Poppy seed anaphylaxis: clinical and allergic features
Main Article Content
Keywords
allergy, anaphylaxis, children, cross-reactivity, poppy seeds, pediatrics, molecular diagnostics, IgE-mediated food allergy
Abstract
Poppy seeds are increasingly used for flavoring, for example, in cakes, bread, and fruit salads, and it is gaining popularity globally. Most case reports of poppy seed allergy are in children. Ingestion of cake, in which ground poppy seed is used, is mostly associated with anaphylactic reactions. Reactions may occur even with minimal amounts or traces. In sera of patients allergic to poppy seeds, four IgE-reactive poppy seed proteins were identified. Cross allergy with sesame and buckwheat are reported. Cross-reaction is described with nuts (cashew and walnut), wheat, rye flour, buckwheat, rice, and kiwi. Although rare, allergy to poppy seed is often rapid, generalized, and potentially life-threatening and, therefore, should be considered in allergic work-up. Therapy of poppy seed allergy/anaphylaxis is based on an elimination diet. However, oral desensitization could be hypothesized in some high-risk allergic patients, according to other reports of oral desensitization in seed anaphylaxis.
References
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27. Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of sesame seed-induced anaphylaxis. Allergy. 1999;54:526–7.
28. Patel A, Bahna SL. Hypersensitivities to sesame and other common edible seeds. Allergy. 2016;71:1405–13.
29. Scala E, Villalta D, Meneguzzi G, Giani M, Asero R. Storage molecules from tree nuts, seeds and legumes: relationships and amino acid identity among homologue molecules. Eur. Ann. Allergy Clin. Immunol. 2018;50(4):148–155. https://doi.org/10.23822/EurAnnACI.1764-1489.54
30. Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, et al. EAACI guidelines on the management of IgE-mediated food allergy. Allergy. 2025; 80(1):14–36. https://doi.org/10.1111/all.16345
31. Baloh CH, Hsu JT. Oral immunotherapy with sunflower seed butter and a review of seed allergy. Allergy Asthma Proc. 2024;45(2):137–140. https://doi.org/ 10.2500/aap.2024.45.230091
32. Salari F, Bemanian MH, Fallahpour M, Mahdaviani SA, Shokri S, Khoshmirsafa M, et al. The effectiveness of oral immunotherapy in patients with sesame anaphylaxis using omalizumab. Clin. Med. Res. 2022 Aug 23;20(3):125–32. https://doi.org/10.3121/cmr.2022.1730.34
33. Shah A, Cox AL, Groetch M, Kattan JD, Schaible A, Sicherer SH, et al. Sesame oral immunotherapy outcomes in a pediatric cohort. J. Allergy Clin. Immunol. Pract. 2025;13:938–940.e1. https://doi.org/10.1016/j.jaip.2025.01.036
34. Nachshon L, Goldberg MR, Levy MB, Appel MY, Epstein-Rigbi N, Lidholm J, et al. Efficacy and safety of sesame oral immunotherapy-a real-world, single-center study. J. Allergy Clin. Immunol. Pract. 2019;7:2775–2781.e2. https://doi.org/ 10.1016/j.jaip.2019.05.031
35. Jacobs S, Agyemang A, Cox A, Groetch M, Kattan J, Oriel R,∙ et al. Sunflower seed oral immunotherapy outcomes in pediatric patients. J. Allergy Clin. Immunol. 2025; 155: 2.
36. Chua GT, Soller L, Kapur S, McHenry M, Rex GA, Cook VE, et al. Real-world safety and effectiveness analysis of low-dose preschool sesame oral immunotherapy. J. Allergy Clin. Immunol. Glob. 2023;3:100171. https://doi.org/ 10.1016/j.jacig.2023.100171
37. Baloh CH, Hsu JT. Oral immunotherapy with sunflower seed butter and a review of seed allergy. Allergy Asthma Proc. 2024;45:137–140. https://doi.org/ 10.2500/aap.2024.45.230091
38. Eapen AA, Lavery WJ, Siddiqui JS, Lierl MB. Oral immunotherapy for multiple foods in a pediatric allergy clinic setting. Ann Allergy Asthma Immunol. 2019; 123:573–581.32.
2. EFSA Panel on Contaminants in the Food Chain (CONTAM). Scientific Opinion on the risks for public health related to the presence of opium alkaloids in poppy seeds. EFSA J. 2011;9(11):2405. [150 pp.] https://doi.org/10.2903/j.efsa.2011.2405
3. Mahesh PA, Wong GW, Ogorodova L, Potts J, Leung TF, Fedorova O, et al. Prevalence of food sensitization and probable food allergy among adults in India: the EuroPrevall INCO study. Allergy. 2016;71:1010–9.
4. Osterballe M, Hansen TK, Mortz CG, Bindslev-Jensen C. The clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollensensitized adults. Allergy. 2005;60:218–25.
