Immunoglobulin E-mediated pumpkin seed allergy in children: Case series and narrative review with a structured literature search.

Background

Pumpkin seed allergy is a rare but potentially severe immunoglobulin E (IgE) mediated food allergy, with limited pediatric data and few documented cases worldwide.

Objective

To describe the clinical and diagnostic characteristics of pediatric pumpkin seed allergy and to synthesize all previously reported cases through a systematically searched narrative review.

Methods

We retrospectively reviewed the records of children diagnosed with IgE-mediated pumpkin seed allergy at a tertiary pediatric allergy clinic in Turkey (2016-2024). The diagnosis relied on the clinical history, specific IgE (sIgE), and skin-prick tests (SPT); patients in select cases had oral food challenges. Data on clinical presentation, comorbidities, co-allergies, and laboratory findings were extracted. A structured literature search of medical literature data bases identified all published cases of patients with pumpkin seed allergy, which were qualitatively reviewed.

Results

Twenty-five children (76% boys) were identified, with a median diagnosis age of 2.98 years. Immediate reactions were universal, and anaphylaxis occurred in 64%. The median SPT wheal was 13 mm, and the median sIgE level was 10.3 kUA/L. Atopic comorbidities were frequent (atopic dermatitis, 92%; asthma, 48%). Co-allergy was common (tree nuts, 76%; other seeds, 72%); watermelon seed sensitization occurred in 83%, with six patients experiencing clinical reactions after watermelon seed ingestion. Pumpkin pulp was tolerated in all the patients. A literature review revealed 14 previously published cases, mostly adults, with 57% experiencing anaphylaxis.

Conclusion

Pumpkin seed allergy, although uncommon, frequently causes systemic reactions in children. Our case series underscores the need for clinician awareness, diagnostic inclusion of pumpkin seed in high-consumption regions, and further research into its molecular allergens and cross-reactivity.