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

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.