5. Lyons SA, Clausen M, Knulst AC, Ballmer-Weber BK, Fernandez-Rivas M, Barreales L, et al. Prevalence of food sensitization and food allergy in children across Europe. J. Allergy Clin. Immunol. Pract. 2020;8:2736–2746.e9.
6. Bartra J, García-Moral A, Enrique E. Geographical differences in food allergy. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 June;59(6):755–63. English. https://doi.org/10.1007/s00103-016-2357-0
7. Belohlavkova S, Kabrnova R, Pospisilova T, Fuchs M. P34-Food-induced anaphylaxis in children: most common triggers in the Czech Republic. Clin. Transl. Allergy. 2014;4(Suppl 1):P89. https://doi.org/10.1186/2045-7022-4-S1-P89
8. Jensen-Jarolim E, Gerstmayer G, Kraft D, Scheiner O, Ebner H, Ebner C. Serological characterization of allergens in poppy seeds. Clin. Exp. Allergy. 1999;29:1075–1079. https://doi.org/10.1046/j.1365-2222.1999.00592.x
9. Podzhilkova A, Nagl C, Hummel K, Bindslev-Jensen C, Eller E, Mortz CG, et al. Poppy seed allergy: molecular diagnosis and cross-reactivity with tree nuts. J. Allergy Clin. Immunol. Pract. 2024;12(8):2144–2154.e11. https://doi.org/10.1016/j.jaip.2024.05.001
10. Kalyoncu AF, Stålenheim, G. Allergy to poppy seed. Allergy. 1993;48(4):295. https://doi.org/10.1111/j.1398-9995.1993.tb00732.x
11. Frantzen B, Bröcker EB, Trautmann A. Immediate-type allergy caused by poppy seed. Allergy. 2000;55:97–98.
12. Oppel T, Thomas P, Wollenberg A. Cross-sensitization between poppy seed and buckwheat in a food-allergic patient with pop seed anaphylaxis. Int. Arch. Allergy Immunol. 2006;140(2):170–3.
13. Keskin O, Sekerel BE. Poppy seed allergy: a case report and review of the literature. Allergy Asthma. Proc. 2006;27(4):396–8.
14. Panasoff J. Poppy seed anaphylaxis. J. Investig. Allergol. Clin. Immunol. 2008; 18: 224–5.
15. Yavuz ST, Gungor A, Kaya G, Gülec M, Gok F. Two children with rare food allergies: anaphylaxis with pumpkin seed and poppy seed. Allergy: Eur. J. Allergy Clin. Immunol. 2015;70:S101.
16. Kowalczyk A, Kuczyńska R, Żbikowska-Gotz M, Bartuzi Z, Krogulska A. Anaphylaxis in an 8-year-old boy following the consumption of poppy seed. J. Investig. Allergol. Clin. Immunol. 2020;30(4):281–304.
17. Varga EM, Kollmann D, Zach M, Bohle B. Anaphylaxis to buckwheat in an atopic child: a risk factor for severe allergy to nuts and seeds? Int. Arch. Allergy Immunol. 2011;156:112-6.
18. Vocks E, Borga A, Szliska C, Seifert HU, Seifert B, Burow G, et al. Common allergenic structures in hazelnut, rye grain, sesame seeds, kiwi, and poppy seeds. Allergy. 1993;48:168–72.
19. Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, Lidholm J, Andersson K, Akkerdaas JH, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J. Allergy Clin. Immunol. 2013;132:393–9.
20. Ballmer-Weber BK, Lidholm J, Lange L, Pascal M, Lang C, Gernert S, et al. Allergen recognition patterns in walnut allergy are age dependent and correlate with the severity of allergic reactions. J. Allergy Clin. Immunol. Pract. 2019;7: 1560–1567.e6.
21. Kabasser S, Radauer C, Eber E, Haber ME, Hieden K, Zieglmayer P, et al. Cosensitization to the 3 nonhomologous major cashew allergens Ana o 1, Ana o 2, and Ana o 3 is caused by IgE cross-reactivity. J. Investig. Allergol. Clin. Immunol. 2024; 34:38–48.
22. Geiselhart S, Nagl C, Dubiela P, Pedersen AC, Bublin M, Radauer C, et al. Concomitant sensitization to legumin, Fag e 2 and Fag e 5 predicts buckwheat allergy. Clin. Exp. Allergy. 2018;48:217–24.
23. Beyer K, Bardina L, Grishina G, Sampson HA. Identification of sesame seed allergens by 2-dimensional proteomics and Edman sequencing: seed storage proteins as common food allergens. J. Allergy Clin. Immunol. 2002;110:154–9.
