per million people. prevalence is the number of cases alive, expressible as existing cases per million people during a period of time. sesame allergy prevalence is in the range of 0.1–0.2% in the us and western europe, and confirmed as high as 0.8–0.9% in the middle east and other countries where sesame seeds are used in traditional foods. reporting of sesame seed allergy has increased over recent decades, either a true increase due to exposure from more foods or an increase in awareness. self-reported allergy prevalence is always higher than food-challenge confirmed allergy. one review of a large survey conducted in the us reported 0.49% for the former and 0.23% for the latter. regulation whether food allergy prevalence is increasing or not, food allergy awareness has increased, with impacts on the quality of life for children, their parents and their immediate caregivers. in the united states, the food allergen labeling and consumer protection act (falcpa) of 2004 causes people to be reminded of allergy problems every time they handle a food package. although not regulated under falcpa, some restaurants have added allergen warnings to menus. the culinary institute of america, a premier school for chef training, offers courses in allergen-free cooking and a separate teaching kitchen. some school systems have protocols about what foods can be brought into the school. despite all these precautions, people with serious allergies are aware that accidental exposure can easily occur at other people's houses, at schools or in restaurants. regulation of labeling an example of "may contain traces of..." as a means of listing trace amounts of allergens in a food product due to cross-contamination during manufacture in response to the risk that certain foods pose to those with food allergies, some countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain major allergens or if byproducts of major allergens are among the ingredients intentionally added to foods. 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. ingredients intentionally added (u.s.) falcpa became effective 1 january 2006, requiring companies selling foods in the united states to disclose on labels whether a packaged food product contains any of these eight major food allergens, added intentionally: cow's milk, peanuts, eggs, shellfish, fish, tree nuts, soy and wheat. in november 2020, the us food and drug administration issued draft guidance recommending that food manufacturers add sesame-containing foods to labels, making sesame the ninth required allergy label requirement. the "faster act" was passed in april 2021, stipulating that labeling be mandatory, to be in effect 1 january 2023, making it the ninth required food ingredient label in the us. ingredients intentionally added (other than u.s.) further information: food allergy § regulation of labelling in addition to the eight major food allergens, canada added sesame seeds and all foods made from or with sesame seeds, be declared on food labeling. in 2005, the european union required listing for those eight major allergens plus molluscs, celery, mustard, lupin, sesame and sulfites. in japan, regulations distinguish between required and recommended labeling. sesame is among a list of foods for which labeling is recommended but not required.