Half of patients with sunflower seed allergy experience anaphylaxis

In a recent case series, researchers found that half of patients with a clinical allergy to sunflower seeds experienced anaphylaxis after undergoing allergy tests.

Celine Galleani, MD, from the Hospital Universitario 12 de Octubre in Madrid, and colleagues said the case series is — to their knowledge — the largest one to date that investigated sunflower seed sensitization. The researchers conducted the study to help fill the gap in research on sunflower seed allergy.

The results were published in an online supplement to The Journal of Allergy and Clinical Immunology on Feb. 1, and were presented at the American Academy of Allergy, Asthma and Immunology Annual Meeting.

The study included 117 adult patients (median age, 32 years) from an outpatient clinic who were sensitized to sunflower seeds. The patients underwent skin tests, sunflower seed-specific IgE antibody tests and, if indicated, oral food challenges from 2013 to 2020.

Overall, 28 patients (24%) were determined to have a clinical allergy to sunflower seeds. Only five of these patients reported experiencing symptoms during childhood, according to the researchers.

Most patients with a clinical allergy to sunflower seeds also had a history of atopic disease, including rhinitis (86%), and reactions to peanuts and tree nuts (75%) and Rosaceae fruits (54%).

The most common reactions to sunflower seeds were cutaneous symptoms (89%), respiratory symptoms (54%), oral allergy syndrome (46%) and gastrointestinal symptoms (32%), according to the researchers.

Fourteen patients (50%) experienced anaphylaxis, graded as severe in one case and moderate in the others. The most reported symptoms of anaphylaxis were respiratory and cutaneous (86%). Ten patients (71%) required emergency medical care, and two (14%) required adrenaline.

The researchers said there was a significant difference in skin test wheal size (median, 9 mm vs. 6 mm) and sunflower seed-IgE level (median, 2.16 kUA/L vs. 0.69 kUA/L) among patients with a clinical allergy compared with those who tolerated sunflower seeds. In addition, patients with a clinical allergy to sunflower seeds were also significantly more likely to have skin testing reactivity to Artemisia pollen (71% vs. 22%).

“In conclusion, half of the patients with clinical allergy to sunflower seed experienced anaphylaxis,” Galleani said during a presentation. “The size of sunflower seed skin tests, sunflower seed IgE level and reactivity to Artemisia pollen seems to be associated with clinical reactivity.”