Sunflower Seed Allergy: Natural History, Oral Food Challenge Outcomes, and Review of the Literature.

Abstract

An increase in reactions to sunflower seed (SFS) has been observed and reported in recent years, yet little is known about SFS allergy. To examine the characteristics, natural course, and oral food challenge (OFC) outcomes of patients evaluated for SFS allergy at a pediatric food allergy referral center. The electronic medical record was searched for patients who underwent SFS serum IgE testing between March 2017 and September 2018. Pertinent demographic and clinical data were recorded for patients advised to avoid SFS. In addition, the outcomes for all patients who underwent consecutive SFS OFCs between March 2019 and June 2023 were reviewed. SFS IgE testing was performed in 7% (326 of 5008) of patients evaluated; 71% (n = 230) were advised to avoid SFS. Most patients were male (71%) with atopic comorbidities. All but 1 patient had another food allergy, mostly tree nuts, sesame, and peanut. Most SFS avoidance (77%) was due to positive testing results rather than SFS reaction history. Among 72 consecutive SFS OFCs, 60 (83%) were negative, 10 (14%) positive, and 2 (3%) indeterminate. Four patients (40%) with positive OFCs were treated with epinephrine. A positive OFC was associated with a history of SFS reaction and larger skin prick test wheal size at initial evaluation but not most recent skin prick test or specific IgE. SFS allergy is an emerging and potentially severe pediatric food allergy that may co-occur with other seed or nut allergies. Sensitization is more common than true clinical reactivity; thus, physician-supervised OFC should be considered when clinically indicated.