title: Allergy to sunflower seed and sunflower butter as proposed vehicle for sensitization.
abstract: BACKGROUND
  It is hypothesized that household exposure to allergenic proteins via an impaired skin barrier, such as atopic dermatitis, may contribute to the development of IgE sensitization. Household presence of peanut is a risk factor for the development of peanut allergy in children. Sunflower seed butter is a peanut-free alternative to peanut butter, and sunflower seed allergy is an uncommon but reported entity.
  
  
  METHODS
  A 3 year old boy presented with oral discomfort that developed almost immediately after he ate sunflower seeds for the first time. He was given a dose of diphenhydramine. Subsequently he vomited, and his symptoms gradually resolved. A similar episode occurred to a commercial snack made with sunflower seed butter. Skin prick testing demonstrated a large positive (10 mm wheal) wheal-and-flare response to a slurry of fresh sunflower seed within 3-4 minutes associated with severe pruritus. This child has an older sibling with confirmed peanut allergy (PNA). After the PNA diagnosis was made, the family home became peanut-free. In lieu of peanut butter, sunflower butter was purchased and eaten frequently by family members, but not by the child reported herein. Subsequent to the episodes above, the child ate a bread roll with visible poppy seeds and developed itchy throat, dyspnea, and urticaria. Epicutaneous skin testing elicited a >10 mm wheal size within 3-4 minutes in response to a slurry of whole poppy seeds and 8 mm to fresh pumpkin seed, which had never been consumed.
  
  
  CONCLUSIONS
  A case of sunflower allergy in the context of household consumption of sunflower butter has not yet been reported. We suggest that homes which are intentionally peanut-safe may provide an environment whereby infants with impaired skin barrier are at increased risk of allergy to alternative "butter" products being used, via cutaneous exposure to these products preceding oral introduction to the child.
authors: Department of Pediatrics, Pediatric Allergy Clinic, Humber River Regional Hospital, c / o 404-586 Eglinton Avenue East, Toronto, ON Canada M4P 1P2.
authors: Elana
authors: E
authors: Lavine
authors: Department of Pediatrics, Division of Pediatric Allergy and Clinical Immunology, McGill University Health Centre, Montreal, QC Canada.
authors: Moshe
authors: M
authors: Ben-Shoshan
keywords: Allergy; Risk factors; Sunflower seed
references: J Allergy Clin Immunol. 2009 Feb;123(2):417-23
references: 19203660
references: Open Biochem J. 2008;2:16-28
references: 18949071
references: Eur Ann Allergy Clin Immunol. 2005 May;37(5):183-6
references: 15984317
references: Med J Aust. 2007 Nov 5;187(9):542-3
references: 17979622
references: J Allergy Clin Immunol. 2001 Jun;107(6):1077-81
references: 11398088
references: Biol Chem. 2014 Feb;395(2):239-50
references: 24057594
references: J Allergy Clin Immunol. 2000 Nov;106(5):962-7
references: 11080721
references: J Investig Allergol Clin Immunol. 2013;23(6):446-7
references: 24459826
references: J Allergy Clin Immunol. 2011 Mar;127(3):661-7
references: 21377035
references: J Allergy Clin Immunol. 2014 Dec;134(6):1453-6
references: 25253515
references: Allergy. 1994 Aug;49(7):517-20
references: 7825717
references: J Allergy Clin Immunol. 2014 Feb;133(2):291-307; quiz 308
references: 24388012
references: Curr Allergy Asthma Rep. 2012 Aug;12(4):346-72
references: 22723032
references: Allergy. 2010 Oct;65(10):1340-1
references: 20384612
references: J Allergy Clin Immunol. 1979 Apr;63(4):242-4
references: 429702
references: Allergy. 2000 Jan;55(1):97-8
references: 10696869
references: N Engl J Med. 2003 Mar 13;348(11):977-85
references: 12637607