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 lit- erature 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 num- ber, including two of my own. Of these, nine were proved by passive transfer. Matthew Walzcr reported six cases proved by passive trans- fer, with excellent results following the removal of the offending pro- tein. Figlcy reported one proved case in which asthma was also pres- ent.. 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 urti- carial-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 con- siderable erythema. (utancous and intracutaneous tests with silk solu- tion 1 :lOOO were positirc .: + + .:. The Walzcr reaction was demon- strated after eating a few peanuts. The 10~1 passi\‘<? transfer sitv was gradually desensitized by intracutaneous injections of gradually in- creasing strengths of silk protein solution until finally no reactions were obtained.

The treatment consisted in removing all contact to silk and the substi- tution of cotton. The eczema cleared up rapidly. The asthma stopped afdcr avoiding eggs, peanuts, and h;lnal~:~s. An attempt is being made at present. to desensitize the child against silk hy gradually incrcasitm injections of silk protein solution.

CASE 2.--B. I)., fcmalc, singlo, white, aged twcsnty-eight years. The patient complained of an excessive seal\- vveping eruption on

the folds of the> 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 mark- edly positive reaction to silk was obtained after cutaneous tests. This is the only protein to which this patient has shown any positive rvar- tion. She was rcbclucstt4 to discard illI silk vlothiug ant1 suhstitutcb

TAl.:l% : ALLEX(iY DIrE TO SILK 547

cotton. Immediate improvement followed and after one week the itch- ing stopped and the eczema began to improve considerably. At present, after t\vo years, the skin is clear.

Passive transfer was done on a nonallergic individual. Four-plus ( !. + + +) reactions were obtained after cut.ancous, intracutaneous, and POlltilCt tests.

An attempt was made to desensitize this patient but the local and systemic reactions W’CW rather severe in spite of very small dosage, and she refused further trctatment. Rcagin is still present in the blood, as demonstrated by positive skin tests to silk as well as positive reactions following passive transfer.

HESI.LTS OF QUESTIOKXAIR.E REGARDING SKIS Hsacmoss TO SILK, SRKT TO .?o ALLEROISTS

---- ---;------- Total skin reactions due to silk 105 Total cases clinically proved

Eczema Urticarin Rhinitis Asthma

22 4 0 1

Cases showing skin reactions to silk but in which no etiologic rclatiowdlip could he proved

Eczema 38 Urticaria 17 Rhinitis 33 Asthma 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 con- sidcred.

There is a definite tendency for silk protein to give nonspecific reac- tions 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 ex- amination of the patient.

I wish to acknowledge with thanks the ansmcrs received to the questionnaire and also t.he valuable aasistsnce received from S. M. Feinherg.

55 EAST WASHINGTQN STRFST.