Anaphylaxis to the Ingestion and Inhalation of Tenebrio Molitor (Mealworm) and Zophobas Morio (Superworm)

It has been well documented, worldwide, that inhalation and/or contact with airborne particulate insect products has resulted in sensitivity to insect proteins and is manifested by such common entities as dermatitis, conjunctivitis, rhinitis, and asthma. However, the deliberate ingestion of a variety of insects (undertaken to prove their edibility and nutrient value) resulted in subsequent sensitization of some individuals. Such an outcome has not previously been reported in the literature. The objective was to document the anaphylactic reaction to the purposeful ingestion of mealworm in an individual known to be sensitized to the inhalation of beetle larvae. We used the occasion of the Centennial Celebration of The New York Entomological Society to expose members and guests of the Society to the ingestion of various insects. The subjects of the study consisted of: 1) Three members who were adversely affected; 2) One individual with Baker's asthma; and 3) A number of controls with no known hypersensitivity to insect products. The investigation was undertaken by food challenges, inhalation challenges, skin testing to the individual insect allergens, a) Tenebrio molitor (TM), b) Zophobas morio (ZM), c) Blattella germanica (BG), skin testing to common indoors and outdoor allergens, and direct bind ELISA and ELISA inhibition. One individual manifesting hypersensitivity both by ingestion and inhalation to mealworm was identified. This sensitivity was documented clinically as well as by objective testing.