Familial Anaphylaxis after Silkworm Ingestion

Abstract

Herein, we present a case of anaphylaxis in multiple family members after ingesting silkworms, an Asian delicacy. While food allergies, including anaphylaxis are unfortunately common, there are no previous reports of multiple family members suffering an anaphylactic reaction after eating silkworms. In addition, both family members required multiple doses of epinephrine and eventually an epinephrine infusion to improve their blood pressures. All interventions, including the epinephrine infusions, were started by emergency medical services (EMS) with on-line medical direction. Both the reaction and the required treatment are not extensively documented in the medical literature.

Allergic risks of consuming edible insects: A systematic review

“…In all cases, the patients had no previous history of allergic shock and were consuming silkworm pupae for the first time. Gautreau et al reports two simultaneous cases of anaphylaxis following ingestion of silkworm pupae on two Nepalese immigrants in the U.S.A. The subjects were father and son and both were consuming silkworm pupae for the first time and neither had antecedents of other allergic diseases.…”

“…Of these 25 articles, 8 studied the cross-reactivity/cosensitisation between edible insects, crustaceans and HDM [35][36][37][38][39][40][41][42], 3 identified and characterized allergens of edible insects [43][44][45], 10 were cases reports or case series of food allergy caused by insects (8 case reports [46][47][48][49][50][51][52][53], and 2 case series [54,55]), 3 assessed the frequency of anaphylaxis caused by entomophagy [56][57][58] and 1 assessed the prevalence of allergy among insect-eaters [59].…”

“…Regarding articles reporting allergic reactions following intentional consumption of insects, we found three studies that assessed the frequency of anaphylaxis caused by entomophagy and one study of prevalence of allergy among insect‐eaters , eight case reports , two case series (Table ). The species reported to have caused allergic reactions were locusts, grasshoppers , silkworm ( Bombyx mori ) pupae , vegetable worm ( Cordyceps sinensis ) , mopane worms ( Imbrasia belina ) , yellow mealworm ( Tenebrio molitor ) , cicadas , bee pupae, bee larvae, moth ( Clanis bilineata ) and sago worms ( Rhynchophorus ferrugineus ) .…”

“…Silkworm pupae are widely consumed in China and there are several reported cases of food allergy to their consumption, not only in China but also in the U.S.A . Ji et al reported the case of a French man visiting China with a history of allergic rhinitis that went into anaphylactic shock after consuming silkworm for the first time.…”

Shellfish Tropomyosin IgE Cross‐Reactivity Differs Among Edible Insect Species

“…In Asia, consumption of edible insects including silkworms as well as grasshoppers and locusts have resulted in reports of anaphylaxis. [ 3 ] Mealworms ( Tenebrio molitor ; MLW) were recently identified as a source of both primary respiratory and food allergy in Northern Europe. [ 4 ] Some individuals with shrimp (SHR) allergy may be at risk of allergic reactions to insects.…”