Oral immunotherapy for the treatment of pumpkin seed allergy: a real-world case series.

backgroundPumpkin seed, a member of the Cucurbitaceae family, is increasingly consumed because of its high protein content and perceived health benefits. Along with its growing use, cases of pumpkin seed allergy are being reported. However, data on pumpkin seed allergy and oral immunotherapy (OIT) remain scarce.

methodsWe conducted a retrospective chart review at a tertiary pediatric center (Sainte-Justine University Hospital Center, Montreal, Canada) including all patients who initiated or completed pumpkin seed OIT since 2019. OIT protocols were individualized, with dose increases typically performed every four weeks. Target maintenance doses were at least 300 mg of pumpkin seed protein.

resultsEleven patients (median age at OIT initiation: 6.5 years; range 1-12) underwent pumpkin seed OIT. Ten patients (91%) reached maintenance dosing within a median of 9.5 months (range 6-22) while one patient discontinued OIT due to persistent abdominal pain. No anaphylactic reactions occurred at home during treatment. Two anaphylactic reactions requiring epinephrine occurred during in-clinic up-dosing visits in a single patient, despite this, the patient ultimately achieved maintenance. Gastrointestinal and oral symptoms were the most frequent adverse events and were generally managed with temporary premedication. Most patients (91%) underwent concomitant multi-food OIT. Patients with significant adverse reactions had high ratios of pumpkin-specific IgE to total IgE.

conclusionPumpkin seed OIT appears feasible in a highly atopic pediatric population, with a safety profile comparable to that reported for OIT to other food allergens. Given the increasing dietary exposure to pumpkin seeds, larger prospective studies are needed to better define risk factors and long-term outcomes.