Q:

10/15/2013
I have 11 year-old female reacting to SILK clothes, scarf (facial swelling, urticaria, rhinoconjunctivitis issues) within 5 minutes of contact, supports “IgE” mediated reaction. Symptoms resolved with Benadryl. No other Hx of atopy. No special hobby either. Any case report(s) for SILK protein allergy or cross reaction to other fiber?

A:

Thank you for your inquiry.

Allergic reactions including both anaphylaxis and respiratory allergy have been reported to silk on a number of occasions. Copied below are several examples of these reports including both references and abstracts where they were available. You might find the reference by Borelli, et al., in “Allergy” particularly helpful in regards to your patient.

In addition, there is an ImmunoCAP available to the “silkworm moth,” and I have copied below a link to the ImmunoCAP website (Phadia), which you will also find extremely helpful in supplying information about allergic reactions to silk.

This of course does not necessarily mean that your patient indeed does have an IgE-mediated reaction to silk as described in this literature, but the references will certainly allow you to evaluate your patient appropriately in this regard.

Thank you again for your inquiry and we hope this response is helpful to you.

Allergy. 1999 Aug;54(8):900-1.
A silk cardigan inducing asthma.
Borelli S, Stern A, Wüthrich B.
Source
Department of Dermatology, University Hospital Zurich, Switzerland

Moth

Extreme sensitivity test reactions to silk in a negative skin-test pollen patient; a clinical study.
Kahn IS, Rouse JW.
Ann Allergy. 1950 May-Jun;8(3):404-6. No abstract available.

Am J Respir Crit Care Med. 2001 Apr;163(5):1108-12.
Asthma, rhinitis, and skin test reactivity to aeroallergens in families of asthmatic subjects in Anqing, China.
Celedón JC, Palmer LJ, Weiss ST, Wang B, Fang Z, Xu X.
Source
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.

Erratum in
Am J Respir Crit Care Med. 2002 Sep 1;166(5):774-5.
Abstract
In industrialized countries with a Western lifestyle, sensitization to perennial aeroallergens is strongly associated with asthma, whereas sensitization to seasonal aeroallergens is closely related to allergic rhinitis. Little is known, however, about the relation between skin test reactivity to aeroallergens and either asthma or rhinitis in mainland China. We studied 10,009 members of 2,544 families in Anqing (China) that were selected on the basis of physician-diagnosed asthma in at least two siblings. Generalized estimating equations were employed to study the association between skin test reactivity to aeroallergens and either asthma or rhinitis. After adjustment for age, sex, intensity of smoking, skin test reactivity to other aeroallergens, and household correlations, sensitization to dust mite was an independent predictor of both asthma (OR = 1.3, 95% CI = 1.1 to 1.5, p = 0.008) and rhinitis (OR = 1.3, 95% CI = 1.0 to 1.8, p = 0.04). Sensitization to mold was significantly associated with asthma (OR = 1.6, 95% CI = 1.1 to 2.3, p = 0.008), and sensitization to silk was an independent predictor of rhinitis (OR = 1.5, 95% CI = 1.1 to 2.2, p = 0.02). Although 46.9% of the study participants were sensitized to at least one allergen, only 3.5% of study subjects reported nasal symptoms consistent with rhinitis. Among asthmatic subjects, 6.2% reported nasal symptoms. Whereas sensitization to perennial aeroallergens was associated with asthma among families of asthmatic subjects in rural China, sensitization to silk was the strongest predictor of rhinitis in this population. Our findings also suggest that allergic rhinitis is far less common among asthmatic subjects in rural China than in asthmatic subjects in industrialized countries with a Western lifestyle.

