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Allergic and nonallergic hypersensitivity reactions to silicone: A report of one case

Authors:
Allergic and nonallergic
hypersensitivity reactions to
silicone: a report of one case
A. Rubio*, C. Ponvert, O. Goulet, P. Scheinmann, J. de
Blic
Keywords: children; immediate-type allergy;
prick-tests; silicone.
Although silicones were presumed to be
inert materials, immune-mediated reac-
tions in human and animal tissues have
been reported
since the begin-
ning of the use of
silicone implants
(1–5). Silicone
has been impli-
cated as the
causative agent
of chronic local or systemic reactions
such as inflammatory processes,
foreign-body reactions or rheumatologic
diseases. However, at present, only one
case of immediate-type hypersensitivity
to silicone has been reported (5). We
report a case of immediate pruritus,
oedema and erythema upon the first
insertion of a silicone nasogastric tube in a
10-year-old boy.
A 10-year-old nonatopic boy was
treated with enteral nutrition through a
polyurethane nasogastric tube for a
severe Crohn!s disease without incident
during several weeks. For greater com-
fort considering the more flexible con-
sistency of silicone, it was suggested
that the patient try a silicone nasogas-
tric tube. The tube was inserted without
any resistance. However, a few minutes
later, the patient experienced nasal and
throat pruritus, erythema and mild
oedema of the wings of nose and
mouth, and repeated sneezing. The tube
was immediately withdrawn. Symptoms
rapidly decreased and totally disap-
peared within 2 h without requiring
medication. A polyurethane nasogastric
tube was reinserted and nutrition was
resumed uneventfully. No allergological
work-up was performed at the time of
the reaction. Two years later, the
insertion of a central venous catheter
for parental nutrition was required.
During the preanaesthesia consultation,
the allergic-like event was recalled by
the parents. A work-up for suspected
latex and/or silicone allergy was under-
taken. Latex serum IgE determination
was negative, as well as skin prick tests
with latex extracts and with a silicone
gel (Silisonde
!
, Vygon, Ecouen,
France). Prick tests with silicone were
also negative in three control subjects
with no suggestive history of silicone
allergy. Negative and positive (codeine
phosphate) prick test controls (Staller-
ge
`nes, Antony, France) elicited negative
and positive responses respectively.
Challenge tests (prolonged cutaneous
and mucous contact with a silicone
nipple and with a silicone nasogastric
tube) were negative. The central venous
catheter was inserted in the internal
jugular vein and was well tolerated on
the short and long term.
Medical silicone devices have the
potential to induce foreign-body and
local and systemic nonspecific
(nonallergic) inflammatory reactions.
However, evidence for true allergic
reactions to silicone in implants and
silicone-coated medical devices has
also been provided (1–6). Delayed
hypersensitivity seems to play a major
role in the de novo development of this
allergy (4).
In our patient, the rapid course of
events suggested a type-I hypersensitiv-
ity reaction. At present, only one case
of immediate-type hypersensitivity to a
silicone tracheal tube has been
reported by Stuck et al. (5). Skin
prick and patch tests and specific-IgE
were negative, and only scratch tests
with native tube material generated
positive responses. Unfortunately, our
patient was tested 2 years after the
initial episode. Specific-IgE and prick
test with latex and prick test with
silicone were negative, and the child
tolerated prolonged cutaneous,
mucous and venous contact with
silicone. We cannot explain the initial
reaction of the child to the insertion of
a silicone nasogastric tube. Neverthe-
less, it is probable that this outcome
reflects an initial nonspecific (nonaller-
gic) reaction to the silicone tube rather
than a true IgE-mediated hypersensitiv-
ity spontaneously resolving within
2 years.
We report the case of a child with
suspected immediate-type allergy to
latex and/or silicone. Together with
the data of the literature, our
observation confirms that most
reactions to silicone are nonallergic
(nonspecific) and suggests that the
specificity and negative predictive value
of immediate-reading skin tests with
silicone are good.
*Universite
´de Nice Sophia Antipolis
Poˆ le Enfant Adolescent, CHU de Nice
Hoˆ pital Archet 2
133 Route de Saint Antoine de Ginestie
`re,
06200 Nice (France)
Tel.: 00 33 (0)4 92 03 64 71
Fax: 00 33 (0)4 92 03 59 51
E-mail: rubio.a@chu-nice.fr
Accepted for publication 16 March 2009
Allergy 2009: 64:1555
"2009 John Wiley & Sons A/S
DOI: 10.1111/j.1398-9995.2009.02086.x
References
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We report the case of a
child with suspected
immediate-type allergy
to latex and/or silicone.
ALLERGY Net
"2009 John Wiley & Sons A/S Allergy 2009: 64: 1554–1561 1555
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