Tingling of lips, laryngeal oedema, generalised angioedema, generalised urticaria, bronchospasm, abdominal pain (Noyes et al. 1979 [440]).

Diffuse pruritus, urticaria, angioedema, nausea and vomiting, chest tighness and wheezing followed by vascolar collapse and loss of consiousness in one patient and diffuse pruritus, urticaria and facial angioedema in another (Halsey et al. 1986 [975]).

Anaphylaxis beginning with abdominal pain, followed by pharyngeal pruritis and facial oedema with nasal congestion and finally generalised urticaria and impaired respiration (Kanny et al. 1994 [376]).

Symptoms ranging from itching of the mouth, ears and eyes, cough dyspnea, generalised urticaria, angioedema (Axelsson et al. 1994 [270]).

Anaphylaxis with laryngeal oedema, dyspnea, vomiting, generalised urticaria and hypotension (Iwaya et al. 1994 [366]).

Oral pruritus (8/12), anaphylaxis (4/12), angioedema of lips/mouth (4/12), gastrointestinal symptoms (3/12), urticaria (2/12), and rhinoconjunctivitis 1/12 patients (Garcia-Ortiz et al. 1996 [753]).

Vomiting and hypotension; urticaria and angioedema; itchy mouth; anaphylaxis; angioedema and fever in 5 patients (Kelly et al. 2000) [87].

Anaphylaxis 15 minutes after eating a bread roll with sunflower seeds (Asero et al. 2002 [973])

Asero et al. (2002) [973] used seeds from the roll to which the patient had reacted.

Histamine was used as positive control in all studies. The definition of a positive response was >3 mm or >5 mm diameter wheals.

Three patients who had reacted to sunflower were strongly positive (Noyes et al, 1979 [440]).
Stricker et al. (1986) [522] found 3 patients were SPT positive to sunflower seed and this was clinically relevant in one case.
Positive response to oil and to sunflower seed proteins and pollen, mugwort (Kanny et al. 1994 [376])
Three patients were positive to sunflower seed (a fourth was not tested) (Axelsson et al. 1994 [270]).
A wheal of 7x18mm on SPT to sunflower seed (Iwaya et al. 1994 [366]).
Positive SPT in 5 patients Kelly et al. (2000) [87].
A wheal of 10 mm diameter on SPT with roast sunflower seeds (Asero et al. 2003 [973]).

3 patients (Noyes et al. 1979) [440].
1 patient (Iwaya et al. 1994) [366].
5 patients (Kelly et al. 2000) [87]

Noyes et al. (1979) [440] found IgE to sunflower extract in two patients by RAST.

Iwaya et al. 1994 [366] found IgE to sunflower by RAST and immunoblotting gave a mass of 13.5 kDa.

Kelly et al. (2000) [87] found positive RAST scores in three patients with sunflower seed positive skin prick tests.

The gel was incubated in equilibrating buffer (25 mM Tris-HCl, 192 mM glycine containing 20% MeOH) for 15 min, and then proteins were transferred to a PVDF membrane with a semidry blotter. The membrane was then blocked with 1% (w/v) casein in PBS, 0.025% (v/v) Tween 20. The membrane was cut into strips before incubation with sera (1:10 diluted in casein blocking solution) overnight at 4°C. The strips were then washed four times with PBS solution containing 0.025% (v/v) Tween 20. Membranes were then incubated with goat antihuman IgE horseradish peroxidase conjugate for 4 h at 4°C. The membranes were washed again four times as before, and chemiluminescent reagents (Amersham, Arlington, Heights, IL, USA) added to reveal binding (Kelly et al. 2000) [86] and [87].

Iwaya et al. 1994 [366] found IgE binding to a 13.5 kDa allergen.

Kelly et al. (2000) [87] found that sera bound 2 to 7 distinct proteins of 10.5, 13.5, 15.9, 16.7, 17.2, 22.7, 33.2, 43.6, and 48.9 kDa. Two out of three sera recognized two proteins between 16 and 17 kDa. Kelly et al. (2000) [86] identified the purified 2S albumin as the major IgE binding protein in the sera from these patients. The sera recognised allergens after IEF with pIs of 5.91 (mature) and 5.35 (consistent with the 16 kDa precursor).

Asero et al. 2002 [973] found IgE binding to three proteins with masses near the 14 kDa standard and to one between the 43 and 67 kDa standards.

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