Pediatrics. 2001 May;107(5):E80.
Sensitization to silk and childhood asthma in rural China.
Celedón JC, Palmer LJ, Xu X, Wang B, Fang Z, Weiss ST.
Source
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Abstract
Objective: Sensitization to perennial aeroallergens is associated with asthma in industrialized countries with a Western lifestyle. Because silk products are commonly used in Chinese society, we were interested in examining the relation between sensitization to silk and asthma.
Design: Cross-sectional study of 871 children in 503 families living in Anqing, a predominantly rural province of China.
Results: After adjustment for age, gender, familial correlations, and sensitization to other aeroallergens, skin test reactivity to silk was an independent predictor of asthma (odds ratio = 2.6; 95% confidence interval = 1.2-5.7). This association became stronger after inclusion of the eosinophil count and history of parasitic diseases of the participants in the multivariate model (odds ratio = 3.6; 95% confidence interval = 1.4-8.9).
Conclusion: Because sericulture is an important activity in China and other countries throughout the world, sensitization to silk may influence the pathogenesis and severity of asthma in people living in these nations.

Allergy Asthma Proc. 1999 Mar-Apr;20(2):107-8.
Silk-induced asthma.
Vovolis V, Galatas I.
Source
Department of Allergy and Clinical Immunology, Sotiria Hospital of Lung Diseases, Athens, Greece.
Abstract
The existence of professional allergens in the home environment is important because their avoidance usually resolves the problem completely. We report on a case of an asthmatic woman who, for five years, was helping her husband create large artistic screens with the cocoons of the silkworms. Extensive laboratory evaluation revealed that she was allergic to silk and her symptoms resolved in three months following discontinuation of her exposure to silk allergens.

Nightly asthma caused by allergens in silk-filled bed quilts: clinical and immunologic studies.
Johansson SG, Wüthrich B, Zortea-Caflisch C. J Allergy Clin Immunol. 1985 Apr; 75(4):452-9.

Wien Klin Wochenschr. 1987 Aug 7;99(15):542-6.
[Wild silk-induced asthma. A contribution to the knowledge of inhalation allergies caused by wild and tussah silk-filled bed quilts].
[Article in German]
Ebner H, Kraft D.
Source
Ambulatorium für Allergie und klinische Immunologie, Wien.
Abstract
In the silk industry occupational IgE-mediated hypersensitivities to different allergens are well known. Since the use of silk waste for the filling of bed quilts a great number of patients suffering especially from silk-asthma could be observed. Immunological investigations showed clearly that in this context sericin and also antigens from an insect of the genus anthrenus in the silk material are of allergenic importance. On the basis of typical case histories from the occupational and private scene the diagnostic difficulties of silk allergy are discussed.

J Allergy Clin Immunol. 1985 Apr;75(4):452-9.
Nightly asthma caused by allergens in silk-filled bed quilts: clinical and immunologic studies.
Johansson SG, Wüthrich B, Zortea-Caflisch C.
Abstract
Bed quilts filled with silk waste were found to cause nightly attacks of asthma. The first symptoms appeared on an average after 7 mo of exposure at a mean patient age of 30 yr. About 50% of the patients could be classified as atopic. Extract of the filling material revealed positive scratch and RAST tests in most patients. The bed quilts were advertised as being filled with pure wild silk (from silk moths of the genus Antheraea feeding on oak leaves), but it was found that in most cases the filling also included waste of cultivated silk (Bombyx mori). The origin of the allergen was sought. Since textile products of silk are considered to be practically nonallergenic, some type of contaminant appeared the most likely candidate. No allergen was found in cocoons, chrysalis (pupa), or moths of Antheraea. However, some cocoons of Bombyx mori, usually in small amounts, and excretions of the silkworm did contain allergen. High concentrations of allergen were found in an extract of living insects of the genus Anthrenus that was present in one batch of Bombyx mori cocoons. Thus, the silk waste appeared to be contaminated with material from the silkworms and also with infesting insects, which together create a very potent allergen repertoire that after a short incubation time, in a considerable frequency, elicits a rise in asthmatic symptoms and high serum IgE antibody levels.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology