Severe allergic shock caused by silkworm pupa consumption.
Anaphylactic shock caused by silkworm pupa consumption in China
Article first published online: 8 SEP 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Munksgaard
Volume 63, Issue 10, pages 1407–1408, October 2008
How to Cite
Ji, K.-M., Zhan, Z.-K., Chen, J.-J. and Liu, Z.-G. (2008), Anaphylactic shock caused by silkworm pupa consumption in China. Allergy, 63: 1407–1408. doi: 10.1111/j.1398-9995.2008.01838.x
- Issue published online: 8 SEP 2008
- Article first published online: 8 SEP 2008
- Accepted for publication 23 May 2008
- anaphylactic shock;
- food allergen;
- silkworm pupa;
Materials derived from the bodies of the domesticated silkworm Bombyx mori, including silks, contain allergens which can trigger or aggravate allergic diseases such as allergic asthma, hypersensitivity pneumonitis, allergic rhinitis and atopic dermatitis (1). The silkworm life cycle includes four distinct developmental stages: ova, larva, pupa, and imago.
Silkworm pupae are nutrient-rich, comprised of ∼50% protein with abundant amounts of essential amino acids for humans (1). As a result of the cultural influences of traditional Chinese food and medicine, Chinese people often eat oil-fried pupa, water-boiled pupa or ground pupa powder. The use of silkworm pupa as food may be a custom unique to China.
Silkworm pupa can be allergenic (1). It is estimated that each year in China, there are over 1000 patients who suffer anaphylactic reactions after consuming silkworm pupa, 50 of whom received emergency room treatment for severe anaphylactic reaction. Hence, we previously purified protein allergens from a crude silkworm pupa extract through ion exchange chromatography, gel filtration and sodium dodecyl sulphate polyacrylamide gel electrophoresis. Our subsequent immunoblot analysis revealed an ∼30-kDa protein as silkworm pupa’s major allergen (1).
Here we report the case of a French national visiting China who went into anaphylactic shock after consuming silkworm. A 37-year-old French man, with a history of allergic rhinitis, ate oil-fried silkworm chrysalis in his dinner during his visit to China in August, 2003. Thirty minutes later, he felt an itchy sensation in his mouth and on his face, accompanied by mild nausea and by flushing and swelling of his face. He proceeded to the Hospital Emergency Department, where he began to experience difficulty breathing. Upon physical examination, the emergency room physician noted cardiovascular signs of shock, including low blood pressure (70/40 mmHg) and an elevated heart rate 105/min. A diagnosis of anaphylactic shock caused by a silkworm pupa food allergic reaction was made and the patient was immediately treated with a hypodermic injection of epinephrine 1 mg. The patient was also given supplemental oxygen by mask and intravenous infusion of vitamin C 3 g and hexadecadrol 10 mg. He recovered within 3 days of the incident.
A summary of 13 prior cases of severe anaphylactic reaction caused by silkworm pupa consumption is provided in Table 1 (2–5). Treatment of this condition is consistent with the general principles of treating allergic shock generally (6). Following proper and timely therapy, patients who suffer an allergic reaction to silkworm do not exhibit sequelae (2–5).
|Reference||No. of cases Sex: age (years)||History of previous allergy||History of previous allergic shock||First time SP consumed||Symptoms after SP ingestion||Reported time of onset of symptoms (h)||Diagnosis of reported case(s)||Treatment in emergency department|
|(2)||1 case 1 male: 21||–||None||Yes||P, U, FA, H, F, UC||0.5||Anaphylactic shock||Supplemental oxygen; Epinephrine 1 mg (HDI); hexadecadrol 10 mg (IVI).|
|(3)||3 cases 1 male, 19 2 females: 37,54||–||None||Yes||U, FA, HA, H, AP, V, D||2–3||Anaphylactic shock||Supplemental oxygen; Epinephrine 1 mg (HDI); hexadecadrol 10 mg (IMI); Chlorphenamine Maleate 10 mg (IMI); Cetacort 300 mg (IVI).|
|(4)||1 case 1 male: 20||–||None||Yes||P, U, FA, H, F, N, UC||0.5||Anaphylactic shock||Supplemental oxygen; Epinephrine 1 mg (HDI); hexadecadrol 10 mg (IVI).|
|(5)||8 cases 5 males: 9–46 3 females: 9–46||None||None||Yes||P, U, FA, A, AP, V, N, D||0.5–4||Severe anaphylactic reaction||Supplemental oxygen; Diprazine 25 mg (IMI) plus hexadecadrol 5 mg (IMI). After 2 h, hexadecadrol 10 mg (IVI) plus VtC 3 g (IVI) and VtB6 0.2 g (IVI) (only for 2 cases).|
In the absence of treatment, anaphylactic shock can lead to death within minutes. A portion of the increasing number of western tourists who visit China choose to try traditional Chinese foods. However, regulation of food allergen labeling has not yet to be achieved in China. The present case highlights the need for foreign nationals visiting China to be alerted to the allergenic risks of local foods, such as silkworm pupa, in order to reduce the risk of negative consequences on their health.
- 1Identification and purification of protein allergens from pupa of Bombyx mori. J Trop Med 2006;6:496–498 (article in Chinese)., , , , .
- 2Successful curative treatment of a patient with anaphylactic shock caused by ingestion of silkworm pupa. Guangzhou Med 1987;3:36–36 (article in Chinese)., , .
- 3Three cases of anaphylactic shock caused by ingestion of silkworm pupa. China J Lepr Skin Dis 1999;15:56–57 (article in Chinese)., , .
- 4A case of anaphylactic shock caused by ingestion of silkworm pupa. Lit inf prev med 2002;8:458–459 (article in Chinese)..
- 5Eight cases of severe type-1 allergic reaction caused by consumption of silkworm pupa. Henan J Prev Med 2005;16:148–148 (article in Chinese)., , , , , et al.