds are not essential to the diet and can be avoided without causing nutritional harm. Lessons should be learned from recent studies in Australia.2
Until recently, the age of sesame sufferers was greater than reported for peanut allergy. The rise in pediatric referrals began in 1993 and, as stated in my letter, there is now considerable evidence that exposure of young children to sesame products is associated with an increase in the prevalence of sesame allergy.
Since Ms Hignett emphasises that Nestlé UK takes all issues relating to food allergies extremely seriously, how can it justify pushing a highly allergenic food at infants? Food-induced anaphylaxis is already a serious health problem in the UK. Highly allergenic foods are neither sought after nor desired. Clinicians, who are experts in the field with no affiliations to the food industry, state categorically that sesame seeds can cause allergies in children.5 Clearly, this health warning should appear on the product.
Maggie Spirito Perkins
Radlett, Hertfordshire
Ms JOHANNA HIGNETT (nutrition manager, Nestlé Food Division, Nestlé UK Ltd) replies: It is well known that those who have a higher risk of developing allergies are those from atopic families. Children born to families with a history of asthma, eczema, hay fever and severe allergies should be advised by a health professional about suitable foods for their diet. A statement to this effect has been included on the packs of Sesame Sticks since late 1999 to advise families with a history of allergy to take care when selecting foods for their children. The statement reads: "Sesame may be unsuitable for young children if there is a family history of asthma, eczema or allergies. Please consult a health professional."