24. Dramburg S, Hilger C, Santos AF, de Las Vecillas L, Aalberse RC, Acevedo N, et al. EAACI molecular allergology user’s guide 2.0. Pediatr. Allergy Immunol. 2023;34 Suppl 28: e13854. https://doi.org/10.1111/pai.13854
25. Mori F, Trippella G, Valleriani C, Giovannini M, Barni S, Ricci S, et al. Cross-sensitisation between sesame and other seeds in children. Clin. Exp. Allergy. 2024;54(8):624-626. https://doi.org/10.1111/cea.14510.
26. Saf S, Borres MP, Södergren E. Sesame allergy in children: new insights into diagnosis and management. Pediatr. Allergy Immunol. 2023;34(8):e14001. https://doi.org/10.1111/pai.14001.
27. Asero R, Mistrello G, Roncarolo D, Antoniotti PL, Falagiani P. A case of sesame seed-induced anaphylaxis. Allergy. 1999;54:526–7.
28. Patel A, Bahna SL. Hypersensitivities to sesame and other common edible seeds. Allergy. 2016;71:1405–13.
29. Scala E, Villalta D, Meneguzzi G, Giani M, Asero R. Storage molecules from tree nuts, seeds and legumes: relationships and amino acid identity among homologue molecules. Eur. Ann. Allergy Clin. Immunol. 2018;50(4):148–155. https://doi.org/10.23822/EurAnnACI.1764-1489.54
30. Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, et al. EAACI guidelines on the management of IgE-mediated food allergy. Allergy. 2025; 80(1):14–36. https://doi.org/10.1111/all.16345
31. Baloh CH, Hsu JT. Oral immunotherapy with sunflower seed butter and a review of seed allergy. Allergy Asthma Proc. 2024;45(2):137–140. https://doi.org/ 10.2500/aap.2024.45.230091
32. Salari F, Bemanian MH, Fallahpour M, Mahdaviani SA, Shokri S, Khoshmirsafa M, et al. The effectiveness of oral immunotherapy in patients with sesame anaphylaxis using omalizumab. Clin. Med. Res. 2022 Aug 23;20(3):125–32. https://doi.org/10.3121/cmr.2022.1730.34
33. Shah A, Cox AL, Groetch M, Kattan JD, Schaible A, Sicherer SH, et al. Sesame oral immunotherapy outcomes in a pediatric cohort. J. Allergy Clin. Immunol. Pract. 2025;13:938–940.e1. https://doi.org/10.1016/j.jaip.2025.01.036
34. Nachshon L, Goldberg MR, Levy MB, Appel MY, Epstein-Rigbi N, Lidholm J, et al. Efficacy and safety of sesame oral immunotherapy-a real-world, single-center study. J. Allergy Clin. Immunol. Pract. 2019;7:2775–2781.e2. https://doi.org/ 10.1016/j.jaip.2019.05.031
35. Jacobs S, Agyemang A, Cox A, Groetch M, Kattan J, Oriel R,∙ et al. Sunflower seed oral immunotherapy outcomes in pediatric patients. J. Allergy Clin. Immunol. 2025; 155: 2.
36. Chua GT, Soller L, Kapur S, McHenry M, Rex GA, Cook VE, et al. Real-world safety and effectiveness analysis of low-dose preschool sesame oral immunotherapy. J. Allergy Clin. Immunol. Glob. 2023;3:100171. https://doi.org/ 10.1016/j.jacig.2023.100171
37. Baloh CH, Hsu JT. Oral immunotherapy with sunflower seed butter and a review of seed allergy. Allergy Asthma Proc. 2024;45:137–140. https://doi.org/ 10.2500/aap.2024.45.230091
38. Eapen AA, Lavery WJ, Siddiqui JS, Lierl MB. Oral immunotherapy for multiple foods in a pediatric allergy clinic setting. Ann Allergy Asthma Immunol. 2019; 123:573–581.32.
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Published
Mar 1, 2026
Article Details
How to Cite
Novembre, E., Mastrorilli, C., Pecoraro, L., Arasi, S., Barni, S., Caminiti, L., Castagnoli, R., Gelsomino, M., Klain, A., Giovannini, M., Liotti, L., Mori, F., Saretta, F., & Miraglia Del Giudice, M. (2026). Poppy seed anaphylaxis: clinical and allergic features. Allergologia Et Immunopathologia, 54(2), 151–155. https://doi.org/10.15586/aei.v54i2.1404
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Review Article
How to Cite
Novembre, E., Mastrorilli, C., Pecoraro, L., Arasi, S., Barni, S., Caminiti, L., Castagnoli, R., Gelsomino, M., Klain, A., Giovannini, M., Liotti, L., Mori, F., Saretta, F., & Miraglia Del Giudice, M. (2026). Poppy seed anaphylaxis: clinical and allergic features. Allergologia Et Immunopathologia, 54(2), 151–155. https://doi.org/10.15586/aei.v54i2.1404