Sunflower Seed Allergy: A Case Series

Abstract

We sought to investigate the clinical and immunologic features of adult patients sensitized to sunflower seed. A retrospective case series study of 117 consecutive patients (median age 32 yr) having positive sunflower seed-specific IgE was performed. Patients underwent skin tests and detection of specific IgE and if indicated, oral food challenges. Clinical allergy to sunflower seed was recognized in 28 patients (24%). Most had a history of atopic disease (26 patients; 93%) and nuts (21 patients; 75%) and Rosaceae fruits (15 patients; 54%) reactions. The onset of the symptoms occurred mostly in adulthood (23 patients; 82%). Fourteen patients (50%) suffered anaphylaxis, graded as moderate (13 patients) and severe (1 patient). Anaphylaxis most frequent symptoms were cutaneous and respiratory (12 patients; 86%), and 10 patients (71%) required emergency department visits. There was significant difference in skin test wheal size (median: 9 vs. 6 mm; p = 0,006) and sunflower seed-IgE level (median: 2.16 vs. 0.69 kUA/L; p = 0.001) between patients with proved clinical allergy and those who tolerated its ingestion. Skin testing reactivity to Artemisia pollen was found to be more frequent in clinical allergic patients (71% vs. 22%, p = 0.021). No differences were found on LTP or other pollens sensitization rates. Half of the patients with actual clinical allergy to sunflower seed experienced anaphylaxis. The size of skin testing, sunflower seed-IgE level, and reactivity to Artemisia pollen seems to be associated with clinical reactivity. To our knowledge, this is the largest series of sunflower seed sensitization.