Allergy due to silk

AT,LERGY

DUE

TO SILK*

SAMIJEL J. TAUD, M.D. CHICAGO, ILL.

P

ROTEIN sensitization accounts for many eczemas. Most of these have been ascribed to foods. Eczemas caused by contact of the skin to a foreign protein have been rarely described. One of the most interesting of the contact eczemas is that caused by silk. My impression is that it is not as rare an occurrence as the literature indicates. Therefore a questionnaire, to determine the frequency of silk allergy and other clinical facts, was sent to fifty allergists. I have tabulated the results of the questionnaire and have divided the eases into two groups.

One group consists of those cases giving positive skin reactions to silk and in which the clinical relation was definitely established. Another group consists of cases also giving a positive skin reaction to silk but. in which no clear-cut relation to the clinical symptoms could be proved or in which positive reactions to many other things complicated the picture. Forty-eight replies were received. There was a total of 105 skin reactions to silk, including cases of eczema, urticaria, rhinitis, and asthma. There were 120 skin reactions to several proteins as well as silk, and they represent combinations of urticaria and asthma, rhinitis and eczema, and asthma and eczema. Casts of eczema due to contact to silk protein alone were 22 in number, including two of my own. Of these, nine were proved by passive transfer. Matthew Walzcr reported six cases proved by passive transfer, with excellent results following the removal of the offending protein. Figlcy reported one proved case in which asthma was also present.. An excellent result followed after the offending protein was removed. A short rcvicw of my two cases follows: CASE 1.---V.

I’., female, aged four years. Eczema was first noticed at the age of two months, following the wearing of a silk veil. It first appeared on the head and face and soon spread to the rest of the body. At the age of three months, urticaria developed and at the age of two years asthma began. When one year old, the child was given a small amount of egg and the tongue and lips began to swell and vomiting occurred. Eggs were discontinued from the diet. Peanuts had the same effect and it. was thought that the eczema and asthma were due to a food. One day, the child was playing *From the Asthma and Hay Fever Clinic. Northwestern University Medical School. Read before the Eighth .4nnual Meeting of the Association for the Study of .Ulergy, Detroit, June 24, 1930. 539

with a silk nccktic around her neck atltl the mother noticed many small hives on the skin where the nccktic had rubbtld. A\ small pieer ot silk rubbed locally over a normal skin area produced many small urticarial-like lesions which hecamc conglomerate artd arranged t hemselvvs in t)atch(ls rescmhling the other cczematous lesions. (‘utaneous skin tests ww doncb with the following results : Egg white Egg yolk Ovomucoid F;gp whole Peanut HanaIM

Silk Passive transfer was done on a nonallergic adult. Hubhing a piece of silk on the passive transfer site produced a large wheal with considerable erythema. (utancous and intracutaneous tests with silk solution 1 :lOOO were positirc .: + + .:. The Walzcr reaction was demonstrated after eating a few peanuts. The 10~1 passi\‘ skin. Itching was cxtrcmc at night. This eruption first appeared when she was six months old and had been present (car since. At times it would hc somewhat bcttrr. on1.v to reappear again. She had hrcA11 unahlc to work brcausc‘ of thcb al)t)t’;lt’anct~ of hfr hands and fact. Thai only significant facts in the t)ast history ww measles. chickvtl pox, scarlet fever, pneumonia, whooping cough and bronchitis in child hood. Crticaria and prickly heat in infancy. The physical examination was negative except for the extensive clcz(‘ma practically all over the body. She was t rt’at t4 by various dclrmatologist s without relief. Skin tests wcrtb made on the anterior surface of the thighs as all other areas were unavailable because of the cxtensivc eczema. A markedly positive reaction to silk was obtained after cutaneous tests. This is the only protein to which this patient has shown any positive rvarShe was rcbclucstt4 to discard illI silk vlothiug ant1 suhstitutcb tion.

TAl.:l%

ALLEX(iY

:

cotton. Immediate improvement ing stopped and the eczema began after t\vo years, the skin is clear. Passive transfer was done on ( !. + + +) reactions were obtained POlltilCt

DIrE

TO

547

SILK

followed and after one week the itchto improve considerably. At present, a nonallergic individual. Four-plus after cut.ancous, intracutaneous, and

tests.

An attempt was made to desensitize systemic reactions W’CW rather severe and she refused further trctatment. blood, as demonstrated by positive skin reactions following passive transfer.

HESI.LTS

----

OF QUESTIOKXAIR.E

Total Total

Cases

REGARDING SKIS .?o ALLEROISTS

---;-------

skin reactions cases clinically Eczema Urticarin Rhinitis Asthma showing etiologic

this patient but the local and in spite of very small dosage, Rcagin is still present in the tests to silk as well as positive

Hsacmoss

TO

SILK,

SRKT

TO

105

due to silk proved

22 4 0 1

skin reactions to silk but in which no rclatiowdlip could he proved Eczema Urticaria Rhinitis Asthma _--.-..-...--.-

38 17 33 32

-.

Eczema duo to silk has been rarely described in the literature. The results of a questionnaire sent out to a number of allergists indicate that this sensitization is more common than ordinarily considcred. There is a definite tendency for silk protein to give nonspecific reactions which must, be carefully separated from the specific reactions. It is suggested that -the problem of sensitization in eczema due to contact with silk and other proteins bc given more attention in the examination of the patient. also

I wish to acknowledge with thanks t.he valuable aasistsnce received 55

EAST

WASHINGTQN

STRFST.

the from

ansmcrs S. M.

received Feinherg.

to the

questionnaire

and