TOPLINE:

Among 392 oral food challenges (OFCs) performed in 361 participants, 71.9% tolerated sesame reintroduction; success rates for sunflower and mustard were 87.5% and 82.1%, respectively. Skin prick testing (SPT) results showed significant correlation with clinical reactivity to sesame and sunflower.

METHODOLOGY:

• Researchers conducted a retrospective study to characterize the epidemiology and assess the diagnostic performance of SPT and allergen-specific immunoglobulin E (sIgE) for seed allergies extending beyond sesame.
• They evaluated 392 seed OFCs in 361 participants (66.5% boys; 76.2% White) at the Children’s Hospital of Philadelphia in Philadelphia from October 2005 to March 2024, including eight different seeds: sesame, sunflower, mustard, flaxseed, poppy, caraway, chia, and annatto.
• Unblinded OFCs were conducted in up to six steps at 20-minute intervals, targeting age-appropriate cumulative food-protein doses; 15 participants underwent challenges with multiple seeds, and eight underwent repeated challenges with the same seed.

TAKEAWAY:

• Sesame challenges were most frequent, with 295 OFCs performed and a 71.9% tolerance rate. Participants who reacted to vs tolerated sesame had significantly larger median wheal sizes (5 vs 4 mm) and higher specific IgE levels (2.21 vs 1.09 kU/L; P ≤ .007 for both).
• Sunflower challenges showed an 87.5% tolerance rate, with a significantly higher median wheal size in participants who showed allergic responses vs tolerance (8 vs 4 mm; P = .0015).
• Treatment primarily involved H1 antihistamines (n = 81) and epinephrine (n = 61), with two participants receiving three doses of epinephrine for sesame reactions and requiring hospitalization.

IN PRACTICE:

“This study showed a correlation between higher SPT and sIgE for those who reacted to sesame and sunflower compared to those who tolerated these seeds. Sesame SPT findings are similar to those previously reported.” the authors of the study wrote. They added, “Sunflower and sesame SPTs correlated with OFC outcomes and may be reliable indicators of clinical reactivity.”

SOURCE:

Timothy M. Buckey, MD, with Children’s Hospital of Philadelphia, was the corresponding author of the study, which was published online on October 22, 2025, in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The retrospective nature of the study and the exclusion of individuals who did not undergo OFCs restrict the understanding of seed allergy prevalence in the broader population.

DISCLOSURES:

One author reported receiving grant funding from and serving as a consultant for various pharmaceutical companies, the National Institutes of Health, and FARE.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.