[Silk waste--a further allergen in the bedroom]

From 1978 until 1993 we diagnosed 167 cases of inhalative allergy to silk-filled bed quilts. The patients experienced asthma attacks predominantly during the night. Occupational exposure to silk materials was found in six cases. The mean age at first manifestation of symptoms (31 years, range 8 to 58) was relatively high, indicating an aggressive inhalation allergen. Beside a case of occupational asthma in a silk filature, we present two patients with nightly respiratory symptoms: an 8-year-old boy, whose asthma immediately disappeared during his holidays away from home, and a 48-year-old woman diagnosed only eight years after the beginning of an asthma unresponsive to therapy. Elimination of the silk-waste-containing bed quilts led to complete recovery of respiratory symptoms. Prick and intracutaneous skin testing as well as scratch tests using material of silk-filled quilts and the RAST (Pharmacia k 73) to silk waste turned out to be sensitive diagnostic parameters. Many of these bed quilts filled with silk-waste are still used today. Beside the house-dust mites they are a further cause of nightly attacks and should also be considered in allergic work-up.