TOPLINE:

Among children advised to avoid sunflower seeds, more than 75% were recommended avoidance based solely on positive allergy testing rather than on reaction history; over 80% of oral food challenges (OFCs) were negative, and in those with positive OFCs, 40% required epinephrine.

METHODOLOGY:

• Researchers analyzed data from 230 children (71% boys) who underwent serum sunflower seed-specific immunoglobulin E (sIgE) testing and were advised to avoid sunflower seeds to examine the short-term outcomes over a follow-up period of about 5 years.
• They also reviewed 72 consecutive sunflower seed OFCs performed in 71 children (mean age, 5.6 years; 69% boys) using sunflower seed butter, sunflower seeds, or chocolate sunflower butter cups, with a goal of about 2-7 g sunflower seed protein, to evaluate predictors of OFC outcomes.
• Skin prick tests (SPTs) were performed using crushed seeds or sunflower seed butter.

TAKEAWAY:

• Overall, 77% of children were advised to avoid sunflower seeds based on positive testing alone rather than a history of allergic reaction, and nearly all of them (99.5%) had other IgE-mediated food allergies, including cashew/pistachio, Brazil nut, and walnut.
• Sixty (83%) OFCs were negative, while 10 (14%) OFCs were positive. Among those with positive OFCs, 40% required treatment with epinephrine.
• Children with positive OFCs had larger initial skin prick test wheal sizes (P < .001) and were more likely to have a history of suspected allergic reaction to sunflower seed than those with negative OFCs (P = .003)

IN PRACTICE:

"Given the apparent increase in SFS [sunflower seed] allergy and potential severity, patients, caregivers, and allergists should be mindful of SFS as a potential IgE-mediated food allergen," the authors wrote. "In cases of low-level SFS sensitization without reaction history, physician-supervised oral food challenge should be considered," they added.

SOURCE:

Mary Grace Baker, MD, with Icahn School of Medicine at Mount Sinai, New York, was the corresponding author of the study, which was published online on April 10, 2026, in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The study was limited by its small sample size, retrospective nature, and limited follow-up, as well as the uncommon nature of the allergy. Additionally, co‑allergies were often documented based on food avoidance rather than confirmed reaction history or specific test thresholds, which may have overestimated their true incidence.

DISCLOSURES:

One author reported receiving research support from various institutions, including the National Institutes of Health, Pfizer, and Anjo.ai.

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